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. 2023 Mar 15;8(1):e10364.
doi: 10.1002/lrh2.10364. eCollection 2024 Jan.

Analysis of FRAME data (A-FRAME): An analytic approach to assess the impact of adaptations on health services interventions and evaluations

Heather Z Mui  1 , Cati G Brown-Johnson  1 , Erika A Saliba-Gustafsson  1 , Anna Sophia Lessios  1 , Mae Verano  1 , Rachel Siden  1 , Laura M Holdsworth  1
Affiliations

Analysis of FRAME data (A-FRAME): An analytic approach to assess the impact of adaptations on health services interventions and evaluations

Heather Z Mui et al. Learn Health Syst. .

Abstract

Introduction: Tracking adaptations during implementation can help assess and interpret outcomes. The framework for reporting adaptations and modifications-expanded (FRAME) provides a structured approach to characterize adaptations. We applied the FRAME across multiple health services projects, and developed an analytic approach to assess the impact of adaptations.

Methods: Mixed methods analysis of research diaries from seven quality improvement (QI) and research projects during the early stages of the COVID-19 pandemic. Using the FRAME as a codebook, discrete adaptations were described and categorized. We then conducted a three-step analysis plan: (1) calculated the frequency of adaptations by FRAME categories across projects; (2) qualitatively assessed the impact of adaptations on project goals; and (3) qualitatively assessed relationships between adaptations within projects to thematically consolidate adaptations to generate more explanatory value on how adaptations influenced intervention progress and outcomes.

Results: Between March and July 2020, 42 adaptations were identified across seven health services projects. The majority of adaptations related to training or evaluation (52.4%) with the goal of maintaining the feasibility (66.7%) of executing projects during the pandemic. Five FRAME constructs offered the most explanatory benefit to assess the impact of adaptations on program and evaluation goals, providing the basis for creating an analytic approach dubbed the "A-FRAME," analysis of FRAME data. Using the A-FRAME, the 42 adaptations were consolidated into 17 succinct adaptations. Two QI projects discontinued altogether. Intervention adaptations related to staffing, training, or delivery, while evaluation adaptations included design, recruitment, and data collection adjustments.

Conclusions: By sifting qualitative data about adaptations into the A-FRAME, implementers and researchers can succinctly describe how adaptations affect interventions and their evaluations. The simple and concise presentation of information using the A-FRAME matrix can help implementers and evaluators account for the influence of adaptations on program outcomes.

Keywords: COVID‐19 pandemic; adaptation; health services research; implementation science; quality improvement.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

FIGURE 1
FIGURE 1
The framework for reporting adaptations and modifications‐expanded (FRAME), from Wiltsey‐Stirman et al 2019
See this image and copyright information in PMC

References

    1. Chambers DA, Glasgow RE, Stange KC. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement Sci. 2013;8(1):1‐11. doi:10.1186/1748-5908-8-117 - DOI - PMC - PubMed
    1. Chambers DA, Norton WE. The Adaptome: advancing the science of intervention adaptation. Am J Prev Med. 2016;51(4):S124‐S131. - PMC - PubMed
    1. Tyler A, Glasgow RE. Implementing improvements: opportunities to integrate quality improvement and implementation science. Hosp Pediatr [Internet]. 2021;11(5):536‐545. - PMC - PubMed
    1. Stirman SW, Baumann AA, Miller CJ. The FRAME: an expanded framework for reporting adaptations and modifications to evidence‐based interventions. Implement Sci. 2019;14(1):1‐10. doi:10.1186/s13012-019-0898-y - DOI - PMC - PubMed
    1. Stirman SW, Miller CJ, Toder K, Calloway A. Development of a framework and coding system for modifications and adaptations of evidence‐based interventions. Implement Sci. 2013;8(1):1‐12. doi:10.1186/1748-5908-8-65 - DOI - PMC - PubMed

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