Optimizing adaptive stepped-care interventions to change adults’ health behaviors: A systematic review

Abstract

Chronic diseases are ubiquitous and costly in American populations. Interventions targeting health behavior change to manage chronic diseases are needed, but previous efforts have fallen short of producing meaningful change on average. Adaptive stepped-care interventions, that tailor treatment based on the needs of the individual over time, are a promising new area in health behavior change. We therefore conducted a systematic review of tests of adaptive stepped-care interventions targeting health behavior changes for adults with chronic diseases. We identified 9 completed studies and 13 research protocols testing adaptive stepped-care interventions for health behavior change. The most common health behaviors targeted were substance use, weight management, and smoking cessation. All identified studies test intermediary tailoring for treatment non-responders via sequential multiple assignment randomized trials (SMARTs) or singly randomized trials (SRTs); none test baseline tailoring. From completed studies, there were few differences between embedded adaptive interventions and minimal differences between those classified as treatment responders and non-responders. In conclusion, updates to this work will be needed as protocols identified here publish results. Future research could explore baseline tailoring variables, apply methods to additional health behaviors and target populations, test tapering interventions for treatment responders, and consider adults’ context when adapting interventions.

Scientia pro bono humani generis: Science for the benefit of humanity

“…Kaiser et al review innovations in adaptive trial designs, focusing on the seven major elements of adaptation described in the 2019 Food and Drug Administration guidance; these authors offer relevant examples of these design elements [10]. Roddy et al provide a state-of-the-art review of adaptive step-wedge clinical trials that used behavior change-oriented interventions in the management of chronic disease [11]. The 22 studies in the review included singly randomized trials (SRTs) which are traditional designs where participants are randomized only once, and also sequential multiple assignment randomized trials (SMARTs), where participants are randomized at each sequential stage of treatment, informed by prior treatment response [11].…”

“…Roddy et al provide a state-of-the-art review of adaptive step-wedge clinical trials that used behavior change-oriented interventions in the management of chronic disease [11]. The 22 studies in the review included singly randomized trials (SRTs) which are traditional designs where participants are randomized only once, and also sequential multiple assignment randomized trials (SMARTs), where participants are randomized at each sequential stage of treatment, informed by prior treatment response [11]. SMARTs test adaptive interventions systematically and efficiently, saving resources and asking multiple questions about components of an adaptive intervention in a high-quality manner without unduly increasing sample size [11].…”

“…The 22 studies in the review included singly randomized trials (SRTs) which are traditional designs where participants are randomized only once, and also sequential multiple assignment randomized trials (SMARTs), where participants are randomized at each sequential stage of treatment, informed by prior treatment response [ 11 ]. SMARTs test adaptive interventions systematically and efficiently, saving resources and asking multiple questions about components of an adaptive intervention in a high-quality manner without unduly increasing sample size [ 11 ]. The review also identifies future directions for subsequent trials, such as the need to understand what behavioral adaptations are needed, and for whom [ 11 ].…”

“…SMARTs test adaptive interventions systematically and efficiently, saving resources and asking multiple questions about components of an adaptive intervention in a high-quality manner without unduly increasing sample size [ 11 ]. The review also identifies future directions for subsequent trials, such as the need to understand what behavioral adaptations are needed, and for whom [ 11 ].…”