Identify Context

A third strategy is to identify early on in the developmental process of an intervention the location (e.g., community-based agency, home care, hospital, online platform) and context (reimbursement model, staffing, organizational considerations) in which an intervention may ultimately be delivered (Horner, & Blitz, 2014). Knowledge of location and context early on when developing an intervention can help to inform the selection of its delivery characteristics (e.g., dose and intensity, treatment components; see Chapter 5) and evaluation strategies (Jacobs, Weiner, & Bunger, 2014; Campbell et al., 2007). For example, the REACH II intervention that was tested as a 12-session intervention was unable to be implemented by community agencies whose care managers had limited time and interactions with clients (Burgio et al., 2009). If the intervention had been originally developed with a brief visit schedule or had been delivered through a community-based agency, it may have had a better fit with different service contexts and thus may not have required a translational set of activities.

Alternately, a targeted problem area may be complex (e.g., depression, addiction) and not amenable to brief sessions or delivery by, for example, telephone, although this could save an agency money. In this case, by knowing the preferences of an agency upfront (e.g., brief number of sessions), an investigator can be better prepared to demonstrate the added value of conducting home visits with regard to the benefits achieved and associated costs.

A related point is to carefully consider who can deliver an intervention early on if the intervention involves individuals (versus a technological platform) for implementation (this is further considered in Chapter 20). Interventions requiring highly skilled interventionists may be limited to those agencies and regions of a country that have access to such resources and thus influence its future scalability. Alternately, interventions that can be delivered by a broad array of individuals such as community health workers or the indigenous staff of a targeted context may have more opportunities for being widely adopted (Han et al., under review). Nevertheless, clearly, the choice of intervention characteristics must match the purpose of the intervention and targeted problem area and population (see Chapter 5 for discussion of delivery characteristics). Developing an intervention that can have a significant treatment effect yet also be scalable represents a delicate balance in decision making about intervention characteristics including who can deliver the intervention. This point is more fully explored in Chapter 19.

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