• Bethany M Kwan, Jenny Rementer, Natalie Richie, Andrea L Nederveld, Phoutdavone Phimphasone-Brady, Martha Sajatovic, Donald E Nease, and Jeanette A Waxmonsky.
• From the Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora (BMK, JR, ALN, P P-B, DEN, JAW); Adult & Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO (BMK, DEN); Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, CO (NR); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora (NR, PP-B); College of Nursing, University of Colorado Anschutz Medical Campus, Aurora (NR); Case Western Reserve University School of Medicine, Departments of Psychiatry and of Neurology, Cleveland, OH (MS); New Directions Behavioral Healthcare LLC, Overland Park, KS (JAW). bethany.kwan@ucdenver.edu.
• J Am Board Fam Med. 2020 Sep 1; 33 (5): 716-727.

IntroductionComplex behavioral interventions such as diabetes shared medical appointments (SMAs) should be tested in pragmatic trials. Partnerships between dissemination and implementation scientists and practice-based research networks can support adaptation and implementation to ensure such interventions fit the context. This article describes adaptations to and implementation of the Targeted Training in Illness Management (TTIM) intervention to fit the primary care diabetes context.MethodsThe Invested in Diabetes pragmatic trial engaged 22 practice-based research network practices to compare 2 models of diabetes SMAs, based on TTIM. We used surveys, interviews, and observation to assess practice contextual factors, such as practice size, location, payer mix, change and work culture, motivation to participate, and clinical and administrative capacity. The enhanced Replicating Effective Programs framework was used to guide adaptations to TTIM and implementation in participating practices.ResultsPractices varied in size and patient demographics. All practices had integrated behavioral health, but limited health educators or prescribing providers. Adaptations to SMA delivery accommodated the need for flexibility in personnel and reduced scheduling burden. Adaptations to TTIM content were designed to fit general primary care diabetes and Spanish-speaking patients.ConclusionEnhanced Replicating Effective Programs is a useful process framework for adaptation, implementation, and testing of diabetes SMAs in primary care. Adapting intervention content, delivery, and training to fit context can help ensure pragmatic trials have both internal and external validity. Attention to intervention fit to context can support continued practice engagement in research and sustainability of evidence-based interventions.© Copyright 2020 by the American Board of Family Medicine.

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