Table 1 The Consolidated Approach to Intervention Adaptation (CLARION)
8 Common Steps | 5 Steps in M-PACE | Overlap with 6 CLARION Steps |
|---|---|---|
Assess community or population of interest - Assess community context, risk factors, and organizational capacity for implementation | 8CS: Assemble a steering committee of experts (include members with knowledge of community and organizational factors relevant to intervention adaptation and implementation) | |
Understand existing evidence-based interventions - Identify and review relevant evidence-based interventions and understand the theory/logic behind them and their core components | 8CS: Select a candidate intervention 8CS: Identify its mechanisms of action and core components | |
Select an intervention matching the new population and context | ||
Decide what components to adapt - Test the intervention with the new population and interest holders to identify needed adaptations and determine differences between original and new target population - Preserving fidelity to core components and aligning with the new context | Assemble an adaptation steering committee - Include researchers, implementers/practitioners, and community members, including at least one expert on the intervention's theory and effectiveness Implement the unadapted intervention - Provide participants (from the target population for the adapted intervention) with the unadapted intervention Solicit feedback from target participants on optimal adaptation of intervention components - Recommend triangulation of multiple techniques (e.g., surveys, interviews) Summarize target participant feedback - Distribute summary to steering committee members | MPACE: Assemble a steering committee of experts 8CS + MPACE: Implement the original (unadapted) intervention with target users and HCPs working with this population 8CS + MPACE: Identify and consolidate potential modifications |
Adapt the original intervention - Collaboratively adapt content through pilot testing while maintaining core components | Adjudicate recommendations - Use three criteria: importance, feasibility, and congruence with unadapted intervention - Prioritizing experiential knowledge of target users, committee seeks consensus on whether to adapt the intervention based on recommended modifications - Subcommittee implements agreed upon modifications | MPACE: Steering committee review of potential modifications based on adjudication criteria and integrating agreed upon modifications |
Test the adapted intervention - Pre-test adapted materials with interest holders and conduct readability tests - (beyond current scope) Conduct pilot test of the adapted intervention in new target population and modify further, if needed | 8CS: Assess acceptability (pre-test) adapted intervention with interest holders (Phase 2) | |
Implement the intervention - Develop an implementation plan including identifying implementers, behaviors, outcomes, scope, and instructions - Execute adapted intervention | Beyond current scope; to be completed after adaptation | |
Evaluate - Document and evaluate the adaptation process - Evaluate the outcomes of the implemented adaptation - Plan evaluation (questions, data collection, analysis, reporting) | Beyond current scope; to be completed after adaptation | |