Behavioral interventions for prevention and treatment are an important part of the fight against drug abuse and related conditions such as HIV/AIDS and Hepatitis C. The science of behavioral interventions in these areas faces many challenges. Among them is how to optimize the potency of interventions in order to achieve the greatest public health benefits. Generally, even the best behavioral interventions have not been systematically optimized. This suggests they could be performing even better. Optimization of new interventions as they are being developed, and revision of existing interventions with the objective of optimization, holds out the promise of substantial improvements in public health impact, and a corresponding reduction in morbidity and mortality.

Collins, Murphy, Nair, and Strecher (in press; see abstract below) have outlined a methodological framework, the multiphase optimization strategy (hereafter called MOST), that provides a set of principles for systematic optimization of behavioral interventions. MOST divides behavioral intervention research into three phases: screening, in which a set of intervention components under consideration (where "components" refers both to characteristics of the program and aspects of its delivery) is efficiently sorted through to identify a set that is sufficiently promising to merit further investigation; refining, in which optimal intervention doses are determined and interactions between program components and characteristics of the individual, environment, and so on are examined; and confirming, in which an optimized program constructed on the basis of the results of the screening and refining phases is subjected to a full evaluation. Two key features of MOST are (a) exclusive reliance on randomized experimentation, and (b) the significant role played by the behavioral theory underlying the intervention, particularly in practical design and analysis choices made in the screening and refining phases. This general perspective has a long history in agriculture, engineering, and other fields, where it has been demonstrated to be practical and is routinely used. Evidence that the MOST perspective is practical for behavioral interventions in drug abuse and other areas is provided by the work of Dr. Victor Strecher (University of Michigan), who is currently successfully implementing these ideas in a National Cancer Institute-funded study to develop a behavioral intervention for smoking cessation.

How MOST differs

Challenges

Reference List

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