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Table 3 Examples of implementation strategy modifications

From: Strengthening methods for tracking adaptations and modifications to implementation strategies

Data element Example 1: study-level (shortening) Example 2: clinic-level (addition) Example 3: study-level (addition)
Frame
 Modification Reduced frequency of peer support meetings from 1x/month to 1x/2 months Additional information shared between clinics within a wedge Additional questions in the assessment organizations complete at baseline
 When did modification occur After wedge 1 Within wedge 3 After wedge 2
 Who made decision to modify IST Practice coach IST
 Goal of modification Increase acceptability of the implementation effort Improve outcomes Improve fit
 Nature of modification Shortening, reduced frequency Adding elements Adding elements
 Reason for modification Organizational Organizational, Available Resources, Staffing Organizational, Context
 Source information for reason Based on discussion during IST meetings Stated by clinic during check in meeting Based on discussion during IST meetings
CFIR / ERIC
 CFIR domain Access to Knowledge and Information Available Resources Readiness for implementation
 ERIC category Provide Interactive Assistance Develop Stakeholder Interrelationships Use Evaluative and Iterative Strategies
 ERIC implementation strategy Facilitation Capture and share local knowledge Assess for readiness and identify barriers and facilitators
Proctor
 Primary actor Practice coach Practice coach requests information from clinic with expertise Practice coach
 Supporting actor(s) Project champions Project champion at study clinic, staff at peer clinic IST, project champion
 Action Meetings which include project champions and members of the implementation teams of all clinics within a study wedge. Practice coach facilitates meetings. Project champions attend meetings and share information between clinics Practice coach requests information from clinic with expertise. Clinic with expertise shares knowledge, clinic seeking expertise reviews and uses the information IST members modified the baseline assessment to include questions about determine whether aspects of the intervention have already been implemented at the clinic. Project champion completes the assessment. Practice coach uses the assessment to plan implementation support
 Format Virtual meeting Email to request information, word document to share information, follow-up meeting to discuss information Learning session, coaching call, email or other informal contact
 Dose Once a month 1 time 1 time
 Temporality Throughout the study Prior to step 3 Prior to step 1
 Justification Pragmatic justification – meeting frequency should be feasible and acceptable to study participants Pragmatic justification - peer-to-peer learning can be effective where there is no empirical evidence is limited Pragmatic justification - understanding context can inform facilitation efforts
 Action target Clinic champion knowledge and self-efficacy Clinic champion has increased knowledge of the role of community health worker Practice coach has increased knowledge about clinic context prior providing implementation support
 Outcome Improved implementation through increased knowledge Clinic champion is prepared to work within the clinic to develop an appropriate staffing plan Practice coach feels more prepared to provide implementation support appropriate for clinic context
 Enacted Yes Yes Yes
Notes