Adaptation Strategies

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Dissemination and adaptation strategies customized for trustworthy clinical practice guidelines using the GRADE framework

We initiated the SNAP-IT research project aiming at improving the dissemination of trustworthy clinical practice guidelines and outlining a structured adaptation process for guidelines developed with the GRADE system. Results from part 1 of the project have been published in scientific journals1–3 and implemented in real life clinical practice guidelines (for an example see

Dissemination strategies

Collaborating with the recently completed DECIDE project ( dr. Kristiansen and colleagues in MAGIC developed user-friendly multilayered presentation formats readable on any electronic device. Recommendations are displayed first with the underlying content available by clicking on the recommendation. Our new presentation format tested favourably against currently available formats in a randomized trial (CLICK-IT study).

Dissemination strategies

Building on current evidence and existing tools for adaptation of guidelines (e.g. ADAPTE) we developed and evaluated a new 5-step adaptation framework (figure 1) customised to guidelines developed with the GRADE system. We specifically aimed to increase efficiency while maintaining transparency and trustworthiness throughout the adaptation process. We performed a real-life application of the framework through the development of a Norwegian guideline for antithrombotic therapy, also implementing the multilayered presentation format. Click here for a quick online presentation of the framework.

Figure 1: 5 steps of adaptation


  1. Kristiansen, A. et al. et al. Adaptation of trustworthy guidelines developed using the GRADE methodology: A novel 5-step process. Chest 146, 727 (2014).
  2. Kristiansen, A. et al. Applying new strategies for the national adaptation, updating and dissemination of trustworthy guidelines: Results from the Norwegian adaptation of the American College of Chest Physicians Evidence-based Guidelines on Antithrombotic Therapy and the Preven. Chest 146, 735–61 (2014).
  3. Kristiansen, A. et al. Development of a novel, multilayered presentation format for clinical practice guidelines. Chest 147, 754–763 (2015).