Note: This construct captures the inherent adaptability of the innovation, not the need to adapt nor the process of adapting the innovation.
Adaptability relies on a definition of the core components (elements that cannot be changed) versus the adaptable periphery (elements that can be changed) of the innovation itself (T. Greenhalgh, Robert, et al. 2004; Fixsen 2007). A component analysis can be performed to identify the core components versus adaptable periphery (Carroll et al. 2007), but often the distinction is one that can only be discerned through trial and error as the innovation is disseminated more widely and adapted for a variety of contexts (Mendel et al. 2008). The tension between the need to achieve full and consistent implementation across multiple contexts while providing flexibility to adapt the innovation as needed is real and must be balanced, which is no small challenge (Perrin et al. 2006; von Thiele Schwarz, Aarons, and Hasson 2019).
The original CFIR (Laura J. Damschroder et al. 2009) elaborated on this construct, stating that information about the hard core and soft periphery can be used to assess “fidelity” as an implementation outcome (Denis et al. 2002). The hard core may be defined by a research protocol or “black-box” packaging, while the soft periphery consists of factors that vary from setting to setting. For example, a computerized report system may have set core components that users cannot change but these core components might be accessed from different launch points, depending on workflows of local settings. Greenhalgh et al. describe aspects of adaptability under “fuzzy boundaries” and “potential for reinvention” (T. Greenhalgh, Robert, et al. 2004 p 596-597). An innovation that can be easily modified to adapt to the setting is positively associated with implementation (D. H. Gustafson et al. 2003; J. Leeman, Baernholdt, and Sandelowski 2007; E. Rogers 2003).