Questions to guide teams in adapting an intervention for a new context:
Forming an adaptation team
- Have you involved an appropriate range of stakeholders, including those with expertise in the intervention and its evidence base, and those with knowledge of the new context?
- Is your team clear on roles, including who will make decisions on adaptations, when, and how?
- Will you work with the developers of the intervention? If so, how will you manage any conflicts of interest arising from this?
- How might the membership of your adaptation team need to evolve as adaptation progresses?
Assessing the rationale for intervention, and considering intervention-context fit
- What is the problem that an intervention seeks to improve in the target population?
- Is there more than one potential evidence informed intervention? If so, are there reasons one might be more suitable than others, such as the relevance of its programme theory and change mechanisms?
- What is known about the selected intervention(s) in terms of programme theory, process, effectiveness, cost effectiveness and implementation in other contexts?
- How robust are any claims that the intervention(s) has worked elsewhere?
- How similar and different are original and new contexts, in terms of issues likely to affect implementation and effectiveness?
- Are there any intellectual property issues which limit use and adaptation of the intervention(s)?
Planning for and undertaking adaptations
- What adaptations can you make to respond to constraints and facilitators, while maintaining consistency with intended intervention functions?
- What adaptations need to be made to intervention materials, such as manuals, to capture changes made to the intervention?
- Might interactions with aspects of the new context lead to any new unintended consequences?
- What costs and resources are needed to deliver the adapted intervention?
- Who will deliver the adapted intervention, and how will you recruit them?
Planning for and undertaking evaluation
- Given what is known about the intervention, and the likely transferability of previous evidence, what type and extent of re-evaluation is warranted?
- What will be the value of new information to policymakers, practitioners, and other stakeholders?
- What resources are available for re-evaluation?
- Does initial feasibility testing indicate that any further adaptations are needed?
- How will you capture responsive adaptations and decide whether the intervention remains consistent with intended functions and change mechanisms?
- How will you evaluate effectiveness, cost effectiveness, and process, if this is warranted by uncertainty about whether existing evidence will transfer?
Implementing and maintaining the intervention at scale
- What long term partnerships and capacity will be needed for maintenance of the intervention?
- How will you monitor whether the intervention continues to be delivered, and maintains its effectiveness, over time in real world practice?
This checklist was written as part of an article for The BMJ. The link to the full article can be found here.