Strengthening methods for tracking adaptations and modifications to implementation strategies

Amber D. Haley, Byron J. Powell, Callie Walsh-Bailey, Molly Krancari, Inga Gruß, Christopher M. Shea, Arwen Bunce, Miguel Marino, Leah Frerichs, Kristen Hassmiller Lich, Rachel Gold

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


BACKGROUND: Developing effective implementation strategies requires adequate tracking and reporting on their application. Guidelines exist for defining and reporting on implementation strategy characteristics, but not for describing how strategies are adapted and modified in practice. We built on existing implementation science methods to provide novel methods for tracking strategy modifications. METHODS: These methods were developed within a stepped-wedge trial of an implementation strategy package designed to help community clinics adopt social determinants of health-related activities: in brief, an 'Implementation Support Team' supports clinics through a multi-step process. These methods involve five components: 1) describe planned strategy; 2) track its use; 3) monitor barriers; 4) describe modifications; and 5) identify / describe new strategies. We used the Expert Recommendations for Implementing Change taxonomy to categorize strategies, Proctor et al.'s reporting framework to describe them, the Consolidated Framework for Implementation Research to code barriers / contextual factors necessitating modifications, and elements of the Framework for Reporting Adaptations and Modifications-Enhanced to describe strategy modifications. RESULTS: We present three examples of the use of these methods: 1) modifications made to a facilitation-focused strategy (clinics reported that certain meetings were too frequent, so their frequency was reduced in subsequent wedges); 2) a clinic-level strategy addition which involved connecting one study clinic seeking help with community health worker-related workflows to another that already had such a workflow in place; 3) a study-level strategy addition which involved providing assistance in overcoming previously encountered (rather than de novo) challenges. CONCLUSIONS: These methods for tracking modifications made to implementation strategies build on existing methods, frameworks, and guidelines; however, as none of these were a perfect fit, we made additions to several frameworks as indicated, and used certain frameworks' components selectively. While these methods are time-intensive, and more work is needed to streamline them, they are among the first such methods presented to implementation science. As such, they may be used in research on assessing effective strategy modifications and for replication and scale-up of effective strategies. We present these methods to guide others seeking to document implementation strategies and modifications to their studies. TRIAL REGISTRATION: ID: NCT03607617 (first posted 31/07/2018).

Original languageEnglish (US)
Pages (from-to)133
Number of pages1
JournalBMC Medical Research Methodology
Issue number1
StatePublished - Jun 26 2021


  • Implementation context
  • Implementation strategies
  • Modification and adaptation
  • Reporting

ASJC Scopus subject areas

  • Epidemiology
  • Health Informatics


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