In many cases, implementation approaches (composed of one or more strategies) may need to change over time to work optimally. We use a literature review to inform a mechanistic analysis of such on-the-go adaptations. We suggest that such adaptations of implementation strategies consist of three necessary steps. The first component is the initial effect of the implementation approach on intended implementation, service delivery, or clinical outcomes. Second, these initial effects must in turn be used to modify, alter, intensify, or otherwise change the implementation approach. Third, the modified approach itself has effects. Conceiving of adaptation as all three steps implies that a full understanding of adaptation involves ( a) a sense of initial effects, ( b) conceptualizing and documenting content and rationale for changes in approach (e.g., alteration, intensification), and ( c) the effects of the changed approach (including how the latter effects depend on initial effects). Conceptualizing these steps can help researchers ask questions about adaptation (e.g., thresholds for change, dosing, potentiation, sequencing) to advance our understanding of implementation strategies.

中文翻译：

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卫生领域实施方法和策略的动态调整：新兴观点和研究机会

在许多情况下，实施方法（由一种或多种策略组成）可能需要随着时间的推移而改变才能发挥最佳作用。我们通过文献综述来对这种动态适应进行机械分析。我们建议实施战略的此类调整包括三个必要步骤。第一个组成部分是实施方法对预期实施、服务交付或临床结果的初步影响。其次，这些初始效果必须反过来用于修改、改变、强化或以其他方式改变实施方法。第三，修改后的做法本身就有效果。将适应视为所有三个步骤意味着对适应的充分理解涉及（a）初始效果的感觉，（b）概念化和记录方法变化的内容和理由（例如，改变，强化），以及（c）改变方法的效果（包括后者的效果如何取决于初始效果）。概念化这些步骤可以帮助研究人员提出有关适应的问题（例如，变化的阈值、剂量、增强、测序），以增进我们对实施策略的理解。