PDF(Pubmed)
Abstract：
BACKGROUND: A key question in implementation science is how to balance adaptation and fidelity in translating interventions to new settings. There is growing consensus regarding the importance of planned adaptations to deliver interventions in contextually sensitive ways. However, less research has examined ad-hoc adaptations, or those that occur spontaneously in the course of intervention delivery. A key question is whether ad-hoc adaptations ultimately contribute to or detract from intervention goals. This study aimed to (a) identify ad-hoc adaptations made during delivery of a family therapy intervention and (b) assess whether they promoted or interrupted intervention goals.
METHODS: Tuko Pamoja (Swahili: \"We are Together\") is an evidence-informed family therapy intervention aiming to improve family dynamics and mental health in Kenya. Tuko Pamoja employs a task-shifting model, delivered by lay counselors who are afforded a degree of flexibility in presenting content and in practices they use in sessions. We used transcripts of therapy sessions with 14 families to examine ad-hoc adaptations used by counselors. We first identified and characterized ad-hoc adaptations through a team-based code development, coding, and code description process. Then, we evaluated to what extent ad-hoc adaptations promoted the principles and strategies of the intervention (\"TP-promoting\"), disrupted them (\"TP-interrupting\"), or neither (\"TP-neutral\"). To do this, we first established inter-coder agreement on application of these categories with verification by the intervention developer. Then, coders categorized ad-hoc adaptation text segments as TP-promoting, TP-interrupting, or TP-neutral.
RESULTS: Ad-hoc adaptations were frequent and included (in decreasing order): incorporation of religious content, exemplars/role models, community dynamics and resources, self-disclosure, and metaphors/proverbs. Ad-hoc adaptations were largely TP-promoting (49%) or neutral (39%), but practices were TP-interrupting 12% of the time. TP-interrupting practices most often occurred within religious content and exemplars/role models, which were also the most common practices overall.
CONCLUSIONS: Extra attention is needed during planned adaptation, training, and supervision to promote intervention-aligned use of common ad-hoc adaptation practices. Discussing them in trainings can provide guidance for lay providers on how best to incorporate ad-hoc adaptations during delivery. Future research should evaluate whether well-aligned ad-hoc adaptations improve therapeutic outcomes.
BACKGROUND: Pilot trial registered at clinicaltrials.gov (C0058).
METHODS: Tuko Pamoja (Swahili: \"We are Together\") is an evidence-informed family therapy intervention aiming to improve family dynamics and mental health in Kenya. Tuko Pamoja employs a task-shifting model, delivered by lay counselors who are afforded a degree of flexibility in presenting content and in practices they use in sessions. We used transcripts of therapy sessions with 14 families to examine ad-hoc adaptations used by counselors. We first identified and characterized ad-hoc adaptations through a team-based code development, coding, and code description process. Then, we evaluated to what extent ad-hoc adaptations promoted the principles and strategies of the intervention (\"TP-promoting\"), disrupted them (\"TP-interrupting\"), or neither (\"TP-neutral\"). To do this, we first established inter-coder agreement on application of these categories with verification by the intervention developer. Then, coders categorized ad-hoc adaptation text segments as TP-promoting, TP-interrupting, or TP-neutral.
RESULTS: Ad-hoc adaptations were frequent and included (in decreasing order): incorporation of religious content, exemplars/role models, community dynamics and resources, self-disclosure, and metaphors/proverbs. Ad-hoc adaptations were largely TP-promoting (49%) or neutral (39%), but practices were TP-interrupting 12% of the time. TP-interrupting practices most often occurred within religious content and exemplars/role models, which were also the most common practices overall.
CONCLUSIONS: Extra attention is needed during planned adaptation, training, and supervision to promote intervention-aligned use of common ad-hoc adaptation practices. Discussing them in trainings can provide guidance for lay providers on how best to incorporate ad-hoc adaptations during delivery. Future research should evaluate whether well-aligned ad-hoc adaptations improve therapeutic outcomes.
BACKGROUND: Pilot trial registered at clinicaltrials.gov (C0058).
摘要：
背景：实施科学中的一个关键问题是如何在将干预措施转化为新环境时平衡适应性和保真度。越来越多的共识是，有计划的适应措施对于以上下文敏感的方式提供干预措施的重要性。然而,研究临时适应的研究较少，或在干预交付过程中自发发生的那些。一个关键问题是临时适应最终是否有助于或减损干预目标。这项研究旨在（a）确定在实施家庭治疗干预措施期间进行的临时适应措施，以及（b）评估它们是否促进或中断了干预目标。
方法：TukoPamoja（斯瓦希里语：“我们在一起”）是一种基于证据的家庭治疗干预措施，旨在改善肯尼亚的家庭动态和心理健康。TukoPamoja采用了任务转移模型，由外行辅导员提供，他们在会议中使用的内容和实践中具有一定程度的灵活性。我们使用了14个家庭的治疗记录来检查辅导员使用的临时适应。我们首先通过基于团队的代码开发来识别和描述临时适应，编码,和代码描述过程。然后，我们评估了临时适应在多大程度上促进了干预的原则和策略(“TP促进”)，中断了它们(“TP中断”)，或两者都不（“TP中性”）。要做到这一点，我们首先就这些类别的应用建立了编码间协议，并由干预开发者进行验证。然后，编码员将临时适应文本段归类为TP推广，TP中断,或TP中性。
结果：临时改编是频繁的，并且包括（按降序）：宗教内容的整合，范例/榜样，社区动态和资源，自我披露,和隐喻/谚语。临时适应主要是TP促进（49％）或中性（39％），但实践是TP中断12%的时间。TP中断实践最常发生在宗教内容和榜样/榜样中，这也是最常见的做法。
结论：在计划适应期间需要额外的关注，培训,和监督，以促进对共同的临时适应做法的干预协调使用。在培训中讨论它们可以为非专业提供者提供有关如何在交付过程中最好地纳入临时适应的指导。未来的研究应该评估是否协调一致的临时适应改善治疗结果。
背景：在clinicaltrials.gov（C0058）注册的试点试验。
方法：TukoPamoja（斯瓦希里语：“我们在一起”）是一种基于证据的家庭治疗干预措施，旨在改善肯尼亚的家庭动态和心理健康。TukoPamoja采用了任务转移模型，由外行辅导员提供，他们在会议中使用的内容和实践中具有一定程度的灵活性。我们使用了14个家庭的治疗记录来检查辅导员使用的临时适应。我们首先通过基于团队的代码开发来识别和描述临时适应，编码,和代码描述过程。然后，我们评估了临时适应在多大程度上促进了干预的原则和策略(“TP促进”)，中断了它们(“TP中断”)，或两者都不（“TP中性”）。要做到这一点，我们首先就这些类别的应用建立了编码间协议，并由干预开发者进行验证。然后，编码员将临时适应文本段归类为TP推广，TP中断,或TP中性。
结果：临时改编是频繁的，并且包括（按降序）：宗教内容的整合，范例/榜样，社区动态和资源，自我披露,和隐喻/谚语。临时适应主要是TP促进（49％）或中性（39％），但实践是TP中断12%的时间。TP中断实践最常发生在宗教内容和榜样/榜样中，这也是最常见的做法。
结论：在计划适应期间需要额外的关注，培训,和监督，以促进对共同的临时适应做法的干预协调使用。在培训中讨论它们可以为非专业提供者提供有关如何在交付过程中最好地纳入临时适应的指导。未来的研究应该评估是否协调一致的临时适应改善治疗结果。
背景：在clinicaltrials.gov（C0058）注册的试点试验。
