Adaptation of the PRIDE in All Who Served Facilitation Manual to Support Scale-Up of a Novel Program for LGBTQIA+ Veterans

Pride In All Who Served (PRIDE) is the first manualized, evidence-based group intervention developed for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and/or other diverse sexual/gender identities (LGBTQIA+) Veterans. PRIDE has spread to over 70 Veterans Administration Medical Centers (VAMCs) in every region of the country and continues to scale to new sites. In 2023, a PRIDE Manual Revision Team was formed to create a new version of the PRIDE Facilitation Manual (Version 3) that updated information and best practices for the LGBTQIA+ Veteran population and improved ease of facilitation for staff. The purpose of this study was to describe the iterative process used to incorporate input from over 270 Veterans, clinicians, and subject matter experts and to track modifications using the Framework for Reporting Adaptations to Evidence-Based Interventions (FRAME)-a novel application of this framework. Results revealed 76 distinct modifications to improve the feasibility, fit, satisfaction, engagement, and effectiveness of the PRIDE group for LGBTQIA+ Veterans. All modifications occurred during the "Scale-Up" phase of PRIDE, reflecting the program's current progress implementing across the national health care system. This work used a multishareholder modification approach within a large, complex health care setting and provides an example for effectively tracking changes to ensure fidelity of adaptations and promote sustainability in a rapidly expanding field. As additional interventions are disseminated to new settings, systematically tracking modifications can increase understanding of their impact on health outcomes and contribute to successful implementation and sustainment efforts.