Developing, evaluating, and then implementing and sustaining behavioral interventions in real settings is an important endeavor, but is not without its challenges. It takes many years of an investigator’s and a team’s effort to move an intervention from discovery to its efficacy testing, and then even more years for evaluation of its implementation and sustainability potential in practice settings.
Generally, interventions begin with a period of discovery or idea inception (discussed in Chapter 3), and move forward with formal evaluative processes, and then, if the intervention is efficacious, feasible, and responsive to community and/or individual needs, an evaluation of implementation and sustainability.
There is no single, agreed upon approach for advancing behavioral interventions. To understand the steps of and associated activities for intervention development, the pipeline concept is initially a useful heuristic. Although its assumptions of linearity and incremental progression are somewhat flawed, the research community at large and funding agencies and reviewers, in particular, continue to assess the adequacy of grant proposals for behavioral intervention research on the basis of how the evaluation of an intervention is described along a pipeline. Thus, understanding the assumed incremental steps in a linear pathway can still be useful, particularly in the grant application process.
The traditional pipeline for medical interventions and drug discovery has typically been applied to behavioral intervention work. Nevertheless, there is growing recognition that a traditional (Figure 2.1) pipeline is insufficient. Our elongated pipeline (Figure 2.2) is more responsive to the growing recognition that additional processes and steps are necessary for moving interventions beyond their initial testing phases. We refer to the elongated pipeline throughout this book.
However, new perspectives for intervention development are emerging. These include integrating a user perspective and identifying stakeholders early on when developing an intervention, among the other approaches we have discussed in this chapter. These strategies may provide the necessary knowledge of contextual factors and implementation challenges early on in the developmental and evaluation phases to inform intervention protocol advancement and facilitate rapid and efficient translation of proven programs into practice. This is a theme that is addressed in various chapters throughout this book.
New process-oriented and iterative approaches for designing an intervention are important to advance that may enable more rapid responses to generating research that is responsive to practice environments (Figure 2.3). Implementation science has the potential to help inform this more iterative reconstruction of the pipeline. This reconstructed pipeline also reflects the intersection of implementation science with behavioral intervention research.