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Madrigal C, Mills WL, Keleher VC, Pimentel CB, Hartmann CW, Snow AL, Camp C, Hilgeman MM. A Spotlight on Adaptation: Pre-Implementation of Montessori-Based Activity Programming in Long-Term Care Using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME). The Gerontologist. 2022 Aug 24.
BACKGROUND AND OBJECTIVES: Effectively adapting evidence-based interventions for nursing home (NH) implementation is a critical, yet under-examined, component of improving care quality. Montessori-based activity programming (MAP) is an evidence-based intervention that promotes person-centered care, engages persons living with dementia, and mitigates distress behaviors. Currently, there is sparse evidence of MAP in Department of Veterans Affairs NHs (i.e., Community Living Centers, CLCs). CLCs differ significantly from community NHs and require adaptations to support MAP use and sustainability. This study uses the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to track changes made to MAP as an exemplar for clinicians and implementation scientists. This work fills a gap on adapting interventions through detailed examination of the adaptation process in NHs. RESEARCH DESIGN AND METHODS: Qualitative and quantitative data were collected across eight CLCs (e.g., advisory panel, staff interviews, training evaluations, field notes, fidelity assessments). We used an iterative, rapid content analytic approach to triangulate findings and identify needed adaptations for the CLC setting. RESULTS: Thirty-six adaptations were made. Most adaptions occurred during the pre-implementation phase, were reactive, focused on training/evaluation, and involved researchers, intervention developers, and practitioners. All were fidelity-consistent with MAP. The most common goal across adaptations was increased reach/engagement of the intervention. DISCUSSION AND IMPLICATIONS: CLCs and community NHs can use findings to support intervention adaptation, and adapt and implement MAP to improve meaningful engagement for persons living with dementia and other residents. Future research should further evaluate and standardize FRAME for diverse users of complex interventions.