Intervention Content and Delivery Adaptations across the Replicating Effective Programs Phases
| Intervention Content and Delivery Adaptations | Replicating Effective Programs Phases | ||
|---|---|---|---|
| Preconditions Phase | |||
| Selection of intervention content | Stakeholder input prioritizes mental and physical health content | Selected TTIM curriculum based on inclusion of diabetes self-management and mental health focus | |
| Specification of core elements for delivery of SMAs | Stakeholder input prioritizes patients selecting topics, peer mentors, and involvement of behavioral health professionals | Selected TTIM based on inclusion of peer educators | |
| Pre-implementation Phase | |||
| Content adaptations: reordering elements and adjusting timing | Repackaged and reordered content into 6 2-hour modules (vs original 12, 1-hour modules) | Divided content and training material for standardized versus patient-driven SMA conditions. | Adjusted timing to fit experience of interventionists |
| In patient-driven condition, provided instructions for reordering content to fit cohort-specific preferences | In standardized condition, manual provides instructions on duration of each topic; patient-driven manual provides suggested time only | ||
| Content adaptations: removing elements | Removed ongoing TTIM illness management phase | Changed TTIM manual language to focus more on a primary care population rather than SMI population | Less focus on serious mental illness, with now-optional mental health elements |
| Content adaptations: adding and substituting elements | General stress and coping module substituted for primary care population in lieu of Diabetes and Serious Mental Illness module | PROs and instructions for addressing PROs as part of tailoring content to patients added | Translation of TTIM instructor's manual and patient handbook to Spanish |
| Emphasized medical management of diabetes | Updated stress management tips with infographic from the American Heart Association “Fight Stress with Healthy Habits” | ||
| Added 1:1 visits with prescribing provider for medical management | In patient-driven condition, behavioral health provider and peer mentor instructions added | Up-to-date diabetes management, nutrition, and physical activity content substituted | |
| Delivery adaptations: personnel | Delivered by practice staff: health educators, behavioral health providers, peer mentors (differs by condition) | Added PharmD as eligible for prescribing provider | |
| Implementation Phase | |||
| Content adaptations: packaging and visual appeal | Use of icons and text formatting to guide reader through use of the instructor's manual | Professional graphic design for visuals for patient handbook and PowerPoint slides | Developed two versions of instructor manual based on study condition (standardized vs patient-driven SMA) |
| Practice facilitation adaptations | Expanded beyond initial 5 planned sessions to meet practices' needs for additional support | Developed system to prioritized practice facilitation outreach based on practice implementation progress | |
| Training adaptations | Offered remote and multiday trainings in addition to full-day in person trainings | Incorporated role play into trainings | Group facilitation instructions added |
PRO, patient-reported outcomes; SMA, shared medical appointments; TTIM, targeted training in illness management; SMI, serious mental illness.