Multi-method, longitudinal documentation of adaptations and their impact in the Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science San Diego colorectal cancer screening implementation study.
Adaptations are common in implementation studies, yet they are rarely documented systematically. Understanding when, why, and how adaptations occur can improve implementation processes, support interpretation of study outcomes, and inform scaling in diverse settings. Using comprehensive frameworks such as reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) and expanded framework for reporting adaptations and modifications-enhanced can guide systematic documentation, but practical, standardized approaches remain underdeveloped.
This study describes a multi-method, framework-guided approach to documenting adaptations across all phases of the accelerating colorectal cancer screening and follow-up through implementation science San Diego study, which implemented multilevel, evidence-based interventions to reduce colorectal cancer in community health center (CHC) systems.
We documented 44 adaptations over the pre-implementation (n = 22), implementation (n = 19), and sustainment (n = 3) phases. Most were verified through emails/meetings, with research staff/CHC staff as primary informants. Adaptations most frequently involved intervention materials, content, and format, and were primarily driven by pragmatic considerations to align with CHC workflows, patient needs, and contextual factors. While most adaptations had no major impact on RE-AIM outcomes, several improved implementations (e.g. centralizing FIT kit procurement to address COVID-19-related supply chain issues). Negative impacts were rare.
A multi-method, framework-based approach to adaptation documentation is feasible and valuable in complex, real-world implementation studies. Early and ongoing tracking supports proactive problem-solving, enhances contextual fit, and informs sustainability planning. This methodology can serve as a model for systematic adaptation tracking in safety-net and community-based healthcare settings, strengthening the evidence base for how adaptations influence implementation and effectiveness outcomes.
The Clinical Trials Registration #NCT04941300.
This study describes a multi-method, framework-guided approach to documenting adaptations across all phases of the accelerating colorectal cancer screening and follow-up through implementation science San Diego study, which implemented multilevel, evidence-based interventions to reduce colorectal cancer in community health center (CHC) systems.
We documented 44 adaptations over the pre-implementation (n = 22), implementation (n = 19), and sustainment (n = 3) phases. Most were verified through emails/meetings, with research staff/CHC staff as primary informants. Adaptations most frequently involved intervention materials, content, and format, and were primarily driven by pragmatic considerations to align with CHC workflows, patient needs, and contextual factors. While most adaptations had no major impact on RE-AIM outcomes, several improved implementations (e.g. centralizing FIT kit procurement to address COVID-19-related supply chain issues). Negative impacts were rare.
A multi-method, framework-based approach to adaptation documentation is feasible and valuable in complex, real-world implementation studies. Early and ongoing tracking supports proactive problem-solving, enhances contextual fit, and informs sustainability planning. This methodology can serve as a model for systematic adaptation tracking in safety-net and community-based healthcare settings, strengthening the evidence base for how adaptations influence implementation and effectiveness outcomes.
The Clinical Trials Registration #NCT04941300.
Authors
Largaespada Largaespada, Nodora Nodora, Covin Covin, Preciado-Hidalgo Preciado-Hidalgo, Ortwine Ortwine, Howard Howard, Gupta Gupta, Martinez Martinez, Roesch Roesch, Castaneda Castaneda, Rabin Rabin
View on Pubmed