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Theory and methods
How can we adapt complex population health interventions for new contexts? Progressing debates and research priorities
  1. Rhiannon Emily Evans1,
  2. Graham Moore1,
  3. Ani Movsisyan2,3,
  4. Eva Rehfuess2,3
  5. The ADAPT Panel
    1. 1 DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
    2. 2 Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
    3. 3 Pettenkofer School of Public Health, Munich, Germany
    1. Correspondence to Rhiannon Evans Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, Wales CF10 3BD, UK; EvansRE8{at}cardiff.ac.uk

    Abstract

    Introduction The UK Medical Research Council and National Institute for Health Research have funded the ADAPT study (2018–2020), to develop methodological guidance for the adaptation of complex population health interventions for new contexts. While there have been advances in frameworks, there are key theoretical and methodological debates to progress. The ADAPT study convened a panel meeting to identify and enrich these debates. This paper presents the panel’s discussions and suggests directions for future research.

    Methods Sixteen researchers and one policymaker convened for a 1-day meeting in July 2019. The aim was to reflect on emerging study findings (systematic review of adaptation guidance; scoping review of case examples; and qualitative interviews with funders, journal editors, researchers and policymakers), progress theoretical and methodological debates, and consider where innovation may be required to address research gaps.

    Discussion Despite the proliferation of adaptation frameworks, questions remain over the definition of basic concepts (eg, adaptation). The rationale for adaptation, which often focuses on differences between contexts, may lead to adaptation hyperactivity. Equal emphasis should be placed on similarities. Decision-making about intervention modification currently privileges the concept of ‘core components’, and work is needed to progress the use and operationalisation of ‘functional fidelity’. Language and methods must advance to ensure meaningful engagement with diverse stakeholders in adaptation processes. Further guidance is required to assess the extent of re-evaluation required in the new context. A better understanding of different theoretical perspectives, notably complex systems thinking, implementation science and realist evaluation may help in enhancing research on adaptation.

    • Research methods
    • Public health
    • Outcome research evaluation
    • Health policy
    • Geography
    https://creativecommons.org/licenses/by/4.0/

    This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

    https://doi.org/10.1136/jech-2020-214468

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      Footnotes

      • Collaborators The ADAPT Panel comprises of Laura Arnold, Julie Bishop, Andrew Booth, Lauren Copeland, Peter Craig, Frances Gardner, Penny Hawe, Pat Hoddinott, Frank Kee, Hannah Littlecott, Laurence Moore, Simon Murphy, Alicia O’ Cathain.

      • Contributors RE and GM obtained funding for the study. RE drafted the manuscript with input from GM, AM and ER. AM produced table 1. All members of the ADAPT panel confirmed the content of the manuscript.

      • Funding The ADAPT Study was funded by the MRC-NIHR Methodology Research Programme [MR/R013357/1]. The project was undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The study was also supported by its successor, the Centre for Development, Evaluation, Complexity and Implementation in Public Health improvement, funded by Health and Care Research Wales from 2020. Peter Craig and Mhairi Campbell receive funding from the UK Medical Research Council (MC_UU_12017-13) and the Scottish Government Chief Scientist Office (SPHSU13).

      • Competing interests None declared.

      • Patient consent for publication Not required.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data availability statement No data are available.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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