Table 1 Description of steps in ADAPT-ITTa framework for adaptation of BETTERb from primary care to a public health context
Step in ADAPT-ITT | Application to BETTER HEALTH | Adaptations |
|---|---|---|
Assessment | Initial assessment by the study team based on expertise and using the results of an existing structured literature review: - reviewed the BETTER participant recruitment strategies - reviewed the baseline survey content and delivery method - reviewed Prevention Practitioner (PP) visit & toolkit vis a vis the study population | Irrelevant questions removed from baseline survey Survey further adapted to include items about living in poverty, food insecurity, and social support Baseline survey administered in person by research assistant Public health nurses designated as PPs PP toolkit revised: - included community resources for social services support e.g. for income and food insecurity - minor revisions to Prevention Prescription (a take-home document for participants written by PPs summarizing reminders and referrals for CDPS activities), including asking about social determinants of health Changed visit location from physicians’ offices to a place preferred by community residents and PPs e.g. local libraries and residents’ homes if they chose |
Decision | Decision by research team to proceed to administration step based upon review of initial adaptation | |
Administration | Interviews and focus groups with target population to understand barriers and facilitators to disease prevention and lifestyle modification and explore elements for adaptation to BETTER HEALTH | Qualitative results from community residents: Supported public health nurse as PPs who were viewed as knowledgeable and able to provide information and linkages to community services and/or primary care Reinforced changes to PP toolkit i.e., include community resources for social services (e.g., income support) and other resources (e.g., shelters, community kitchens, mental health supports) –and help with referrals (if desired by participant) PP visits to be confidential and 1:1 Location of visit: space mutually agreed upon by resident and PP |
Production | Production of a further refined version | N/A |
Topical experts | Study team; key stakeholders in Durham Region, Ontario; public health Prevention Practitioners, and community residents living in low income neighbourhoods (CAC), further refined the recruitment strategies for the trial | Incorporated study displays at local community events Retained intervention components that had been adapted by the research team |
Integration | A final adapted version that integrates all findings | Adapted intervention was used in the trial |
Training | Training of current PPs on adapted BETTER HEALTH | N/A |
Testing | Qualitative evaluation by community residents post visit; quantitative testing in cluster randomized controlled trial | Due to time constraints, we did not pilot test the adapted intervention |