Section 3.3: Adapting Knowledge to a Local Context
Margaret Harrison
Ian D. Graham
Beatrice Fevers
Why Should We Adapt Practice Guidelines for Local Use?
- Often there are many quality guidelines on the same topic, little need for a brand new guideline
- Reduces duplication of effort and optimizes use of existing resources
- Encourages consideration of implementation and 'fit' with the local context – enhances applicability
- Typically engages end-users thus helping uptake
How Do We Adapt Practice Guidelines for Local Use?
- Using a transparent, rigorous and replicable process
- Involves an explicit, participatory process involving relevant decision makers including clinicians, managers, researchers, and policy makers
- Preserving the integrity of the evidence-based recommendations
What is the ADAPTE Process?
- The ADAPTE process consists of three main phases:
- planning and set-up
- adaptation, and
- development of a final product
- 9 modules
- 24 Steps
Phase I: Set-Up
Preparation Module
Steps
- Establish an Organizing Committee and working panel, resource team
- Select a topic using criteria
- Check if adaptation is feasible
- Identify necessary resources and skills
- Complete tasks for set-up phase inc. terms of reference, declaration of conflicts of interest, consensus process, endorsement bodies, guideline authorship, dissemination and implementation strategies
- Write the adaptation plan
Phase II: Adaptation
Scope and Purpose Module
- Determine/clarify health questions using PIPOH
Search and Screen Module
- Search for Guidelines and other relevant documentation
- Screen retrieved guidelines – record characteristics/content
- Reduce a large number of retrieved guidelines using AGREE instrument
Assessment Module
- Assess guideline quality
- Assess guideline currency
- Assess guideline content
- Assess guideline consistency
- Assess acceptability and applicability of recommendations
Decision and Selection Module
- Review Assessments
- Select between guidelines and recommendations to create an adapted guideline
Customization Module
- Prepare draft adapted guideline
Phase III: Finalization
External Review and Acknowledgement Module
- External Review – target audience of the guideline
- Consult with endorsement bodies
- Consult with source guideline developers
- Acknowledge source documents
Aftercare Planning Module
- Plan for aftercare of the adapted guideline
Final Production Module
- Produce final guideline document
Future Research
- Evaluation (effectiveness, efficiency) of the ADAPTE methodology by both guideline developers and those undertaking adaptation as 1st step in implementation
- Development of tools to capitalize on implementation planning activity during guideline adaptation
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