Adaptability

Adaptability relies on a definition of the ‘core components’ (the essential and indispensable elements of the intervention itself) versus the ‘adaptable periphery’ (adaptable elements, structures, and systems related to the intervention and organization into which it is being implemented) of the intervention [1][2]. A component analysis can be performed to identify the core versus adaptable periphery components [3], but often the distinction is one that can only be discerned through trial and error over time as the intervention is disseminated more widely and adapted for a variety of contexts [4]. The tension between the need to achieve full and consistent implementation across multiple contexts while providing the flexibility for local sites to adapt the intervention as needed is real and must be balanced, which is no small challenge [5].

Information about the core components and adaptable periphery can be used to assess “fidelity” [6]. The core components may be defined by a research protocol or “black-box” packaging while the adaptable periphery may consist of factors that vary from site to site. For example, a computerized report system has a fundamental core that users cannot change but it might be accessed from different launch points, depending on workflows of individual organizations. Greenhalgh, et al describe aspects of adaptability under “fuzzy boundaries” and “potential for reinvention” [1, page 596-597]. An intervention that can be easily modified to adapt to the setting is positively associated with implementation [7][8][9].