Better Information for Generalizable Knowledge: Systematic Study of Local Adaptation

Promising and evidence-based models must often be adapted from the original programs in order to work well locally. Just as a cook needs to adapt a recipe for the constraints of the kitchen, so our efforts in health and health care have to be adapted to local barriers and opportunities. Many questions arise about how adaptation occurs and whether, in fact, the adaptation is still consistent with the model. And if the adaptation is consistent with the model, is it important, does it address a prevalent barrier, and is it therefore worth sharing? These questions arise in any effort to expand and scale high-quality models and practices. But evaluation as currently practiced is not a suitable tool to understand these questions, because of the focus on outcomes and accountability for funds expended. A new set of methods is proposed to help practitioners and developers to share what they are learning about how to implement a model in many different contexts. Examples are drawn from adult physical activity, childhood obesity prevention, healthcare quality improvement, and intimate partner violence prevention.