Documenting adaptations across the Accelerating Colorectal Cancer Screening and follow-up through Implementation Science research programs: methods and adaptation examples.

Introduction: Adaptations are common, expected, and often imperative for successful uptake and sustained implementation of clinical or public health programs in real-world practice settings. Understanding which adaptations have been made to evidence-based interventions and subsequent implementation strategies throughout the life cycle of a project can contextualize findings and support future scale-up of the program. Systematic documentation of adaptations is rarely conducted or reported, and little guidance exists on approaches to documenting adaptations. Methods: Accelerating Colorectal Cancer Screening and follow-up through Implementation Science (ACCSIS) is a National Cancer Institute-funded Beau Biden Cancer Moonshot Results: ACCSIS programs varied substantially in how they defined and documented adaptations. Nine approaches were used to document adaptations; the most common were periodic reflections and review of meeting minutes and agendas. Nine analytic methods were reported to guide adaptation analysis; the most frequently mentioned were rapid qualitative methods, descriptive statistics, and mixed-methods analysis. A total of 96 adaptations were reported by the eight research programs, most of which occurred during the pre-implementation stage (68%) or were made to the program format (71%). Only 36% of the adaptations were due to the COVID-19 pandemic. Conclusions: Our multi-method, systematic approach allowed us to explore how sites document and analyze adaptations across eight ACCSIS Moonshot programs. Using a systematic approach allowed for comparisons of intervention and strategy adaptations within and across research programs and can inform the science of adaptations, while building a knowledge base of why such adaptations are needed and how they can inform implementation efforts across time. Methods described herein provide a template for similar assessment activities in other large, multi-site research initiatives.