Development of a method for Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI): a modified Delphi study.

BACKGROUND: Intervention adaptation is often necessary to improve the fit between evidence-based practices/programs and implementation contexts. Existing frameworks describe intervention adaptation processes but do not provide detailed steps for prospectively designing adaptations, are designed for researchers, and require substantial time and resources to complete. A pragmatic approach to guide implementers through developing and assessing adaptations in local contexts is needed. The goal of this project was to develop Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI), a method for intervention adaptation that leverages human centered design methods and is tailored to the needs of intervention implementers working in applied settings with limited time and resources. METHOD: MODIFI was iteratively developed via a mixed-methods modified Delphi process. Feedback was collected from 43 implementation research and practice experts. Two rounds of data collection gathered quantitative ratings of acceptability and inclusion (Round 1) and feasibility (Round 2), as well as qualitative feedback regarding MODIFI revisions analyzed using conventional content analysis. RESULTS: In Round 1, most participants rated all proposed components as essential but identified important avenues for revision which were incorporated into MODIFI prior to Round 2. Round 2 emphasized feasibility, where ratings were generally high and fewer substantive revisions were recommended. Round 2 changes largely surrounded operationalization of terms/processes and sequencing of content. Results include a detailed presentation of the final version of the three-step MODIFI method (Step 1: Learn about the users, local context, and intervention; Step 2: Adapt the intervention; Step 3: Evaluate the adaptation) along with a case example of its application. DISCUSSION: MODIFI is a pragmatic method that was developed to extend the contributions of other research-based adaptation theories, models, and frameworks while integrating methods that are tailored to the needs of intervention implementers. Guiding teams to tailor evidence-based interventions to their local context may extend for whom, where, and under what conditions an intervention can be effective.

Development of a method for Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI): A modified Delphi study.

Background: Intervention adaptation is often necessary to improve the fit between evidence-based practices/programs and implementation contexts. Existing frameworks describe intervention adaptation processes but do not provide detailed steps for prospectively designing adaptations, are designed for researchers, and require substantial time and resources to complete. A pragmatic approach to guide implementers through developing and assessing adaptations in local contexts is needed. The goal of this project was to develop Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI), a method for intervention adaptation that leverages human centered design methods and is tailored to the needs of intervention implementers working in applied settings with limited time and resources. Method: MODIFI was iteratively developed via a mixed-methods modified Delphi process. Feedback was collected from 43 implementation research and practice experts. Two rounds of data collection gathered quantitative ratings of acceptability (Round 1) and feasibility (Round 2), as well as qualitative feedback regarding MODIFI revisions analyzed using conventional content analysis. Results: In Round 1, most participants rated all proposed components as essential but identified important avenues for revision which were incorporated into MODIFI prior to Round 2. Round 2 emphasized feasibility, where ratings were generally high and fewer substantive revisions were recommended. Round 2 changes largely surrounded operationalization of terms/processes and sequencing of content. Results include a detailed presentation of the final version of the three-step MODIFI method (Step 1: Learn about the users, local context, and intervention; Step 2: Adapt the intervention; Step 3: Evaluate the adaptation) along with a case example of its application. Discussion: MODIFI is a pragmatic method that was developed to extend the contributions of other research-based adaptation theories, models, and frameworks while integrating methods that are tailored to the needs of intervention implementers. Guiding teams to tailor evidence-based interventions to their local context may extend for whom, where, and under what conditions an intervention can be effective.

The dual pandemics of COVID-19 and systemic racism: Navigating our path forward.

The Coronavirus disease 2019 (COVID-19) disrupted the way of life for humans all around the world. As the consequences continue to be revealed, it has been abundantly clear that the pandemic has disproportionately impacted communities of color. The COVID-19 pandemic shined a magnifying glass on racially based structural inequities in a manner that was impossible to unsee or to look away. COVID-19 disrupted education norms-from forcing online classroom instruction models to hindering our reliance on standardized testing. Education is already rife with evidence of systemic racism as its foundation. Disproportionality in special education, disproportionate punitive discipline, underrepresentation in highly capable learning problems are well established structures that maintain systemic racism in education (Diamond, 2018). As systemic racism is embedded in all of our social and environmental contexts, it is easy to conclude that systemic racism and COVID-19 are not just coexisting, they are interacting to exacerbate negative outcomes for communities of color. This commentary addresses the disproportionate impact of the dual pandemics: COVID-19 and systemic racism. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Near Miss Reporting.

Imaging is no stranger to patient safety events. There was a tremendous opportunity at WakeMed in North Carolina to change the safety culture of the imag- ing services department and provide staff with a system that rewarded them for identifying safety risks. Most staff could articulate the difference between a near miss and an actual event, but very few staff knew how to report a near miss. Staff who did know how to report a near miss believed the online process was too lengthy. Staff also reported a fear of punitive action associated with reporting events. Imaging services leadership successfully developed and implemented a "Good Catch" program. One of the most important objectives of the program was to remove the negative stigma associated with near miss reporting.

Ethnic and Gender Variation in Religious Involvement: Patterns of Expression in Young Adulthood.

This study used latent class analysis to empirically derive profiles of religious involvement among a sample of 808 young adults and describe ethnic and gender differences within such religious involvement patterns. Items on the Duke Religion Index were included as part of a larger longitudinal survey of emotional, physical, and behavioral health. The scale measured the organizational, nonorganizational, and intrinsic dimensions of religiosity (Koenig et al. 2001) in a sample of young adults at two waves of the study-age 27 and age 30. At age 27, five religious profiles were distinguishable in the sample while at age 30 six profiles emerged. Ethnic differences were found for each of the religious profiles where religious involvement manifested in different ways. Religious profiles between ages 27 and 30 changed over time and were affected by gender and ethnicity.