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Table 3 Health system guideline/recommendation adaptation strategies (FRAME)

From: Strategies to adapt and implement health system guidelines and recommendations: a scoping review

Author Adaptation strategies Justification When the modification occurred; was adaptation planned Who participated in the decision to modify What was modified; content of modification Level of delivery
Andrade et al. (2017) [75] Attention to chronic conditions model (ACCM) Lack of resources Not reported; planned proactive Steps were conditioned for the ability of health professionals to understand the seven macro processes and their engagement based on available resources The seven steps of the ACCM (they cut three of the steps to adapt to this health system); removing/skipping elements Health professionals are the primary and secondary level of care
Armstrong et al. (2014) [90] Maternal and perinatal death reviews (MPDR) system implementation Adaptations based on challenges that were identified through a case review including lack of training These are suggested solutions to challenges that were identified—may or may not have been put into practice; reactive Determined these during an MPDR meeting Training and evaluation—providing skills and education to maternity staff and women in the community, respectively; adding elements—training and education Community (women) and clinic/unit level (maternity staff at hospital/reproductive and child health coordinator)
Bryce et al. (2005) [58] IMCI generic guidelines can be adapted by any country or area to reflect their specific epidemiological profile and health system characteristics
WHO worked to develop guidelines for the country adaptation process, including evidence for intervention choices, models for how to incorporate additional diseases and conditions into the training materials, and how to conduct local studies to identify terminology and local foods
Cadres of “IMCI adaptation consultants” were trained at regional and global levels
Review of the guideline expectations Pre-implementation and early implementation; proactive Countries that implement this programme adapt it to fit their local context Contextual—setting; tailoring to their local context Target intervention group
Carneiro et al. (2018) [100] The more physicians in Brazil programme (MPBP) has resulted in changes in the work processes of the Family Health Strategy (FHS), including changes to the management and control models used in the region Municipalities experienced strong ascending trends in the number of prenatal consultations and lack of access to resources Implementation; reactive Ministry of Health (MoH) Contextual—how treatment is delivered; tailoring/tweaking/refining—reorganization of the prenatal care Target intervention group
Gueye et al. (2016) [108] Strategies were adapted to implement management of malaria programme
Introducing new or adapting strategies, from insecticide rotation to lessen the risk of insecticide resistance, to an increase in parasitological screening in development areas to curtail the risk of transmission, to collaborations with the private sector
None reported Early implementation; reactive Staff Contextual; tailoring to local context Organization
Halpern et al. (2010) [77] Adaptation of a standardized HIV patient monitoring system (PMS)
WHO provided training on the HIV care and antiretroviral treatment (ART) PMS, and the technical working group adapted each component for Guyana
System tools and functions were modified based on feedback from the training session participants, and a pilot PMS was subsequently implemented at one site
None reported Pre-implementation; planned/proactive Technical working group Contextual—patient chart data elements and functionality to PMS system; tailoring/tweaking, adding elements to patient chart Clinic-unit level—HIV care ART
Kihembo et al. (2018) [57] Implement nationwide ISDR training to health facilities based on the revised guidelines developed
Post-training support through integrated supervision
Two challenges from the first implementation:
Lack of funding resulted in a lack of resources and capacities at the operational level
A need for a harmonized outbreak response and information flow at the district level
Pre-implementation; planned Ministry of health along with key partners Aimed to enhance the capacity of districts to promptly detect, access and effectively respond to public health emergencies; adding elements—training Health workforce all the way up to the operational national level
Leethongdee (2007) [83] Government decided to fund the scheme by pooling the Ministry of Public Health (MoPH) budgets for public hospitals, other health facilities, and Medical Welfare Scheme (MWS) and voluntary health card scheme and providing additional money The initial plan met resistance from quarters such as the civil service and the labour unions Pre-implementation; reactive Civil service and labour unions rejected the initial plan, government then had to reassess Implementation and scale-up activities; substituting the funding structures Target intervention group
Mutabazi et al. (2020) [87] Over the years, the prevention of mother-to-child transmission of HIV/AIDS (PMTCT) guidelines have been adapted, but no strategies reported None reported None reported None reported None reported None reported
Ryan et al. (2020) [109] Comprehensive community mental health programme (CCMHP)
A scale-up initiative for the general mental health policy implementation in Nigeria through public–private partnership in healthcare delivery
Absence of more clinical resources Scale-up; reactive None reported Phone psychiatrists as needed; adding element Community psychiatric nurses (CPNs) and community health extension worker (CHEWs)
Schneider and Nxumalo (2017) [97] Re-engineering of primary healthcare (PHC) To meet the needs and demands of each community health programme Not reported; planned proactive District managers, senior provincial managers, PHC facility managers, outreach team leaders, senior district official, subdistrict managers, PHC facility supervisors, professional nurses, environmental health officers Health posts vs PHC re-engineering
Roles of nongovernmental organizations were redefined
Change in the method of payment of CHW
New curricula and training processes; tailoring leadership and governance changes
Healthcare workers—specifically community-based workers
Stein et al. (2008) [106] Incorporating counselling skills into the Practical Approach to Lung Health in South Africa (PALSA) PLUS model
Ongoing onsite training provides emotional support
Given the limiting understanding of nurse counselling skills (i.e. they often threatened patients instead of making recommendation), nurses conceive counselling as “advice” that must be complied with rather than the patient feeling empowerment in decision-making During the implementation of the PALSA PLUS programme and this evaluation; reactive Not reported Ongoing site training and counselling; adding elements—incorporation of a prayer into nurse-training sessions, as a means of accessing spiritual reserves for emotional support Primary healthcare nurses
Wingfield et al. (2015) [113] Innovative socioeconomic intervention against TB (ISIAT) strategy was evaluated under the community randomized evaluation of a socioeconomic intervention to prevent TB (CRESIPT) project
Regular steering meetings, focus group discussions and contact in the health posts
Increase adherence and participation in the programme Pre-implementation and implementation; proactive Stakeholders + recipients Contextual—increased the speed of bank transfers; substituting the funding structures Target intervention group
Zakumumpa et al. [85] ART scale-up
Nonphysician cadre were prescribing antiretroviral therapy
The shortage of physician-level cadre was identified as a constraint Scale-up; reactive Individual practitioners Implementation and scale-up activities; tweaking—nonphysician cadre were prescribing ART due to rapidly expanding patient volumes Clinic/unit level, individual practitioner