STRATEGIES FOR ACCELERATING INTERVENTION DEVELOPMENT
Given the elongated time frame involved in building the evidence for behavioral interventions, recent efforts have been directed at identifying strategies for accelerating this process (Curran, Bauer, Mittman, Pyne, & Stetler, 2012; Glasgow, 2010; Riley, Glasgow, Etheredge, & Abernethy, 2013). To this end, we have identified six strategies that may result in more rapid intervention advancement as well as the generation of interventions that are more user-centric and flexible for implementation in different communities, practices, or service contexts. These strategies may be introduced at different points along the elongated pipeline and as early as in the discovery prephase (discussed in Chapter 3). Table 2.3 describes each strategy and the suggested phase in which it might best be considered.
Align Targets With Research Studies
The first strategy that can be considered is to better align intervention targets with findings from population-based or epidemiological studies when beginning to develop an intervention. Population-based studies may be helpful in identifying who is at high risk for the identified problem area, modifiable contributors, and who might benefit the most from an intervention. This may help to propel interventions forward with more efficiency and rapidity by ensuring relevance of intervention
TABLE 2.3 Strategies for Accelerating Intervention Development and Evaluation
Phase to Use Strategy
Explanation of Strategy
Use epidemiological data to identify population need and potential targets for an intervention.
Align intervention development with data from population-based epidemiological studies as it pertains to population needs and potential targets for intervention. This may result in interventions that are more responsive to public health issues.
Engage all stakeholders and end users (target population, interventionists, administrators).
Discovery and throughout all phases
Adopt a usability perspective. Involve key stakeholders (e.g., agency directors, administrators, representatives from health care organizations), including end users (e.g., representatives for the persons who will deliver the intervention and/ or the targeted population or who will use the intervention). Their involvement may help ensure alignment of intervention delivery characteristics and testing strategies with the values, interests, and outcomes of most interest to targeted end users.
Identify and understand delivery context.
Starting in discovery and throughout pipeline
Identify context(s) in which the intervention can be integrated and the potential supports and barriers. This can inform the development of the intervention and delivery characteristics, training of interventionists, and preparation for implementation in early phases of intervention development.
Identify costs associated with intervention.
Phases I and II
Traditionally, cost analyses are performed after an efficacy phase in which an intervention is shown to be efficacious. However, at Phases I and II, the cost of each of the intervention components could be established. This could lead to an immediate understanding of whether the intervention is feasible, the resources needed for its implementation, and whether there are opportunities in Phase II or Phase III to curtail costs by altering the proposed delivery characteristics and evaluating impact.
Implement design efficiencies (technologies) to lower costs, scalability, and impact).
Knowledge of what aspects of the intervention are costly can inform changes to delivery characteristics to lower costs if necessary and improve scalability. For example, a home-based intervention may be too costly for a clinic to implement, whereas delivery of the content of the intervention via telephone videoconferencing or other technology may reduce costs, improve implementation potential, and widen reach of the intervention.
TABLE 2.3 Strategies for Accelerating Intervention Development and Evaluation (Continued)
Phase to Use Strategy
Explanation of Strategy
Use blended design strategies.
Design strategies such as a pragmatic trial, hybrid designs, and mixed methodologies efficiently combine research questions to optimize investigations testing interventions. This may minimize time between testing and full implementation.
targets and appropriateness of identified populations and risk factors. Reviewing published epidemiological studies or conducting secondary analyses of population-based data sets are important ways to substantiate the basis for and importance of an intervention.