Towards a comprehensive model for understanding adaptations' impact: the model for adaptation design and impact (MADI)
Towards a comprehensive model for understanding adaptations' impact: the model for adaptation design and impact (MADI)
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DOI：
10.1186/s13012-020-01021-y
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发表时间：
2020-07-20
影响因子：
7.2
通讯作者：
Birken, Sarah A.
中科院分区：
文献类型：
--
作者：
Kirk, M. Alexis;Moore, Julia E.;Birken, Sarah A.
背景：实施科学正在从将适应定性为好或坏转向理解适应及其影响。现有的适应分类框架主要是描述性的（例如，谁做的调整），并面向研究人员。它们并不能帮助从业者围绕适应做出决策（例如，适应是否可能产生负面影响？是否应该继续？）。此外，他们缺乏考虑适应的“涟漪效应”的结构（即，对结果的预期和非预期影响，认识到旨在对一种结果产生积极影响的适应可能对其他结果产生非预期影响）。最后，他们没有具体说明适应和结果之间的关系，包括调解和调节关系。我们的研究的目的是促进系统评估的预期和非预期的影响，适应利用现有的框架，建立一个模型，提出constructs.Materials和方法之间的关系：我们审查，巩固和完善的结构，从两个适应框架和一个干预实施结果框架。使用巩固和完善的结构，我们编码的14个适应现有的证据为基础的干预措施的定性描述，14个适应设计在以前的研究中的利益相关者小组使用修改后的德尔菲法。14个改编中的每一个都有详细的描述，包括改编的性质，谁做的，以及它的目标和原因。使用编码数据，我们将现有框架的结构安排到一个模型中，即适应设计和影响模型（MADI），该模型确定了适应特征，其预期和非预期影响（即，涟漪效应），以及适应对结果影响的潜在中介者和调节者。我们还开发了一个决策辅助工具和网站（MADIguide.org），以帮助实施科学家在他们的工作中应用MADI。结果和结论：我们的模型和相关决策辅助工具建立在现有框架的基础上，全面描述适应性，提出适应性如何影响结果，并为设计适应性提供实用指导。MADI鼓励研究人员思考适应的潜在因果途径（例如，调解人和主持人）和适应措施对结果的预期和非预期影响。MADI鼓励实践者以预期预期和非预期影响的方式设计适应措施，并利用研究中的最佳做法。
Background: Implementation science is shifting from qualifying adaptations as good or bad towards understanding adaptations and their impact. Existing adaptation classification frameworks are largely descriptive (e.g., who made the adaptation) and geared towards researchers. They do not help practitioners in decision-making around adaptations (e.g., is an adaptation likely to have negative impacts? Should it be pursued?). Moreover, they lack constructs to consider "ripple effects" of adaptations (i.e., both intended and unintended impacts on outcomes, recognizing that an adaptation designed to have a positive impact on one outcome may have unintended impacts on other outcomes). Finally, they do not specify relationships between adaptations and outcomes, including mediating and moderating relationships. The objective of our research was to promote systematic assessment of intended and unintended impacts of adaptations by using existing frameworks to create a model that proposes relationships among constructs.Materials and methods: We reviewed, consolidated, and refined constructs from two adaptation frameworks and one intervention-implementation outcome framework. Using the consolidated and refined constructs, we coded qualitative descriptions of 14 adaptations made to an existing evidence-based intervention; the 14 adaptations were designed in prior research by a stakeholder panel using a modified Delphi approach. Each of the 14 adaptations had detailed descriptions, including the nature of the adaptation, who made it, and its goal and reason. Using coded data, we arranged constructs from existing frameworks into a model, the Model for Adaptation Design and Impact (MADI), that identifies adaptation characteristics, their intended and unintended impacts (i.e., ripple effects), and potential mediators and moderators of adaptations' impact on outcomes. We also developed a decision aid and website (MADIguide.org) to help implementation scientists apply MADI in their work.Results and conclusions: Our model and associated decision aids build on existing frameworks by comprehensively characterizing adaptations, proposing how adaptations impact outcomes, and offering practical guidance for designing adaptations. MADI encourages researchers to think about potential causal pathways of adaptations (e.g., mediators and moderators) and adaptations' intended and unintended impacts on outcomes. MADI encourages practitioners to design adaptations in a way that anticipates intended and unintended impacts and leverages best practice from research.