Behavioral interventions matter! Over the past 50 years, a wide range of novel and important behavioral (psychosocial, environmental, technology-based) or nonpharmacological interventions have been developed, evaluated, translated, and implemented in community and clinical settings. We have proven effective behavioral interventions that address a broad range of behavioral, physical, emotional, and cognitive health, as well as social issues across the life span. Exemplars include but are not limited to: reducing behavioral disturbances in young children (Chicago Parent Program, Gross et al., 2009); enhancing dementia caregiver well-being (REACH II, Belle et al., 2006; Skills2CareR, Gitlin, Jacobs, & Earland, 2010); reducing depression in older adults in primary care (IMPACT, Stewart, Perkins, & Callahan, 2014; Unutzer et al., 2002) and the community (Get Busy Get Better: Helping Older Adults Beat the Blues, Gitlin et al., 2012); improving chronic disease self-management (CDSMP, Lorig et al., 1999) and its variants such as Harvest Health (Gitlin et al., 2008); reducing functional decline (ABLE, Gitlin et al., 2006), fall risk and fear of falling (LiFe Program, Clemson et al., 2012; Matter of Balance, Tennstedt et al., 1998); addressing delirium in hospital settings (HELP, Inouye et al., 1999); enhancing social connectedness (PRISM, Czaja et al., 2015); improving well-being through physical exercise (Fit and Strong, Hughes et al., 2004); addressing substance abuse in adolescence through the multidimensional family therapy intervention (MDFT, Liddle, Rowe, Dakoff, Ungaro, & Henderson, 2004); and enhancing cognitive status (ACTIVE, Rebok et al., 2014). These reflect only a very small fraction of the well-designed interventions that have been well tested using rigorous methodologies and that, in turn, have been shown to substantially improve the quality of life and health and well-being of the targeted individuals, families, and communities.
This book is intended to introduce the exciting, challenging, stimulating, and inspiring world of behavioral intervention research. It is about the science and state-of-the-art practices in designing, evaluating, and then translating, implementing, and disseminating novel behavioral interventions for maximum impact on the health and well-being of individuals, families, and their communities. Each chapter tackles critical considerations in behavioral intervention research. Our approach is to be as broad and inclusive as possible of the many nuances, intricacies, and issues in this form of inquiry. We cover a wide range of topics including examining the heart of the matter (Part I) or strategies for developing behavioral interventions including the pipeline for advancing interventions, the role of theory, intervention delivery characteristics, standardizing treatments, and use of technology This is followed by evaluative considerations (Part II) including selecting control groups; identifying recruitment, retention, and fidelity strategies; using mixed methodologies; and ethical challenges. Then we examine outcome measures and analytic considerations (Part III) including economic evaluations for maximizing the yield of trial data, and, in Part IV, how implementation science can inform the development and advancement of behavioral interventions. Finally, in Part V, we explore a host of professional issues unique to this form of inquiry including challenges in staffing behavioral interventionist studies, how to obtain funding for developing and evaluating an intervention, and what, when, and where to publish.
Case examples from successful behavioral intervention trials are used throughout each chapter to illustrate key concepts. The primary goal of each chapter is to examine the science and best practices as well as to facilitate decision making related to the fundamental issues in conducting behavioral intervention research. The chapters also identify critical knowledge gaps in an effort to enhance scientific practices in each of the facets of behavioral intervention research.
Despite over 50 years of promising behavioral intervention research, the science of and best practices for behavioral intervention research are not well explicated, and common know-how remains largely undocumented or not systematically shared within the research community, especially across disciplines. Thus, there are lost opportunities for advancing the skills and abilities of the current and next generation of researchers in the state of the science (and art) of this form of inquiry. This book is intended to fill this gap. Whereas classical clinical trial texts provide foundational knowledge important to the conduct of behavioral intervention research, they favor methodologies specific to pharmacological and medical device development and testing. These sources tend to ignore fundamental considerations and challenges specific to behavioral intervention work such as fidelity monitoring, the role and important contributions of mixed methodologies, strategies for recruiting and retaining diverse populations, or approaches for embedding and evaluating interventions under field conditions such as in community and clinical settings. Thus, it is critical that the specifics related to behavioral intervention research be documented, discussed, and advanced.
We aspire to have this book positively impact the work of researchers interested in or actively engaged in behavioral intervention research. We also hope this book helps to advance a rich dialogue and to stimulate further research directed specifically at developing best practices in behavioral intervention research. Behavioral intervention research is a complex and challenging form of inquiry that takes time, occurs over many years, and can be daunting at times. Nevertheless, its potential for yielding evidence-based programs, protocols, strategies, and models of care that can make a real difference to real people in real settings makes it a most commendable scientific enterprise that is worthy of our careful attention and elevation.
Please join us in the conversation and the journey of designing, evaluating, translating, implementing, and disseminating novel, health-promoting, and valuable behavioral interventions that can make a difference in the lives of people, their families, and communities.
Belle, S. H., Burgio, L., Burns, R., Coon, D., Czaja, S. J., Gallagher-Thompson, D., . . . Zhang, S. (2006). Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: A randomized, controlled trial. Annals of Internal Medicine, J45(10), 727-738.
Clemson, L., Singh, M. A. F, Bundy, A., Cumming, R. G., Manollaras, K., O’Loughlin, P, & Black, D. (2012). Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): Randomised parallel trial. British Medical Journal, 345, 1-15.
Czaja, S. J., Boot, W R., Charness, N., Rogers, W A., Sharit, J., Fisk, A. D., . . . Nair, S. N. (2015). The personalized reminder information and social management system (PRISM) trial: Rationale, methods and baseline characteristics. Contemporary Clinical Trials, 40, 35-46.
Gitlin, L. N., Chernett, N. L., Harris, L. F, Palmer, D., Hopkins, P, & Dennis, M. P (2008). Harvest health: Translation of the chronic disease self-management program for older African Americans in a senior setting. The Gerontologist: Practice Concepts, 48(5), 698-705. doi:10.1093/geront/48.5.698
Gitlin, L. N., Harris, L. F, McCoy, M., Chernett, N. L., Jutkowitz, E., & Pizzi, L. T. (2012). A community-integrated home-based depression intervention for older African Americans: Description of the beat the blues randomized trial and intervention costs. BMC Geriatrics, 12(4), 1-11.
Gitlin, L. N., Jacobs, M., & Earland, T. V (2010). Translation of a dementia caregiver intervention for delivery in homecare as a reimbursable Medicare service: Outcomes and lessons learned. The Gerontologist, 50(6), 847-854.
Gitlin, L. N., Winter, L., Dennis, M. P, Corcoran, M., Schinfeld, S., & Hauck, W W (2006). A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults. Journal of the American Geriatrics Society, 54(5), 809-816.
Gross, D., Garvey, C., Julion, W, Fogg, L., Tucker, S., & Mokros, H. (2009). Efficacy of the Chicago parent program with low-income African American and Latino parents of young children. Prevention Science, 10(1), 54-65.
Hughes, S. L., Seymour, R. B., Campbell, R., Pollak, N., Huber, G., & Sharma, L. (2004). Impact of the fit and strong intervention on older adults with osteoarthritis. The Gerontologist, 44(2), 217-228.
Inouye, S. K., Bogardus, S. T., Jr., Charpentier, P A., Leo-Summers, L., Acampora, D., Holford, T. R., & Cooney, L. M., Jr. (1999). A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine, 340(9), 669-676.
Liddle, H. A., Rowe, C. L., Dakof, G. A., Ungaro, R. A., & Henderson, C. E. (2004). Early intervention for adolescent substance abuse: Pretreatment to posttreatment outcomes of a randomized clinical trial comparing multidimensional family therapy and peer group treatment. Journal of Psychoactive Drugs, 36(1), 49-63.
Lorig, K. R., Sobel, D. S., Stewart, A. L., Brown, B. W,Jr., Bandura, A., Ritter, P, . . . Holman, H. R. (1999). Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: A randomized trial. Medical Care, 37(1), 5-14.
Rebok, G. W, Ball, K., Guey, L. T., Jones, R. N., Kim, H. Y., King, J. W, . . . Willis, S. L. (2014). Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults. Journal of the American Geriatrics Society, 62(1), 16-24.
Stewart, J. C., Perkins, A. J., & Callahan, C. M. (2014). Effect of collaborative care for depression on risk of cardiovascular events: data from the IMPACT randomized controlled trial. Psychosomatic Medicine, 76(1), 29-37.
Tennstedt, S., Howland, J., Lachman, M., Peterson, E., Kasten, L., & Jette, A. (1998). A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 53(6), P384-P392.
Unutzer, J., Katon, W, Callahan, C. M., Williams, J. W, Jr., Hunkeler, E., Harpole, L., . . . Impact Investigators. (2002). Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. JAMA, 288(22), 2836-2845.