Delivery Modality and Setting
There are a variety of alternative ways to deliver an intervention such as face-to- face individual or group sessions, telephone or mail, or some technology-mediated format (e.g., the Internet, tablet computers). Each of these alternatives has associated strengths and weaknesses. Face-to-face individual sessions offer the potential benefits of greater therapeutic alliance and the ability to understand the context of an individual. However, this mode of treatment delivery can be costly and challenging with respect to scheduling. Alternatively, the increased use of the Internet has made Internet-based interventions more common. The advantages of using this delivery mode are that it can be more cost-effective (e.g., no travel on the part of the interventionists or the participants) and can offer enhanced flexibility with respect to scheduling and adaptability. Recent reviews (e.g., Tate, Finkelstein, Khavjou, & Gustafson, 2009) indicate that Internet-based behavioral interventions are efficacious. Potential challenges are associated with the technical development of the intervention, Internet access, and the technical skills of the study participants. Further, it can be more challenging to track treatment fidelity and to measure dosage (see Chapter 12).
Some interventions (e.g., REACH II) use a combination of modalities. In these cases, decisions have to be made regarding which components of the intervention will be delivered in a particular format. For example, in REACH II, decisions needed to be made regarding the number of face-to-face home visits versus the number delivered via the computer telephone system as well as which sessions were most amenable to each delivery format. Webb, Joseph, Yardley, and Michie (2010) conducted a review and meta-analysis of Internet-based interventions intended to promote health behavior changes. They found that more extensive use of theory in the development of the intervention was associated with a larger effect size as were interventions that incorporated more behavior change techniques. In addition, the effectiveness of Internet-based interventions was enhanced by the use of additional methods of communicating with patients such as text messages.