Adaptation of evidence-informed complex population health interventions for implementation and/or re-evaluation in new contexts: New guidance

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Complex population-health interventions that are effective in one context may not be effective in a different context, and may even be harmful. This is largely because intervention components work differently across different contexts. As such, an intervention may require adaptation to ensure it fits with a new setting. Further evaluation may be necessary to establish if intervention effects can be replicated. To date there is no guidance to support researchers to adapt and evaluate interventions in new contexts. There is no criteria to support research funders or peer reviewers in deciding upon the appropriateness of proposed or reported adaptations or evaluation. Further, there is limited instruction for policy-makers and practitioners to decide if evidence-informed interventions are appropriate to their context, or if adaptation and further evaluation is needed. This study will provide guidance to these communities to support the adaptation, implementation and/or re-evaluation of complex population health interventions in new contexts. It is important to provide guidance to ensure that interventions are adapted and evaluated using the most appropriate methods. This would minimise public spending on interventions that are not likely to be effective in new contexts due to unsuitable adaptations. It will also reduce the funding of large scale evaluations of interventions in new contexts, where uncertainty about their likelihood of working is insufficient to warrant their expense. We will review existing guidance and examples where complex population-health interventions have been adapted to new contexts. This will help us to understand current practice and to explore how adaptations are made and justified. It will also improve understanding of how guidance is used and how intervention successes or failures are explained in relation to its fit with the new context. We will also conduct interviews with researchers, representatives of international level research funders, peer reviewers, policy makers and practitioners. Participants will be identified from guidance and studies retrieved during the reviews. We will also involve contacts identified by the study's research team. Selected participants will have experience of commissioning, delivering or evaluating evidence-informed population health interventions that have been adapted or implemented in a new context. Interviews with researchers, policy-makers and practitioners will explore how decisions are made and justified around intervention adaptation, the procedures followed, and the use of guidance. Interviews with research funders and peer reviewers will focus on the appropriateness of proposed and reported adaptations and evaluation. We will subsequently complete a web-based Delphi process and consensus meeting to develop adaptation guidance. This will involve three rounds of surveys with experts to decide which recommendations should be included in the guidance and where further research may be required as there is insufficient consensus. Following the surveys we will draft the guidance. A meeting will then be held with experts to reach agreement on, and finalise, the guidance. Once completed, the guidance will be disseminated to researchers, research funders, peer reviewers, policy-makers and practitioners to maximise impact on the way in which intervention adaptations are funded, undertaken and reported.