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Adapting evidence-informed complex population health interventions for new contexts: a systematic review of guidance
Open accessAbstract
Background: Adapting interventions that have worked elsewhere can save resources associated with developing new interventions for each specific context. While a developing body of evidence shows benefits of adapted interventions compared with interventions transported without adaptation, there are also examples of interventions which have been extensively adapted, yet have not worked in the new context. Decisions on when, to what extent, and how to adapt interventions therefore are not straightforward, particularly when conceptualising intervention effects as contingent upon contextual interactions in complex systems. No guidance currently addresses these questions comprehensively. To inform development of an overarching guidance on adaptation of complex population health interventions, this systematic review synthesises the content of the existing guidance papers. Methods: We searched for papers published between January 2000 and October 2018 in 7 bibliographic databases. We used citation tracking and contacted authors and experts to locate further papers. We double screened all the identified records. We extracted data into the following categories: descriptive information, key concepts and definitions, rationale for adaptation, aspects of adaptation, process of adaptation, evaluating and reporting adapted interventions. Data extraction was conducted independently by two reviewers, and retrieved data were synthesised thematically within pre-specified and emergent categories. Results: We retrieved 6694 unique records. Thirty-eight papers were included in the review representing 35 sources of guidance. Most papers were developed in the USA in the context of implementing evidence-informed interventions among different population groups within the country, such as minority populations. We found much agreement on how the papers defined key concepts, aims, and procedures of adaptation, including involvement of key stakeholders, but also identified gaps in scope, conceptualisation, and operationalisation in several categories. Conclusions: Our review found limitations that should be addressed in future guidance on adaptation . Specifically, future guidance needs to be reflective of adaptations in the context of transferring interventions across countries, including macro- (e.g. national-) level interventions, better theorise the role of intervention mechanisms and contextual interactions in the replicability of effects and accordingly conceptualise key concepts, such as fidelity to intervention functions, and finally, suggest evidence-informed strategies for adaptation re-evaluation and reporting. Trial registration: PROSPERO 2018, CRD42018112714 .
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“Flawed programme adaptation efforts can also unintentionally undermine their ToC, reducing effectiveness (Movsisyan et al., 2019).”
From Promoting positive youth development with adolescent boys in UK schools: A theory-driven evaluation of the "Becoming a Man" programme (2026) · cites this paper as Movsisyan et al., 2019
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“A growing body of evidence suggests that effective application and uptake of an evidence-based intervention must be informed by the contextual needs of the intended new users of the intervention [18,19].”
From Promoting the mental health of university students in China: Protocol for contextual assessment to inform intervention design and adaptation (2021) · cites this paper as [18]
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“The use of mixed methods of quantitative and qualitative data collection and frequent dialogue enables the newly formed intervention team to identify the relevant needs for the users of the intervention, availability of resources and infrastructures, and acceptability of the intervention and implementation approaches [18].”
From Promoting the mental health of university students in China: Protocol for contextual assessment to inform intervention design and adaptation (2021) · cites this paper as [18]
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Metadata
- Authors
- Movsisyan, A., Arnold, L., Evans, R., Hallingberg, B., Moore, G., O’Cathain, A., Pfadenhauer, L. M., Segrott, J., & Rehfuess, E.
- Affiliations
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (DE)
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (GB)
- Cardiff Metropolitan University (GB)
- University of Sheffield (GB)
- Corresponding author
- Movsisyan, A.
- ORCID
- Venue
- Implementation Science
- Published
- 2019-12
- Volume
- 14
- Issue
- 1
- Pages
- 105-105
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC6918624
- OpenAlex
- W2995364571
- Cited by
- 331
- References
- 84
- Citations by year
- 2026: 41 · 2025: 45 · 2024: 68 · 2023: 35 · 2022: 46 · 2021: 72 · 2020: 22
- FWCI
- 6.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Implementation Science (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Open access LMU (Ludwid Maxmilian's Universitat Munchen) (submittedVersion, cc-by)
- Cardiff Metropolitan Research Repository (Cardiff Metropolitan University) (submittedVersion, cc-by)
- Funders
- Medical Research Council (MR/R013357/1)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Public Administration › Evaluation and Performance Assessment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- intervention adaptation, evidence-informed interventions, adaptation guidance, contextual adaptation, intervention fidelity, intervention mechanisms, context-aware interaction, stakeholder engagement, minority groups
- MeSH terms
- Population Health, Delivery of Health Care, Health Plan Implementation, Health Promotion, Humans, Evidence-Based Medicine
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