Using the Multiphase Optimization Strategy (MOST) framework to test intervention delivery strategies: a study protocol

Abstract

BackgroundDelivery of behavioral interventions is complex, as the majority of interventions consist of multiple components used either simultaneously, sequentially, or both. The importance of clearly delineating delivery strategies within these complex interventions—and furthermore understanding the impact of each strategy on effectiveness—has recently emerged as an important facet of intervention research. Yet, few methodologies exist to prospectively test the effectiveness of delivery strategies and how they impact implementation. In the current paper, we describe a study protocol for a large randomized controlled trial in which we will use the Multiphase Optimization Strategy (MOST), a novel framework developed to optimize interventions, i.e., to test the effectiveness of intervention delivery strategies using a factorial design. We apply this framework to delivery of Family Navigation (FN), an evidence-based care management strategy designed to reduce disparities and improve access to behavioral health services, and test four components related to its implementation.Methods/designThe MOST framework contains three distinct phases: Preparation, Optimization, and Evaluation. The Preparation phase for this study occurred previously. The current study consists of the Optimization and Evaluation phases. Children aged 3-to-12 years old who are detected as “at-risk” for behavioral health disorders (n = 304) at a large, urban federally qualified community health center will be referred to a Family Partner—a bicultural, bilingual member of the community with training in behavioral health and systems navigation—who will perform FN. Families will then be randomized to one of 16 possible combinations of FN delivery strategies (2 × 2 × 2× 2 factorial design). The primary outcome measure will be achieving a family-centered goal related to behavioral health services within 90 days of randomization. Implementation data on the fidelity, acceptability, feasibility, and cost of each strategy will also be collected. Results from the primary and secondary outcomes will be reviewed by our team of stakeholders to optimize FN delivery for implementation and dissemination based on effectiveness, efficiency, and cost.DiscussionIn this protocol paper, we describe how the MOST framework can be used to improve intervention delivery. These methods will be useful for future studies testing intervention delivery strategies and their impact on implementation.Trial registrationClinicalTrials.gov, NCT03569449. Registered on 26 June 2018.

The realities of scaling within evidence-based policy

“…However, there are research designs that can start to build this evidence and then push evidence-based programs to focus on those areas where we lack evidence, such as non-negotiables. In the phases of both designing new programs and refining existing programs, methods such as Multiphase Optimization Strategy (MOST) (Collins et al , 2011; Broder-Fingert et al , 2019) can add to the empirical evidence called for by the economic model. Programs already being implemented can use continuous quality-improvement methods, leveraging random assignment or testing enhancements to specific aspects of their programs to generate new knowledge.…”

Using nominal group technique to identify barriers and facilitators to preventing HIV using combination same-day pre-exposure prophylaxis and medications for opioid use disorder

“…Though not all components might be a driver of success, having an array of options for participants is paramount. Future directions beyond the establishment of efficacy through a pilot-randomized trial could include the assessment of this program using the multiphase optimization strategy (MOST) [ 40 ]. MOST could help identify the critical components of the program that are minimally sufficient to address the complex needs of PWID accessing same-day PrEP and MOUD.…”

The Multiphase Optimization Strategy (MOST) in Child Maltreatment Prevention Research

“…Relatedly, while the hypothetical example discussed content and engagement related components, MOST could also be used to enhance other qualities of interventions such as implementation fidelity or the delivery of the intervention. Identifying the best strategy for delivering an intervention could provide important information for what type of delivery works best for whom (Supplee & Duggan, 2019), thereby creating a more efficient and affordable intervention (see Broder-Fingert et al, 2019). The hypothetical example did not include elements related to fidelity because the intended target of content and engagement strategies (e.g., parents) differs from that of implementation fidelity components (e.g., providers).…”