# Using end user feedback to specify an adaptive implementation strategy

## TL;DR

This study shows how feedback from users and partners can help create a flexible strategy for implementing a nutrition program in schools.

## Contribution

A practical method for identifying decision points and tailoring variables in adaptive implementation strategies using end-user feedback.

## Key findings

- Low-intensity support includes leadership commitments, local champions, and classroom reminders.
- Response to support is assessed in October, with struggling sites receiving more intensive help.
- Tailoring variables include classroom fidelity rates, with high-intensity support for sites below 60%.

## Abstract

Adaptive implementation strategies tailor support to setting needs rather than applying a uniform approach. These strategies improve efficiency and fit, yet practical guidance on identifying decision points and tailoring variables is limited. This study collected end-user and partner input to specify decision points and tailoring variables for an adaptive implementation strategy.

This study focused on the evidence-based nutrition program, Together, We Inspire Smart Eating (WISE). End users and implementation partners with prior experience in WISE were recruited in two states to participate in semi-structured interviews or focus groups designed to elicit feedback to specify an adaptive implementation strategy for WISE.

Qualitative input supported three crucial decisions for an adaptive implementation strategy: (1) low-intensity support, the starting point for all sites, will include leadership commitments, local champions, an implementation blueprint, classroom reminders, and task-focused facilitation at the site level; (2) assessment of response to low-intensity support will occur in October (Month 3) of the school year; and (3) sites not responding by Month 3 will receive holistic facilitation and tailored educational materials at the teacher level. Participants emphasized the universal need for facilitation at all sites, with struggling sites requiring more. They also identified tailoring variables: sites with fewer than 60% of classrooms achieving fidelity would require high-intensity support.

This study illustrates a process for using feedback from end users and partners to define key elements of an adaptive implementation strategy. Our approach holds significant potential to specify strategies for scaling health-related evidence.