A strategy for optimizing and evaluating behavioral interventions

Background: Although the optimization of behavioral interventions offers the potential of both public health and research benefits, currently there is no widely agreed-upon principled procedure for accomplishing this. Purpose: This article suggests a multiphase optimization strategy (MOST) for achieving the dual goals of program optimization and program evaluation in the behavioral intervention field. Methods: MOST consists of the following three phases: (a) screening, in which randomized experimentation closely guided by theory is used to assess an array of program and/or delivery components and select the components that merit further investigation; (b) refining, in which interactions among the identified set of components and their interrelationships with covariates are investigated in detail, again via randomized experiments, and optimal dosage levels and combinations of components are identified; and (c) confirming, in which the resulting optimized intervention is evaluated by means of a standard randomized intervention trial. To make the best use of available resources, MOST relies on design and analysis tools that help maximize efficiency, such as fractional factorials. Results: A slightly modified version of an actual application of MOST to develop a smoking cessation intervention is used to develop and present the ideas. Conclusions: MOST has the potential to husband program development resources while increasing our understanding of the individual program and delivery components that make up interventions. Considerations, challenges, open questions, and other potential benefits are discussed.