Assess fit
Start here
Identify whoto involve
Define the original THING
Identify whatyou are adapting
Is this a good fit?
Reflect and revisit
Track adaptations
Describe the adaptations
Identify potential impacts
Plan for adaptations
Track adaptations
Do you implement?
Assess fit
Start here
Identify whoto involve
Define the original THING
Identify whatyou are adapting
Is this a good fit?
Reflect and revisit
Track adaptations
Describe the adaptations
Identify potential impacts
Plan for adaptations
Track adaptations
Do you implement?
Resources referenced in Map2Adapt
In developing the Map2Adapt process, several frameworks and resources were referenced. Below, you'll find a list of frameworks as well as key resources that have influenced the process, steps, and activities.
The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions
The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare
Towards a comprehensive model for understanding adaptations’ impact: the Model for Adaptation Design and Impact (MADI)
Ecological Validity Model
Examining adaptations of evidence-based programs in natural contexts
StrategEase Tool
Defining Your Initiative: the WHAT, WHO, and HOW (7 Ps Framework)
The updated Consolidated Framework for Implementation Research based on user feedback
Context Compass Framework ー Making Context Assessment Manageable: How to Slice and Dice Context in Different Ways
Adapting interventions to new contexts—the ADAPT guidance
Assess fit
STEP #1
Identify who to involve
This step aims to identify the people who should be involved in planning adaptations.
This is a unique step because it is relevant for every phase and activity of Map2Adapt and should be revisited throughout the adaptation process.
Resources
Activities
Activities
Assess fit
STEP #1
Identify who to involve
This step aims to identify the people who should be involved in planning adaptations.
This is a unique step because it is relevant for every phase and activity of Map2Adapt and should be revisited throughout the adaptation process.
Resources
Activities
Activities
ACTIVITIES TO:
Identify who to involve
1. Describe who will you involve
2. Define when and how you will engage people
3. Build trust and navigate power dynamics
4. Ask yourselves: Who is at the table, who is not at the table, and why? - Reflect and create a plan when people are not engaged
5. Create an ongoing communication plan
You will revisit and re-engage with different people throughout the initiative's life cycle. This is an ongoing activity!
RESOURCES TO:
Identify who to involve
Tool
Cultiv8 tool
Tool
The Collaboration Spectrum
Tool
Health Equity Toolkit
Applied article
Reframing Adaptations in a Post-pandemic World: Building a Roadmap for Implementation Support Practitioners
Academic article
Advancing a collective vision for equity-based cocreation through prototyping at an international forum
Academic article
How to … do decolonial research
Assess fit
STEP #2
Define the original THING
During this step, you will describe the original THING that you are considering adapting. This will include describing: the WHY of the original THING and goals; a summary of the underlying principles; WHOs (i.e., who is being asked to change); WHATs (i.e., what they are being asked to do); and HOWs (i.e., the change strategies used to support change). Adaptation decisions cannot move forward without first developing a clear understanding of the original THING.
Resources
Activities
Activities
Assess fit
STEP #2
Define the original THING
During this step, you will describe the original THING that you are considering adapting. This will include describing: the WHY of the original THING and goals; a summary of the underlying principles; WHOs (i.e., who is being asked to change); WHATs (i.e., what they are being asked to do); and HOWs (i.e., the change strategies used to support change). Adaptation decisions cannot move forward without first developing a clear understanding of the original THING.
Resources
Activities
Activities
ACTIVITIES TO:
Define the original THING
1. Define the goals, objectives, and collective vision of the THING
2. Describe the principles of the THING
3. Is there a shared understanding of the original THING's goals, values, principles, vision, etc.?
4. What is the evidence of the effectiveness of the original THING?
5. Are there intellectual property issues with making adaptations to the THING.
6. Describe WHO needs to do WHAT differently
7. Define the HOWs (i.e., change strategies) and the underlying functions they address
RESOURCES TO:
Define the original THING
Video
Video #3: What are you implementing?
Online course
The StrategEase: The HOW of Creating Sustainable Change
Tool
Practice profiles
Applied article
From Core Components to Guiding Principles: Reframing Implementation Fidelity
Tools
Hyper Island Toolbox
Tool
Concept of Forms and Functions in the Context of Complex Interventions
Assess fit
STEP #3
Identify what you are adapting
This step aims to identify what aspects of the original THING need to be adapted by reflecting on differences between it and a shared vision for an adapted version. This step can help develop a shared understanding of the reasons or drivers impacting the decision to adapt an existing THING. This is an incredibly important stage in the adaptation process.
Resources
Activities
Activities
Assess fit
STEP #3
Identify what you are adapting
This step aims to identify what aspects of the original THING need to be adapted by reflecting on differences between it and a shared vision for an adapted version. This step can help develop a shared understanding of the reasons or drivers impacting the decision to adapt an existing THING. This is an incredibly important stage in the adaptation process.
Resources
Activities
Activities
ACTIVITIES TO:
Identify what you are adapting
Gather information and describe WHY adaptations may be needed. Discuss differences reflecting on the original THING:
1. Is there alignment in the collective vision and the underlying principles? How?
2. Is the setting/context different? How?
3. What are the goals of the adaptations?
Based on your team’s reflection on the questions above, consider whether it makes sense for you to make adaptation to the:
WHATs
WHOs
HOWs
RESOURCES TO:
Identify what you are adapting
Framework
Consolidated Framework for Implementation Research
Framework
Context Compass Framework
Academic article
A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems
Applied article
From Core Components to Guiding Principles: Reframing Implementation Fidelity
Applied article
An Innovative Way to Address the Fidelity-Adaptation Debate: Forms and Functions
Assess fit
DECISION POINT
Is this a good fit?
This activity aims to decide whether this program is a good fit and, if so, whether to proceed with adaptations.
There are different potential next steps at this decision point. Select your outcome:
The THING is not considered a good fit for the context, even with adaptations.
Uncertain as to whether adaptations are useful or if another THING is more appropriate.
Adaptations are needed to improve fit and the team wants to move forward with this THING.
Plan for adaptations
Assess fit
DECISION POINT
Is this a good fit?
This activity aims to decide whether this program is a good fit and, if so, whether to proceed with adaptations.
There are different potential next steps at this decision point. Select your outcome:
The THING is not considered a good fit for the context, even with adaptations.
Uncertain as to whether adaptations are useful or if another THING is more appropriate.
Adaptations are needed to improve fit and the team wants to move forward with this THING.
Plan for adaptations
Plan for adaptations
STEP #4
Describe the adaptations
This step aims to explore and describe adaptation approaches that can help address the challenges and unique needs of your implementation context.
Resources
Activities
Activities
Resources
Activities
Activities
Assess fit
Plan for adaptations
STEP #4
Describe the adaptations
This step aims to explore and describe adaptation approaches that can help address the challenges and unique needs of your implementation context.
Resources
Activities
Activities
Assess fit
ACTIVITIES TO:
Describe the adaptations
When we make adaptations, they typically fall into four categories - adaptations to:
1. Language, metaphors, and visuals
2. Content and concepts
3. Delivery
4. Principles and functions
RESOURCES TO:
Describe the adaptations
Academic article
The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare
Academic article
The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions
Applied article
Scaling Up: Balancing Adaptations and Implementation Supports
Academic article
A Scoping Study of Cultural Adaptation Frameworks
Academic article
Achieving Cultural Appropriateness in Health Promotion Programs: Targeted and Tailored Approaches
Academic article
The core functions and forms paradigm throughout EPIS: designing and implementing an evidence-based practice with function fidelity
Plan for adaptations
STEP #5
Identify potential impacts
For this step, you will review proposed adaptations and consider impacts on implementation and outcomes, as well as equity considerations.
Resources
Activities
Activities
Plan for adaptations
STEP #5
Identify potential impacts
For this step, you will review proposed adaptations and consider impacts on implementation and outcomes, as well as equity considerations.
Resources
Activities
Activities
ACTIVITIES TO:
Identify potential impacts
1. Do the adaptations change the functions or principles of the WHATs or HOWs?
2. Identify whether there are changes to the THING's design and whether these are surface or deep level adaptations.
3. Would the adaptations have a different impact on different groups of people? Who benefits and who loses if you move forward with these adaptations?
4. If adaptations are successful and everything goes as planned, what would you expect the ideal outcomes to be? What if the opposite occurs?
5. Could any of the adaptations result in unintended harm?
6. Describe whether additional resources (e.g., expertise, materials, funds, etc.) are needed to execute these adaptations.
RESOURCES TO:
Identify potential impacts
If you need more guidance on considering the potential impacts of proposed adaptations, you might find the “Traffic Light Tool” useful (see page page 12 of the first resource below) as it addresses the balance of fit and fidelity.
Academic article
Implementation Science at a Glance: A guide for Cancer Control Practitioners
Academic article
Towards a comprehensive model for understanding adaptations’ impact: the model for adaptation design and impact (MADI)
Plan for adaptations
DECISION POINT
Do you implement?
The purpose of this decision point is to decide whether to move forward with implementing planned adaptations.
There are different potential outcomes at this decision point. Select your outcome:
Adaptations seem insufficient to meet your goals or the changes are likely to significantly change effectiveness.
You need to keep reflecting and working on adaptation approaches.
Adaptations have been well thought out.
Track adaptations
Plan for adaptations
DECISION POINT
Do you implement?
The purpose of this decision point is to decide whether to move forward with implementing planned adaptations.
There are different potential outcomes at this decision point. Select your outcome:
Adaptations seem insufficient to meet your goals or the changes are likely to significantly change effectiveness.
You need to keep reflecting and working on adaptation approaches.
Adaptations have been well thought out.
Track adaptations
Track adaptations
STEP #6
Track adaptations
For this step, you will consider how to monitor and track adaptations for your initiative moving forward.
Resources
Activities
Activities
Plan for adaptations
Track adaptations
STEP #6
Track adaptations
For this step, you will consider how to monitor and track adaptations for your initiative moving forward.
Resources
Activities
Activities
Plan for adaptations
ACTIVITIES TO:
Track adaptations
1. Think about the following:
- Who will track adaptations?
- How will you know that changes to the initiative have been made?
- How often will you check-in to monitor and revisit adaptations?
- Can you embed this tracking process in existing monitoring and evaluating activities?
2. Select what you will track
3. Create a tracking plan
RESOURCES TO:
Track adaptations
Academic article
The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions
Academic article
The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare
Academic article
Methods for capturing and analyzing adaptations: implications for implementation research
Track adaptations
DECISION POINT
Reflect and revisit
This final step in the Map2Adapt process encourages you to think about the activities and principles as an ongoing exercise of review and reflection. Implementation requires deep self-reflection, team reflection, continuous learning, and pivoting. Because reflection is so important in the adaptation process, it’s important to revisit previous steps in the process.
Here are the common steps that people revisit:
Track adaptations
Describe the adaptations
Identify who to involve
Identify what you are adapting
Identify potential impacts
Track adaptations
DECISION POINT
Reflect and revisit
This final step in the Map2Adapt process encourages you to think about the activities and principles as an ongoing exercise of review and reflection. Implementation requires deep self-reflection, team reflection, continuous learning, and pivoting. Because reflection is so important in the adaptation process, it’s important to revisit previous steps in the process.
Here are the common steps that people revisit:
Track adaptations
Describe the adaptations
Identify who to involve
Identify what you are adapting
Identify potential impacts
Content and concepts
People being asked to do something differently (recipients)
This adaptation category involves modifications to the THING's content, including direct content (modifying, adding, removing) or underlying concepts.
- People being asked to do something differently (recipients)
- Are there different policies, laws, or procedures (at the organizational, community, or system level) from those in contexts where the initiative was originally tested?
- Are there now external factors or critical events not present when the initiative was tested in the past (e.g., a pandemic, public vs private systems)?
- Are current cultural norms/ideologies regarding social constructs (e.g., conceptions about race, gender, sexual orientation, disability, socioeconomic status, etc.) different than in the time or place the initiative has been tested?
- Are there systemic inequities/barriers that disproportionately affect certain groups? What can be done to support these groups or to reduce any systemic inequities/barriers?
- Are there historical factors and realities (e.g., past and present-day impacts of colonization) that need to be considered and addressed when thinking about the initiative and potential adaptations?
- Is the initiative being delivered in a different type of organization, community, or system?
- How do the knowledge systems/evidence base that ground the original initiative align with those of the new setting?
- Are there differences in the available resources for implementation (e.g., funding, physical environmental, human resources)?
Toolkit
Liberating Structures
by Henri Lipmanowicz and Keith McCandless
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Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Academic article
The core functions and forms paradigm throughout EPIS: designing and implementing an evidence-based practice with function fidelity
by Alec Terrana, et al.
Example of exploring and using functions and forms in each EPIS (Exploration, Preparation, Implementation, Sustainment) stage to guide adaptations (Tables 2 and 3). Examples offered in this article are relevant throughout all Map2Adapt phases.
Access this resource
Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
Track adaptations
This phase includes one activity that aims to support you in setting up a structure and process to track and monitor adaptations. The final decision point is about whether there is a need to revisit previous activities or to gather more information.
Describe the adaptations
Digging into the specifics of the adaptations (e.g., adaptations to content, language, and visuals).
Revisit this step
Regarding people doing the implementation work:
REFLECTING ON
- Will the roles that people play within the initiative be different? Why?
- Will the THING be implemented by people with different characteristics than those who have taken part in past initiatives? (e.g., training, worldviews, experiences)
- Do different people need to implement the THING to address oppressive systems and structures faced by the new population(s)?
- Do the identities of at least some people implementing the THING share characteristics with the people impacted by implementation?
- Can new relationships be formed, or existing relationships adjusted to support implementation to support new people/places of implementation?
Adaptations to the WHOs
Regarding people impacted by implementation:
- Are adaptations needed to reach a different population?
- Are the people impacted by implementation different than in previous initiatives? How and why?
- Might their experiences of barriers and facilitators differ?
- Do they have different values and beliefs about the THING?
- Is available data from past initiatives representative of people in the present initiative?
- Does this population have lived experiences or cultural needs that must be considered to adapt the THING (e.g., language needs, cultural values, etc.)?
- Are there historical, social, or political factors that may influence how the population(s) perceive the THING compared to previous population(s)?
Academic article
The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare
by Christopher Miller, et al.
The FRAME-IS can help you characterize and report on adaptation elements to the HOWs. It includes four core modules of questions and elements (e.g., what is being modified with the HOWs, adaptation goals) and three optional modules. The FRAME-IS is helpful in the Plan for adaptations and Track adaptations phases.
Access this resource
Framework
Context Compass Framework
by The Center for Implementation
A framework that describes contextual factors that influence implementation processes and decisions in variable and diverse settings and systems. The Context Compass Framework is particularly useful in the Assess fit phase.
Access this resource
Academic article
Implementation Science at a Glance: A guide for Cancer Control Practitioners
by National Cancer Institute
Developed for practitioners, this guide introduces foundational implementation science concepts, tools, resources, and case studies organized in a four-stage framework: assess, prepare, implement, and evaluate. Adaptation information is included in the prepare stage of the document. This is helpful in the Plan for adaptations phase.
Access this resource
Framework
Consolidated Framework for Implementation Research
by Laura J. Damschroder, et al.
A multi-level determinant framework that outlines factors that influence implementation of the THING – exploring the THING itself, the outer setting, inner setting, individual-level factors (roles and characteristics), and implementation process activities. The CFIR is particularly useful in the Assess fit phase.
Access this resource
Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Delivery
This category of adaptations involves changes to the way that any component of the THING is delivered.
If the adaptations seem insufficient to meet your goals or the changes are likely to significantly change effectiveness, you may consider choosing or developing a different THING with the people you are working with.
Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
You may consider picking a different THING or developing a new one.
Academic article
The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare
by Christopher Miller, et al.
The FRAME-IS can help you characterize and report on adaptation elements to the HOWs. It includes four core modules of questions and elements (e.g., what is being modified with the HOWs, adaptation goals) and three optional modules. The FRAME-IS is helpful in the Plan for adaptations and Track adaptations phases.
Access this resource
Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
Applied article
From Core Components to Guiding Principles: Reframing Implementation Fidelity
by Julia E. Moore
An article discussing adaptations and the importance of maintaining fidelity to the principles of the THING. Understanding core principles of the THING is important in the Assess fit and Plan for adaptations phases.
Access this resource
Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Toolkit
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HyperIsland Toolbox
by The Center for Implementation
Academic article
Achieving Cultural Appropriateness in Health Promotion Programs: Targeted and Tailored Approaches
by Matthew Kreuter, et al.
Five categories of strategies to enhance cultural appropriateness of the THING: peripheral, evidential, linguistic, constituent-involving, and sociocultural. This is relevant in the Plan for adaptations phase.
Access this resource
Academic article
Examining adaptations of evidence-based programs in natural contexts
by Julia Moore, Brian Bumbarger, and Brittany Rhoades Cooper
Using a taxonomy for adaptations – fit (philosophical vs logistical), timing (proactive versus reactive), valence (positive, negative, neutral) – to understand the realities of program adaptations in real-world/natural settings. Examples are provided throughout this article. This is relevant to all Map2Adapt phases.
Access this resource
REFLECTING ON
Adaptations to the HOWs
- Are there new barriers and facilitators as a result of new populations or settings that might require adaptations to the existing strategies?
- Are additional change strategies needed to address the characteristics of the new setting and system?
- Are changes needed to how the strategies will be delivered?
- Are different supports for implementation required?
- Are new trainings or resources required to enhance the cultural/social safety and responsiveness of the THING?
- Are some of the proposed adaptations likely to introduce additional barriers and facilitators or to affect known ones? What additional strategies may be needed to address new barriers or facilitators? Reflect on the intentions of those strategies.
Applied article
Reframing Adaptations in a Post-pandemic World: Building a Roadmap for Implementation Support Practitioners
by Julia E. Moore
Five tips to plan rapidly for adaptations (considering contextual, logistical, and cultural adaptations). The first tip is to identify and engage key people (e.g., people using the THING, impacted by the THING) in adaptation work. The five tips are relevant to all Map2Adapt phases.
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Applied article
Scaling Up: Balancing Adaptations and Implementation Supports
by Julia E. Moore
An approach to scaling the THING through providing ‘decision-free’ implementation guidance with examples of different adaptations for sites that are struggling with resources and capacity. This is relevant in the Plan for adaptations phase.
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Tool
Hyper Island Toolbox
by Hyper Island
A collection of methods and activities to support collaboration, innovation, and relationship building. Activities in the Hyper Island Toolbox may be considered in all Map2Adapt phases.
Access this resource
Tool
Concept of Forms and Functions in the Context of Complex Interventions
by Monica Perez Jolles, Penny Hawe, and Brian Mittman
Includes tools to explore and describe the THING’s core functions (purpose) and forms (tailored actions of the core function) and an adaptation tracking tool. These tools may be useful in the Assess fit and Plan for adaptations phases.
Access this resource
Academic article
The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions
by Shannon Stirman, Ana Baumann, & Christopher Miller
The FRAME can help you characterize and report on eight adaptation elements to the THING and WHATs. Example elements include who decided on the need for adaptations, what is being adapted, adaptation goals, and rationale. The FRAME is helpful in the Plan for adaptations and Track adaptations phases.
Access this resource
Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
Identify potential impacts
Once adaptations are implemented, you might realize there are unintended impacts of the adaptations.
Revisit this step
Identify what you adapting
Once adaptations are implemented, it’s common to realize additional adaptations are needed (e.g., are more change strategies needed)?
Revisit this step
Click here to revisit this step
Applied article
A Scoping Study of Cultural Adaptation Frameworks
by Jerik Leung, et al.
Proposed steps of the cultural adaptation process and important cultural/social elements to consider in the context of the FRAME. This content is relevant in the Plan for adaptations and Track adaptations phases.
Access this resource
Academic article
Methods for capturing and analyzing adaptations: implications for implementation research
by Jodi Summers Holtrop, et al.
Examples of data collection methods (e.g., interviews, fidelity observations, field notes, tracking log) used to capture and understand adaptations. This is a helpful example in the Track adaptations phase.
Access this resource
Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Tool
Health Equity Toolkit
by National Cancer Institute
Includes information, resources, literature, and practical examples of how to integrate equity principles and practices in implementation initiatives (e.g., community engagement, in theories and frameworks, throughout evaluation). Content in this toolkit are relevant to all Map2Adapt phases.
Access this resource
Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
Perhaps you need more time to connect with people about the original THING, people who would be impacted by the adapted THING, reflect and discuss amongst your team, and/or explore additional THINGs.
You may consider picking a different THING or developing a new one.
Framework
The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions
by Shannon W. Stirman, Ana A. Baumann & Christopher J. Miller
The FRAME can help you characterize and report on eight adaptation elements to the THING and WHATs. Example elements include who decided on the need for adaptations, what is being adapted, adaptation goals, and rationale. The FRAME is helpful in the Plan for adaptations and Track Adaptations phases.
Access this resource
You are ready to move forward with the next phase. Proceed by following the blue line: Track adaptations
Track adaptations
This phase includes one activity that aims to support you in setting up a structure and process to track and monitor adaptations. The final decision point is about whether there is a need to revisit previous activities or to gather more information.
Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
Academic article
Advancing a collective vision for equity-based cocreation through prototyping at an international forum
by Michelle Phoenix, et al.
Four themes to drive equity-based co-creation with communities: go to where people are; nurture relationships and creativity; reflect replenish and grow; and promote thriving and transformation. Principles and ideas included in this article can support adaptation co-creation, and are relevant to all Map2Adapt phases when working and collaborating with people.
Access this resource
Perhaps you need more time to connect with people about the original THING, people who would be impacted by the adapted THING, reflect and discuss amongst your team, and/or explore additional THINGs.
If you need to keep working on adaptation approaches, gather more information, and revisit previous activities.
Framework
The updated Consolidated Framework for Implementation Research based on user feedback
by Laura J. Damschroder, et al.
A multi-level determinant framework that outlines factors that influence implementation of the THING – exploring the THING itself, the outer setting, inner setting, individual-level factors (roles and characteristics), and implementation process activities. The CFIR is particularly useful in the Assess fit phase.
Access this resource
Track adaptations
This phase includes one activity that aims to support you in setting up a structure and process to track and monitor adaptations. The final decision point is about whether there is a need to revisit previous activities or to gather more information.
You are ready to keep moving through the Map2Adapt activities. Proceed by following the pink line: Plan for adaptations.
Academic article
Adapting interventions to new contexts—the ADAPT guidance
by Graham Moore, et al.
Description coming soon.
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Identify potential impacts
Once adaptations are implemented, you might realize there are unintended impacts of the adaptations.
Revisit this step
Video
Video #3: What are you implementing?
by The Center for Implementation
This video from Inspiring Change 2.0 outlines steps and examples to illustrate the importance of understanding barriers and facilitators to doing the WHAT so that you can pick strategies (HOWs) using theories and frameworks. These foundational concepts are important before using and throughout Map2Adapt in the Assess fit and Plan for adaptations phases.
Access this resource
Academic article
The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions
by Shannon Stirman, Ana Baumann, & Christopher Miller
The FRAME can help you characterize and report on eight adaptation elements to the THING and WHATs. Example elements include who decided on the need for adaptations, what is being adapted, adaptation goals, and rationale. The FRAME is helpful in the Plan for adaptations and Track adaptations phases.
Access this resource
Academic article
A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems
by Lou Atkins, et al.
A determinant framework that includes 14 domains/factors that influence individual-level behaviour change (e.g., knowledge, skills, emotion, beliefs about consequences). The TDF is particularly useful in the Assess fit phase.
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Identify what you adapting
Once adaptations are implemented, it’s common to realize additional adaptations are needed (e.g., are more change strategies needed)?
Revisit this step
Click here to revisit this step
Identify who to involve
Almost everyone realizes there are people who were not engaged in the process. Would it be helpful to engage or re-engage people in discussing adaptations?
Revisit this step
Identify who to involve
Almost everyone realizes there are people who were not engaged in the process. Would it be helpful to engage or re-engage people in discussing adaptations?
Revisit this step
Process model
Towards a comprehensive model for understanding adaptations’ impact: the model for adaptation design and impact (MADI)
by M. Alexis Kirk, et al.
A three-domain model that guides adaptation decision making by exploring adaptation characteristics, mediating/moderating factors, and potential adaptation impacts on outcomes. MADI can be considered in the Plan for Adaptations phase when identifying potential adaptation impacts.
Access this resource
You are ready to keep moving through the Map2Adapt activities. Proceed by following the pink line: Plan for adaptations.
Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Tool
The StrategEase: The HOW of Creating Sustainable Change
by The Center for Implementation
A 6-module, self-paced, course that guides you through the StrategEase Pathway to design for and create sustainable change: 1) exploring the THING, 2) defining the WHO and WHAT, 3) assessing barriers and facilitators, and 4) selecting and enacting change strategies (HOWs). These foundational concepts are important before using and throughout Map2Adapt in the Assess fit and Plan for adaptations phases.
Access this resource
Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
Track adaptations
This phase includes one activity that aims to support you in setting up a structure and process to track and monitor adaptations. The final decision point is about whether there is a need to revisit previous activities or to gather more information.
People being asked to do something differently (recipients)
People doing the implementation work
People impacted by the THING
People with a deep knowledge of the context
People with deep knowledge of the THING's evidence base and underlying WHY
Decision makers
Track adaptations
This phase includes one activity that aims to support you in setting up a structure and process to track and monitor adaptations. The final decision point is about whether there is a need to revisit previous activities or to gather more information.
Key elements to track:
People being asked to do something differently (recipients)
WHAT was adapted (including principles)?
WHO delivered the adapted component?
Why was this adaptation made?
Details of the adaptation (the new WHOs, WHATs or HOWs, as applicable)
How does the adaptation affect equity?
How does the adaptation affect other components of the initiative?
Additional elements to track:
Why was this component originally needed?
Details of the adaptation approaches
Who made the decision to adapt?
Was the adaptation planned? When?
When was the adaptation made?
Track adaptations
This phase includes one activity that aims to support you in setting up a structure and process to track and monitor adaptations. The final decision point is about whether there is a need to revisit previous activities or to gather more information.
Framework
The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare
by Christopher J. Miller, et al.
The FRAME-IS can help you characterize and report on adaptation elements to the HOWs. It includes four core modules of questions and elements (e.g., what is being modified with the HOWs, adaptation goals) and three optional modules. The FRAME-IS is helpful in the Plan for adaptations and Track adaptations phases.
Access this resource
If the adaptations seem insufficient to meet your goals or the changes are likely to significantly change effectiveness, you may consider choosing or developing a different THING with the people you are working with.
Principles and functions
People being asked to do something differently (recipients)
Principles are the underlying beliefs or philosophies that guide action. In implementation, principles inform the THING you are implementing (e.g., using an equity-based approach to support underserved groups, using a family-centered approach to empower families and build relationships).
Functions are the intended purpose or desired effect of the THING or the change strategies. These are also referred to as the mechanisms of change.
Applied article
From Core Components to Guiding Principles: Reframing Implementation Fidelity
by Julia E. Moore
An article discussing adaptations and the importance of maintaining fidelity to the principles of the THING. Understanding core principles of the THING is important in the Assess fit and Plan for adaptations phases.
Access this resource
Framework
Context Compass Framework ー Making Context Assessment Manageable: How to Slice and Dice Context in Different Ways
by Sobia Khan and Julia E. Moore
A framework that describes contextual factors that influence implementation processes and decisions in variable and diverse settings and systems. The Context Compass Framework is particularly useful in the Assess fit phase.
Access this resource
Increase reach or engagement (at individual level)
Increase adoption (at site level)
Increase acceptability and appropriateness of the implementation effort
Improve effectiveness/outcomes
Reduce costs
Increase satisfaction
Improve sustainability
Increase health equity or decrease disparities in delivery
Align with a populations values or belief systems
Address operational, procedural, strategic, or administrative constraints or differences
Improve safety and responsiveness of initiative for population(s)
Tools and methods
Design Thinking Bootleg
by Stanford University
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Tool
Cultiv8 tool
by The Center for Implementation
Supports the process of building trusting relationships and navigating power dynamics using trust and power actions/strategies. While important in the Assess fit phase, it has relevance to all Map2Adapt Stages when working and collaborating with people.
Access this resource
Tool
The Collaboration Spectrum
by Tamarack Institute
Helps people understand where they are on the spectrum of collaboration (e.g., compete, as-needed joint work, collaborate) and to identify collaboration and relational goals. While important in the Assess fit phase, it has relevance to all Map2Adapt Stages when working and collaborating with people.
Access this resource
Tool
Practice profiles
by the National Implementation Research Network
A tool that outlines and describes core components and key activities of the THING that can be taught, learned, and applied. This is particularly useful in the Assess fit phase of Map2Adapt.
Access this resource
Applied article
An Innovative Way to Address the Fidelity-Adaptation Debate: Forms and Functions
by Julia E. Moore
An introduction to understanding the THING’s core functions (purpose) and forms (tailored actions of the core function) in adaptation work. This is important in the Assess fit and Plan for adaptations phases.
Access this resource
Tool
StrategEase tool
by The Center for Implementation
An interactive tool that guides you through 1) exploring the THING, 2) defining the WHO and WHAT, 3) assessing barriers and facilitators, and 4) selecting and enacting change strategies (HOWs). These foundational concepts are important before using and throughout Map2Adapt.
Access this resource
Resources
Online collaboration platforms
If doing adaptation activities online, there are many collaborative platforms you could use. Here are a few examples:
- Mural
- Canva (whiteboard feature)
- Slido
- Miro
Activity
Build & Run Prototypes
by Design Kit
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If you need to keep working on adaptation approaches, gather more information, and revisit previous activities.
Process model
Ecological Validity Model
by Guillermo Bernal, Janet Bonilla, and Carmen Bellido
A framework with eight key dimensions used to guide cultural adaptations (to make the THING more inclusive, relevant, and appropriate): language, people, metaphors, content, concepts, goals, methods, and context. This is relevant in the Plan for Adaptations phase.
Access this resource
Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Language, metaphors, and visuals
People being asked to do something differently (recipients)
It is common to adapt language (e.g., from one language to another or switch words to be more appropriate for the context), update metaphors to resonate with the audience, and replace visuals to align with the audience.
Academic article
How to ... do decolonial research
by Danica Anne Simms and Thirusha Naidu
A framework with examples, steps, and prompts to work towards decolonizing research practices (e.g., awareness, deliberation/reflexivity, action). This essential content can be applied to adaptation work. It is relevant to all Map2Adapt phases.
Access this resource
Applied article
Defining Your Initiative: the WHAT, WHO, and HOW (7 Ps Framework)
by Julia Moore and Sobia Khan (adapted from Geoff Curran)
A framework (7 Ps) used to understand/describe WHAT you want people (WHOs) to do differently, use, or adopt, relating to the goal of the initiative. The 7 Ps are programs, practices, policies, procedures, principles, pills, and products. Understanding the 7 Ps of your initiative is important before using Map2Adapt.
Access this resource
Is there a need to add, remove, or modify any of the following:
REFLECTING ON
- Characteristics of programs
- Practices in place
- Relevant procedures for the THING
- Policies in the organization or community
- Products that support the THING
- Underlying principles of the THING
- Delivery or dosage of pills, medications, vaccines, etc.
Adaptations to the WHATs
Will any of these changes affect the underlying functions of the WHATs?
Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
Academic article
Towards a comprehensive model for understanding adaptations’ impact: the model for adaptation design and impact (MADI)
by M. Alexis Kirk, et al.
A three-domain model that guides adaptation decision making by exploring adaptation characteristics, mediating/moderating factors, and potential adaptation impacts on outcomes. MADI can be considered in the Plan for adaptations phase when identifying potential adaptation impacts.
Access this resource
Describe the adaptations
Digging into the specifics of the adaptations (e.g., adaptations to content, language, and visuals).
Revisit this step
Track adaptations
Are you gathering good data on the adaptations?
Revisit this step
Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Activity
Planning the Co-design Activities
by Community-Led Co-design Kit
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Track adaptations
Are you gathering good data on the adaptations?
Revisit this step
You are ready to move forward with the next phase. Proceed by following the blue line: Track adaptations
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Transcript
Assess fit
Start here
Identify whoto involve
Define the original THING
Identify whatyou are adapting
Is this a good fit?
Reflect and revisit
Track adaptations
Describe the adaptations
Identify potential impacts
Plan for adaptations
Track adaptations
Do you implement?
Assess fit
Start here
Identify whoto involve
Define the original THING
Identify whatyou are adapting
Is this a good fit?
Reflect and revisit
Track adaptations
Describe the adaptations
Identify potential impacts
Plan for adaptations
Track adaptations
Do you implement?
Resources referenced in Map2Adapt
In developing the Map2Adapt process, several frameworks and resources were referenced. Below, you'll find a list of frameworks as well as key resources that have influenced the process, steps, and activities.
The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions
The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare
Towards a comprehensive model for understanding adaptations’ impact: the Model for Adaptation Design and Impact (MADI)
Ecological Validity Model
Examining adaptations of evidence-based programs in natural contexts
StrategEase Tool
Defining Your Initiative: the WHAT, WHO, and HOW (7 Ps Framework)
The updated Consolidated Framework for Implementation Research based on user feedback
Context Compass Framework ー Making Context Assessment Manageable: How to Slice and Dice Context in Different Ways
Adapting interventions to new contexts—the ADAPT guidance
Assess fit
STEP #1
Identify who to involve
This step aims to identify the people who should be involved in planning adaptations. This is a unique step because it is relevant for every phase and activity of Map2Adapt and should be revisited throughout the adaptation process.
Resources
Activities
Activities
Assess fit
STEP #1
Identify who to involve
This step aims to identify the people who should be involved in planning adaptations. This is a unique step because it is relevant for every phase and activity of Map2Adapt and should be revisited throughout the adaptation process.
Resources
Activities
Activities
ACTIVITIES TO:
Identify who to involve
1. Describe who will you involve
2. Define when and how you will engage people
3. Build trust and navigate power dynamics
4. Ask yourselves: Who is at the table, who is not at the table, and why?- Reflect and create a plan when people are not engaged
5. Create an ongoing communication plan
You will revisit and re-engage with different people throughout the initiative's life cycle. This is an ongoing activity!
RESOURCES TO:
Identify who to involve
Tool
Cultiv8 tool
Tool
The Collaboration Spectrum
Tool
Health Equity Toolkit
Applied article
Reframing Adaptations in a Post-pandemic World: Building a Roadmap for Implementation Support Practitioners
Academic article
Advancing a collective vision for equity-based cocreation through prototyping at an international forum
Academic article
How to … do decolonial research
Assess fit
STEP #2
Define the original THING
During this step, you will describe the original THING that you are considering adapting. This will include describing: the WHY of the original THING and goals; a summary of the underlying principles; WHOs (i.e., who is being asked to change); WHATs (i.e., what they are being asked to do); and HOWs (i.e., the change strategies used to support change). Adaptation decisions cannot move forward without first developing a clear understanding of the original THING.
Resources
Activities
Activities
Assess fit
STEP #2
Define the original THING
During this step, you will describe the original THING that you are considering adapting. This will include describing: the WHY of the original THING and goals; a summary of the underlying principles; WHOs (i.e., who is being asked to change); WHATs (i.e., what they are being asked to do); and HOWs (i.e., the change strategies used to support change). Adaptation decisions cannot move forward without first developing a clear understanding of the original THING.
Resources
Activities
Activities
ACTIVITIES TO:
Define the original THING
1. Define the goals, objectives, and collective vision of the THING
2. Describe the principles of the THING
3. Is there a shared understanding of the original THING's goals, values, principles, vision, etc.?
4. What is the evidence of the effectiveness of the original THING?
5. Are there intellectual property issues with making adaptations to the THING.
6. Describe WHO needs to do WHAT differently
7. Define the HOWs (i.e., change strategies) and the underlying functions they address
RESOURCES TO:
Define the original THING
Video
Video #3: What are you implementing?
Online course
The StrategEase: The HOW of Creating Sustainable Change
Tool
Practice profiles
Applied article
From Core Components to Guiding Principles: Reframing Implementation Fidelity
Tools
Hyper Island Toolbox
Tool
Concept of Forms and Functions in the Context of Complex Interventions
Assess fit
STEP #3
Identify what you are adapting
This step aims to identify what aspects of the original THING need to be adapted by reflecting on differences between it and a shared vision for an adapted version. This step can help develop a shared understanding of the reasons or drivers impacting the decision to adapt an existing THING. This is an incredibly important stage in the adaptation process.
Resources
Activities
Activities
Assess fit
STEP #3
Identify what you are adapting
This step aims to identify what aspects of the original THING need to be adapted by reflecting on differences between it and a shared vision for an adapted version. This step can help develop a shared understanding of the reasons or drivers impacting the decision to adapt an existing THING. This is an incredibly important stage in the adaptation process.
Resources
Activities
Activities
ACTIVITIES TO:
Identify what you are adapting
Gather information and describe WHY adaptations may be needed. Discuss differences reflecting on the original THING:
1. Is there alignment in the collective vision and the underlying principles? How?
2. Is the setting/context different? How?
3. What are the goals of the adaptations?
Based on your team’s reflection on the questions above, consider whether it makes sense for you to make adaptation to the:
WHATs
WHOs
HOWs
RESOURCES TO:
Identify what you are adapting
Framework
Consolidated Framework for Implementation Research
Framework
Context Compass Framework
Academic article
A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems
Applied article
From Core Components to Guiding Principles: Reframing Implementation Fidelity
Applied article
An Innovative Way to Address the Fidelity-Adaptation Debate: Forms and Functions
Assess fit
DECISION POINT
Is this a good fit?
This activity aims to decide whether this program is a good fit and, if so, whether to proceed with adaptations.
There are different potential next steps at this decision point. Select your outcome:
The THING is not considered a good fit for the context, even with adaptations.
Uncertain as to whether adaptations are useful or if another THING is more appropriate.
Adaptations are needed to improve fit and the team wants to move forward with this THING.
Plan for adaptations
Assess fit
DECISION POINT
Is this a good fit?
This activity aims to decide whether this program is a good fit and, if so, whether to proceed with adaptations.
There are different potential next steps at this decision point. Select your outcome:
The THING is not considered a good fit for the context, even with adaptations.
Uncertain as to whether adaptations are useful or if another THING is more appropriate.
Adaptations are needed to improve fit and the team wants to move forward with this THING.
Plan for adaptations
Plan for adaptations
STEP #4
Describe the adaptations
This step aims to explore and describe adaptation approaches that can help address the challenges and unique needs of your implementation context.
Resources
Activities
Activities
Resources
Activities
Activities
Assess fit
Plan for adaptations
STEP #4
Describe the adaptations
This step aims to explore and describe adaptation approaches that can help address the challenges and unique needs of your implementation context.
Resources
Activities
Activities
Assess fit
ACTIVITIES TO:
Describe the adaptations
When we make adaptations, they typically fall into four categories - adaptations to:
1. Language, metaphors, and visuals
2. Content and concepts
3. Delivery
4. Principles and functions
RESOURCES TO:
Describe the adaptations
Academic article
The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare
Academic article
The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions
Applied article
Scaling Up: Balancing Adaptations and Implementation Supports
Academic article
A Scoping Study of Cultural Adaptation Frameworks
Academic article
Achieving Cultural Appropriateness in Health Promotion Programs: Targeted and Tailored Approaches
Academic article
The core functions and forms paradigm throughout EPIS: designing and implementing an evidence-based practice with function fidelity
Plan for adaptations
STEP #5
Identify potential impacts
For this step, you will review proposed adaptations and consider impacts on implementation and outcomes, as well as equity considerations.
Resources
Activities
Activities
Plan for adaptations
STEP #5
Identify potential impacts
For this step, you will review proposed adaptations and consider impacts on implementation and outcomes, as well as equity considerations.
Resources
Activities
Activities
ACTIVITIES TO:
Identify potential impacts
1. Do the adaptations change the functions or principles of the WHATs or HOWs?
2. Identify whether there are changes to the THING's design and whether these are surface or deep level adaptations.
3. Would the adaptations have a different impact on different groups of people? Who benefits and who loses if you move forward with these adaptations?
4. If adaptations are successful and everything goes as planned, what would you expect the ideal outcomes to be? What if the opposite occurs?
5. Could any of the adaptations result in unintended harm?
6. Describe whether additional resources (e.g., expertise, materials, funds, etc.) are needed to execute these adaptations.
RESOURCES TO:
Identify potential impacts
If you need more guidance on considering the potential impacts of proposed adaptations, you might find the “Traffic Light Tool” useful (see page page 12 of the first resource below) as it addresses the balance of fit and fidelity.
Academic article
Implementation Science at a Glance: A guide for Cancer Control Practitioners
Academic article
Towards a comprehensive model for understanding adaptations’ impact: the model for adaptation design and impact (MADI)
Plan for adaptations
DECISION POINT
Do you implement?
The purpose of this decision point is to decide whether to move forward with implementing planned adaptations.
There are different potential outcomes at this decision point. Select your outcome:
Adaptations seem insufficient to meet your goals or the changes are likely to significantly change effectiveness.
You need to keep reflecting and working on adaptation approaches.
Adaptations have been well thought out.
Track adaptations
Plan for adaptations
DECISION POINT
Do you implement?
The purpose of this decision point is to decide whether to move forward with implementing planned adaptations.
There are different potential outcomes at this decision point. Select your outcome:
Adaptations seem insufficient to meet your goals or the changes are likely to significantly change effectiveness.
You need to keep reflecting and working on adaptation approaches.
Adaptations have been well thought out.
Track adaptations
Track adaptations
STEP #6
Track adaptations
For this step, you will consider how to monitor and track adaptations for your initiative moving forward.
Resources
Activities
Activities
Plan for adaptations
Track adaptations
STEP #6
Track adaptations
For this step, you will consider how to monitor and track adaptations for your initiative moving forward.
Resources
Activities
Activities
Plan for adaptations
ACTIVITIES TO:
Track adaptations
1. Think about the following:
2. Select what you will track
3. Create a tracking plan
RESOURCES TO:
Track adaptations
Academic article
The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions
Academic article
The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare
Academic article
Methods for capturing and analyzing adaptations: implications for implementation research
Track adaptations
DECISION POINT
Reflect and revisit
This final step in the Map2Adapt process encourages you to think about the activities and principles as an ongoing exercise of review and reflection. Implementation requires deep self-reflection, team reflection, continuous learning, and pivoting. Because reflection is so important in the adaptation process, it’s important to revisit previous steps in the process.
Here are the common steps that people revisit:
Track adaptations
Describe the adaptations
Identify who to involve
Identify what you are adapting
Identify potential impacts
Track adaptations
DECISION POINT
Reflect and revisit
This final step in the Map2Adapt process encourages you to think about the activities and principles as an ongoing exercise of review and reflection. Implementation requires deep self-reflection, team reflection, continuous learning, and pivoting. Because reflection is so important in the adaptation process, it’s important to revisit previous steps in the process.
Here are the common steps that people revisit:
Track adaptations
Describe the adaptations
Identify who to involve
Identify what you are adapting
Identify potential impacts
Content and concepts
People being asked to do something differently (recipients)
This adaptation category involves modifications to the THING's content, including direct content (modifying, adding, removing) or underlying concepts.
Toolkit
Liberating Structures
by Henri Lipmanowicz and Keith McCandless
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Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Academic article
The core functions and forms paradigm throughout EPIS: designing and implementing an evidence-based practice with function fidelity
by Alec Terrana, et al.
Example of exploring and using functions and forms in each EPIS (Exploration, Preparation, Implementation, Sustainment) stage to guide adaptations (Tables 2 and 3). Examples offered in this article are relevant throughout all Map2Adapt phases.
Access this resource
Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
Track adaptations
This phase includes one activity that aims to support you in setting up a structure and process to track and monitor adaptations. The final decision point is about whether there is a need to revisit previous activities or to gather more information.
Describe the adaptations
Digging into the specifics of the adaptations (e.g., adaptations to content, language, and visuals).
Revisit this step
Regarding people doing the implementation work:
REFLECTING ON
Adaptations to the WHOs
Regarding people impacted by implementation:
Academic article
The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare
by Christopher Miller, et al.
The FRAME-IS can help you characterize and report on adaptation elements to the HOWs. It includes four core modules of questions and elements (e.g., what is being modified with the HOWs, adaptation goals) and three optional modules. The FRAME-IS is helpful in the Plan for adaptations and Track adaptations phases.
Access this resource
Framework
Context Compass Framework
by The Center for Implementation
A framework that describes contextual factors that influence implementation processes and decisions in variable and diverse settings and systems. The Context Compass Framework is particularly useful in the Assess fit phase.
Access this resource
Academic article
Implementation Science at a Glance: A guide for Cancer Control Practitioners
by National Cancer Institute
Developed for practitioners, this guide introduces foundational implementation science concepts, tools, resources, and case studies organized in a four-stage framework: assess, prepare, implement, and evaluate. Adaptation information is included in the prepare stage of the document. This is helpful in the Plan for adaptations phase.
Access this resource
Framework
Consolidated Framework for Implementation Research
by Laura J. Damschroder, et al.
A multi-level determinant framework that outlines factors that influence implementation of the THING – exploring the THING itself, the outer setting, inner setting, individual-level factors (roles and characteristics), and implementation process activities. The CFIR is particularly useful in the Assess fit phase.
Access this resource
Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Delivery
This category of adaptations involves changes to the way that any component of the THING is delivered.
If the adaptations seem insufficient to meet your goals or the changes are likely to significantly change effectiveness, you may consider choosing or developing a different THING with the people you are working with.
Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
You may consider picking a different THING or developing a new one.
Academic article
The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare
by Christopher Miller, et al.
The FRAME-IS can help you characterize and report on adaptation elements to the HOWs. It includes four core modules of questions and elements (e.g., what is being modified with the HOWs, adaptation goals) and three optional modules. The FRAME-IS is helpful in the Plan for adaptations and Track adaptations phases.
Access this resource
Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
Applied article
From Core Components to Guiding Principles: Reframing Implementation Fidelity
by Julia E. Moore
An article discussing adaptations and the importance of maintaining fidelity to the principles of the THING. Understanding core principles of the THING is important in the Assess fit and Plan for adaptations phases.
Access this resource
Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Toolkit
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HyperIsland Toolbox
by The Center for Implementation
Academic article
Achieving Cultural Appropriateness in Health Promotion Programs: Targeted and Tailored Approaches
by Matthew Kreuter, et al.
Five categories of strategies to enhance cultural appropriateness of the THING: peripheral, evidential, linguistic, constituent-involving, and sociocultural. This is relevant in the Plan for adaptations phase.
Access this resource
Academic article
Examining adaptations of evidence-based programs in natural contexts
by Julia Moore, Brian Bumbarger, and Brittany Rhoades Cooper
Using a taxonomy for adaptations – fit (philosophical vs logistical), timing (proactive versus reactive), valence (positive, negative, neutral) – to understand the realities of program adaptations in real-world/natural settings. Examples are provided throughout this article. This is relevant to all Map2Adapt phases.
Access this resource
REFLECTING ON
Adaptations to the HOWs
Applied article
Reframing Adaptations in a Post-pandemic World: Building a Roadmap for Implementation Support Practitioners
by Julia E. Moore
Five tips to plan rapidly for adaptations (considering contextual, logistical, and cultural adaptations). The first tip is to identify and engage key people (e.g., people using the THING, impacted by the THING) in adaptation work. The five tips are relevant to all Map2Adapt phases.
Access this resource
Applied article
Scaling Up: Balancing Adaptations and Implementation Supports
by Julia E. Moore
An approach to scaling the THING through providing ‘decision-free’ implementation guidance with examples of different adaptations for sites that are struggling with resources and capacity. This is relevant in the Plan for adaptations phase.
Access this resource
Tool
Hyper Island Toolbox
by Hyper Island
A collection of methods and activities to support collaboration, innovation, and relationship building. Activities in the Hyper Island Toolbox may be considered in all Map2Adapt phases.
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Tool
Concept of Forms and Functions in the Context of Complex Interventions
by Monica Perez Jolles, Penny Hawe, and Brian Mittman
Includes tools to explore and describe the THING’s core functions (purpose) and forms (tailored actions of the core function) and an adaptation tracking tool. These tools may be useful in the Assess fit and Plan for adaptations phases.
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Academic article
The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions
by Shannon Stirman, Ana Baumann, & Christopher Miller
The FRAME can help you characterize and report on eight adaptation elements to the THING and WHATs. Example elements include who decided on the need for adaptations, what is being adapted, adaptation goals, and rationale. The FRAME is helpful in the Plan for adaptations and Track adaptations phases.
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Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
Identify potential impacts
Once adaptations are implemented, you might realize there are unintended impacts of the adaptations.
Revisit this step
Identify what you adapting
Once adaptations are implemented, it’s common to realize additional adaptations are needed (e.g., are more change strategies needed)?
Revisit this step
Click here to revisit this step
Applied article
A Scoping Study of Cultural Adaptation Frameworks
by Jerik Leung, et al.
Proposed steps of the cultural adaptation process and important cultural/social elements to consider in the context of the FRAME. This content is relevant in the Plan for adaptations and Track adaptations phases.
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Academic article
Methods for capturing and analyzing adaptations: implications for implementation research
by Jodi Summers Holtrop, et al.
Examples of data collection methods (e.g., interviews, fidelity observations, field notes, tracking log) used to capture and understand adaptations. This is a helpful example in the Track adaptations phase.
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Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Tool
Health Equity Toolkit
by National Cancer Institute
Includes information, resources, literature, and practical examples of how to integrate equity principles and practices in implementation initiatives (e.g., community engagement, in theories and frameworks, throughout evaluation). Content in this toolkit are relevant to all Map2Adapt phases.
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Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
Perhaps you need more time to connect with people about the original THING, people who would be impacted by the adapted THING, reflect and discuss amongst your team, and/or explore additional THINGs.
You may consider picking a different THING or developing a new one.
Framework
The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions
by Shannon W. Stirman, Ana A. Baumann & Christopher J. Miller
The FRAME can help you characterize and report on eight adaptation elements to the THING and WHATs. Example elements include who decided on the need for adaptations, what is being adapted, adaptation goals, and rationale. The FRAME is helpful in the Plan for adaptations and Track Adaptations phases.
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You are ready to move forward with the next phase. Proceed by following the blue line: Track adaptations
Track adaptations
This phase includes one activity that aims to support you in setting up a structure and process to track and monitor adaptations. The final decision point is about whether there is a need to revisit previous activities or to gather more information.
Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
Academic article
Advancing a collective vision for equity-based cocreation through prototyping at an international forum
by Michelle Phoenix, et al.
Four themes to drive equity-based co-creation with communities: go to where people are; nurture relationships and creativity; reflect replenish and grow; and promote thriving and transformation. Principles and ideas included in this article can support adaptation co-creation, and are relevant to all Map2Adapt phases when working and collaborating with people.
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Perhaps you need more time to connect with people about the original THING, people who would be impacted by the adapted THING, reflect and discuss amongst your team, and/or explore additional THINGs.
If you need to keep working on adaptation approaches, gather more information, and revisit previous activities.
Framework
The updated Consolidated Framework for Implementation Research based on user feedback
by Laura J. Damschroder, et al.
A multi-level determinant framework that outlines factors that influence implementation of the THING – exploring the THING itself, the outer setting, inner setting, individual-level factors (roles and characteristics), and implementation process activities. The CFIR is particularly useful in the Assess fit phase.
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Track adaptations
This phase includes one activity that aims to support you in setting up a structure and process to track and monitor adaptations. The final decision point is about whether there is a need to revisit previous activities or to gather more information.
You are ready to keep moving through the Map2Adapt activities. Proceed by following the pink line: Plan for adaptations.
Academic article
Adapting interventions to new contexts—the ADAPT guidance
by Graham Moore, et al.
Description coming soon.
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Identify potential impacts
Once adaptations are implemented, you might realize there are unintended impacts of the adaptations.
Revisit this step
Video
Video #3: What are you implementing?
by The Center for Implementation
This video from Inspiring Change 2.0 outlines steps and examples to illustrate the importance of understanding barriers and facilitators to doing the WHAT so that you can pick strategies (HOWs) using theories and frameworks. These foundational concepts are important before using and throughout Map2Adapt in the Assess fit and Plan for adaptations phases.
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Academic article
The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions
by Shannon Stirman, Ana Baumann, & Christopher Miller
The FRAME can help you characterize and report on eight adaptation elements to the THING and WHATs. Example elements include who decided on the need for adaptations, what is being adapted, adaptation goals, and rationale. The FRAME is helpful in the Plan for adaptations and Track adaptations phases.
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Academic article
A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems
by Lou Atkins, et al.
A determinant framework that includes 14 domains/factors that influence individual-level behaviour change (e.g., knowledge, skills, emotion, beliefs about consequences). The TDF is particularly useful in the Assess fit phase.
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Identify what you adapting
Once adaptations are implemented, it’s common to realize additional adaptations are needed (e.g., are more change strategies needed)?
Revisit this step
Click here to revisit this step
Identify who to involve
Almost everyone realizes there are people who were not engaged in the process. Would it be helpful to engage or re-engage people in discussing adaptations?
Revisit this step
Identify who to involve
Almost everyone realizes there are people who were not engaged in the process. Would it be helpful to engage or re-engage people in discussing adaptations?
Revisit this step
Process model
Towards a comprehensive model for understanding adaptations’ impact: the model for adaptation design and impact (MADI)
by M. Alexis Kirk, et al.
A three-domain model that guides adaptation decision making by exploring adaptation characteristics, mediating/moderating factors, and potential adaptation impacts on outcomes. MADI can be considered in the Plan for Adaptations phase when identifying potential adaptation impacts.
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You are ready to keep moving through the Map2Adapt activities. Proceed by following the pink line: Plan for adaptations.
Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Tool
The StrategEase: The HOW of Creating Sustainable Change
by The Center for Implementation
A 6-module, self-paced, course that guides you through the StrategEase Pathway to design for and create sustainable change: 1) exploring the THING, 2) defining the WHO and WHAT, 3) assessing barriers and facilitators, and 4) selecting and enacting change strategies (HOWs). These foundational concepts are important before using and throughout Map2Adapt in the Assess fit and Plan for adaptations phases.
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Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
Track adaptations
This phase includes one activity that aims to support you in setting up a structure and process to track and monitor adaptations. The final decision point is about whether there is a need to revisit previous activities or to gather more information.
People being asked to do something differently (recipients)
People doing the implementation work
People impacted by the THING
People with a deep knowledge of the context
People with deep knowledge of the THING's evidence base and underlying WHY
Decision makers
Track adaptations
This phase includes one activity that aims to support you in setting up a structure and process to track and monitor adaptations. The final decision point is about whether there is a need to revisit previous activities or to gather more information.
Key elements to track:
People being asked to do something differently (recipients)
WHAT was adapted (including principles)?
WHO delivered the adapted component?
Why was this adaptation made?
Details of the adaptation (the new WHOs, WHATs or HOWs, as applicable)
How does the adaptation affect equity?
How does the adaptation affect other components of the initiative?
Additional elements to track:
Why was this component originally needed?
Details of the adaptation approaches
Who made the decision to adapt?
Was the adaptation planned? When?
When was the adaptation made?
Track adaptations
This phase includes one activity that aims to support you in setting up a structure and process to track and monitor adaptations. The final decision point is about whether there is a need to revisit previous activities or to gather more information.
Framework
The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare
by Christopher J. Miller, et al.
The FRAME-IS can help you characterize and report on adaptation elements to the HOWs. It includes four core modules of questions and elements (e.g., what is being modified with the HOWs, adaptation goals) and three optional modules. The FRAME-IS is helpful in the Plan for adaptations and Track adaptations phases.
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If the adaptations seem insufficient to meet your goals or the changes are likely to significantly change effectiveness, you may consider choosing or developing a different THING with the people you are working with.
Principles and functions
People being asked to do something differently (recipients)
Principles are the underlying beliefs or philosophies that guide action. In implementation, principles inform the THING you are implementing (e.g., using an equity-based approach to support underserved groups, using a family-centered approach to empower families and build relationships). Functions are the intended purpose or desired effect of the THING or the change strategies. These are also referred to as the mechanisms of change.
Applied article
From Core Components to Guiding Principles: Reframing Implementation Fidelity
by Julia E. Moore
An article discussing adaptations and the importance of maintaining fidelity to the principles of the THING. Understanding core principles of the THING is important in the Assess fit and Plan for adaptations phases.
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Framework
Context Compass Framework ー Making Context Assessment Manageable: How to Slice and Dice Context in Different Ways
by Sobia Khan and Julia E. Moore
A framework that describes contextual factors that influence implementation processes and decisions in variable and diverse settings and systems. The Context Compass Framework is particularly useful in the Assess fit phase.
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Increase reach or engagement (at individual level)
Increase adoption (at site level)
Increase acceptability and appropriateness of the implementation effort
Improve effectiveness/outcomes
Reduce costs
Increase satisfaction
Improve sustainability
Increase health equity or decrease disparities in delivery
Align with a populations values or belief systems
Address operational, procedural, strategic, or administrative constraints or differences
Improve safety and responsiveness of initiative for population(s)
Tools and methods
Design Thinking Bootleg
by Stanford University
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Tool
Cultiv8 tool
by The Center for Implementation
Supports the process of building trusting relationships and navigating power dynamics using trust and power actions/strategies. While important in the Assess fit phase, it has relevance to all Map2Adapt Stages when working and collaborating with people.
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Tool
The Collaboration Spectrum
by Tamarack Institute
Helps people understand where they are on the spectrum of collaboration (e.g., compete, as-needed joint work, collaborate) and to identify collaboration and relational goals. While important in the Assess fit phase, it has relevance to all Map2Adapt Stages when working and collaborating with people.
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Tool
Practice profiles
by the National Implementation Research Network
A tool that outlines and describes core components and key activities of the THING that can be taught, learned, and applied. This is particularly useful in the Assess fit phase of Map2Adapt.
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Applied article
An Innovative Way to Address the Fidelity-Adaptation Debate: Forms and Functions
by Julia E. Moore
An introduction to understanding the THING’s core functions (purpose) and forms (tailored actions of the core function) in adaptation work. This is important in the Assess fit and Plan for adaptations phases.
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Tool
StrategEase tool
by The Center for Implementation
An interactive tool that guides you through 1) exploring the THING, 2) defining the WHO and WHAT, 3) assessing barriers and facilitators, and 4) selecting and enacting change strategies (HOWs). These foundational concepts are important before using and throughout Map2Adapt.
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Resources
Online collaboration platforms
If doing adaptation activities online, there are many collaborative platforms you could use. Here are a few examples:
Activity
Build & Run Prototypes
by Design Kit
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If you need to keep working on adaptation approaches, gather more information, and revisit previous activities.
Process model
Ecological Validity Model
by Guillermo Bernal, Janet Bonilla, and Carmen Bellido
A framework with eight key dimensions used to guide cultural adaptations (to make the THING more inclusive, relevant, and appropriate): language, people, metaphors, content, concepts, goals, methods, and context. This is relevant in the Plan for Adaptations phase.
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Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Language, metaphors, and visuals
People being asked to do something differently (recipients)
It is common to adapt language (e.g., from one language to another or switch words to be more appropriate for the context), update metaphors to resonate with the audience, and replace visuals to align with the audience.
Academic article
How to ... do decolonial research
by Danica Anne Simms and Thirusha Naidu
A framework with examples, steps, and prompts to work towards decolonizing research practices (e.g., awareness, deliberation/reflexivity, action). This essential content can be applied to adaptation work. It is relevant to all Map2Adapt phases.
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Applied article
Defining Your Initiative: the WHAT, WHO, and HOW (7 Ps Framework)
by Julia Moore and Sobia Khan (adapted from Geoff Curran)
A framework (7 Ps) used to understand/describe WHAT you want people (WHOs) to do differently, use, or adopt, relating to the goal of the initiative. The 7 Ps are programs, practices, policies, procedures, principles, pills, and products. Understanding the 7 Ps of your initiative is important before using Map2Adapt.
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Is there a need to add, remove, or modify any of the following:
REFLECTING ON
Adaptations to the WHATs
Will any of these changes affect the underlying functions of the WHATs?
Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
Plan for adaptations
This phase includes 2 activities for you to reflect on, and brainstorm, adaptation goals, approaches, and potential outcomes and impacts. This phase ends with the second decision point, to assess whether to proceed with adaptations.
Academic article
Towards a comprehensive model for understanding adaptations’ impact: the model for adaptation design and impact (MADI)
by M. Alexis Kirk, et al.
A three-domain model that guides adaptation decision making by exploring adaptation characteristics, mediating/moderating factors, and potential adaptation impacts on outcomes. MADI can be considered in the Plan for adaptations phase when identifying potential adaptation impacts.
Access this resource
Describe the adaptations
Digging into the specifics of the adaptations (e.g., adaptations to content, language, and visuals).
Revisit this step
Track adaptations
Are you gathering good data on the adaptations?
Revisit this step
Assess fit
This phase includes 3 activities and is about engaging people, exploring the THING, and identifying what may need to be adapted and why. This phase ends with the first decision point, to assess whether the THING is a good fit.
Activity
Planning the Co-design Activities
by Community-Led Co-design Kit
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Track adaptations
Are you gathering good data on the adaptations?
Revisit this step
You are ready to move forward with the next phase. Proceed by following the blue line: Track adaptations