Section 3.3: Adapting Knowledge to a Local Context

[ Table of Contents ]

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


  1. Establish an Organizing Committee and working panel, resource team
  2. Select a topic using criteria
  3. Check if adaptation is feasible
  4. Identify necessary resources and skills
  5. 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
  6. Write the adaptation plan

Phase II: Adaptation

Scope and Purpose Module

  1. Determine/clarify health questions using PIPOH

Search and Screen Module

  1. Search for Guidelines and other relevant documentation
  2. Screen retrieved guidelines – record characteristics/content
  3. Reduce a large number of retrieved guidelines using AGREE instrument

Assessment Module

  1. Assess guideline quality
  2. Assess guideline currency
  3. Assess guideline content
  4. Assess guideline consistency
  5. Assess acceptability and applicability of recommendations

Decision and Selection Module

  1. Review Assessments
  2. Select between guidelines and recommendations to create an adapted guideline

Customization Module

  1. Prepare draft adapted guideline

Phase III: Finalization

External Review and Acknowledgement Module

  1. External Review – target audience of the guideline
  2. Consult with endorsement bodies
  3. Consult with source guideline developers
  4. Acknowledge source documents

Aftercare Planning Module

  1. Plan for aftercare of the adapted guideline

Final Production Module

  1. 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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