Adaptations and modifications to the 15-method in Danish general practice classified using the framework for reporting adaptations and modifications to evidence-based interventions (FRAME)

Background: Unhealthy alcohol use is a major global public health problem, yet alcohol problems often remain unaddressed in primary care. The 15-method, developed in Sweden, offers a flexible, patient-centered approach to alcohol-related issues using opportunistic screening and stepped-care treatment in the same setting. The present study describes adaptations and modifications made to the 15-method by Danish healthcare professionals during a randomized controlled trial testing the 15-method’s effectiveness in Danish general practice. Methods: Data for the present qualitative study were individual and group interviews with 28 healthcare professionals from 12 Danish general practices enrolled in the Identification and Treatment of Alcohol Problems in Primary Care (iTAPP) study, a stepped-wedge cluster randomized controlled trial. Interviews focused on innovation and implementation process determinants from the Consolidated Framework for Implementation Science (CFIR). By means of the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME), data were analyzed to identify modifications to the 15-method when implemented in daily use. Results: Four distinct modifications were identified: a loosening of the method’s structure, condensed use of the method’s materials, modification of screening procedures, and integration into existing clinical procedures. Half of the changes were unplanned, and half were fidelity-consistent. Three of four changes occurred on practice level and were made by general practitioners. The most common goal of the changes was to increase patient reach and engagement. More training and structured follow-up were also identified as important to increase healthcare professionals’ confidence in delivering the 15-method. Conclusion: General practitioners and nurses generally find the 15-method suitable for their work in Danish general practice, and the method can be readily implemented with minor adaptations. More training and implementation planning may promote higher utilization and more consistent use, ultimately increasing the method’s sustainability and effectiveness.