PIPELINES FOR DESIGNING, EVALUATING, AND IMPLEMENTING INTERVENTIONS
The gap between what we know and what we do in public health is lethal to Americans, if not the world.
—David Satcher, MD, PhD, Former U.S. Surgeon General
How does one build the evidence for a behavioral intervention? Whereas drug discovery and biomedical research follow a prescribed set of research steps moving from bench to bed to public health impact, for behavioral intervention research, there is no consensus, agreed upon approach, or recipe for advancing interventions and then implementing and sustaining them in real-world settings (Dougherty & Conway, 2008; Drolet & Lorenzi, 2011).
However, similar to biomedical research, there is no doubt that behavioral interventions develop over time and appear to follow an incremental pathway consisting of a set of activities that incrementally build the evidence for an intervention. This pathway, referred to as the “pipeline,” is typically conceptualized as singular, linear, and methodical, occurring over a lengthy time frame projected as 17 years or upward (see Chapter 1; Craig et al., 2008; Kleinman & Mold, 2009; Westfall, Mold, & Fagnan, 2007).
Nevertheless, the specifics of this pipeline, such as its phases and associated activities, have been differentially conceptualized within the scientific community and among funding agencies. This chapter examines the pathways, both traditional and emerging, for advancing behavioral interventions. We begin by discussing the relative advantages of using the concept of a “pipeline” as a heuristic for understanding the level of development and evidence in support of an intervention and ways to proceed for building its evidence. We then describe two different “pipelines” that capture ways to conceptualize moving interventions forward: the classic or traditional four-phase linear pipeline, and a proposed elongated seven-phase trajectory that recognizes the need to attend to specific processes for moving an intervention from the randomized trial environment to communities or practice environments for public health impact. Finally, we propose a more iterative, dynamic portrayal of intervention development and identify various strategies that may shorten the time for generating behavioral interventions that are better aligned with real-world needs and practice contexts than what currently typically occur.
Our discussion is necessarily conceptual and abstract as it is intended to provide an overarching framework and foundational knowledge concerning the development of behavioral interventions. Each subsequent chapter will link specific intervention research processes to phases along the elongated pipeline and, when appropriate, refer to more dynamic strategies for advancing interventions.