There are also alternative approaches for delivery of an intervention. These include but are not limited to tailoring or adapting an intervention with respect to the characteristics of the participants (e.g., cultural tailoring) or the context in which it will be delivered; using a prescriptive one-size-fits-all approach; adapting a stepped care approach that adjusts the intensity or level of an intervention according to the stage of readiness/need of an individual; or a risk assessment approach that adjusts level of exposure by type and intensity of risk.
In general, the choice of delivery approach should be driven by the nature of the intervention, the relevant literature, and the phase of the pipeline. For example, within the caregiver intervention literature, it is generally found that multicomponent interventions that actively engage the caregiver yield better outcomes. Also, it may not be wise to use an adaptive approach at an early phase of the pipeline when an intervention is initially being developed or the feasibility of an approach is being evaluated.
If an adaptive delivery approach is chosen, decisions need to be made regarding which aspects of an intervention can be adapted, the extent or range of adaptability, who can make decisions regarding adaptability, and how an aspect of an intervention can be adapted. If an intervention involves two cognitive training sessions a week in a laboratory on separate days, a question may arise as to alternative scheduling for participants with transportation problems. Adaptations for these participants might involve scheduling two sessions on the same day (with a rest break) or allowing participants to complete one of the sessions at home. Irrespective of decisions concerning adaptability, protocols for adaptability must be in place and documented. Further, any adaptations made to a protocol must be tracked throughout a trial as they may interject biases into the outcomes that need to be evaluated in data analyses.