A Conceptual Framework for Adaptive Preventive Interventions

Abstract

Recently, adaptive interventions have emerged as a new perspective on prevention and treatment.Adaptive interventions resemble clinical practice in that different dosages of certain prevention or treatment components are assigned to different individuals, and/or within individuals across time, with dosage varying in response to the intervention needs of individuals. To determine intervention need and thus assign dosage, adaptive interventions use prespecified decision rules based on each participant's values on key characteristics, called tailoring variables. In this paper, we offer a conceptual framework for adaptive interventions, discuss principles underlying the design and evaluation of such interventions, and review some areas where additional research is needed. Keywords adaptive interventions; prevention; research designFor most of the history of research-based interventions aimed at prevention and treatment, the composition and dosage of these interventions have been fixed, in other words, a single composition and dosage has been offered to all program participants. For example, a schoolbased drug abuse prevention curriculum might be delivered to all sixth graders. Every component of the intervention that may be necessary for any particular participant is included in the curriculum, and each child is given the same intervention. Although it is recognized that individuals may have different intervention needs, it is expected that the intervention is in no way diluted or made counterproductive if components that are particularly relevant for an individual are combined with components that may have less, or even no, relevance for that individual.Recently, adaptive interventions have emerged as a new perspective on research-based prevention and treatment. According to this perspective, the varying intervention needs of individuals may not be met optimally by using a single uniform composition and dosage. For this reason, an adaptive intervention assigns different dosages of certain program components across individuals, and/or within individuals across time. Dosage varies in response to the intervention needs of individuals, and dosages are assigned based on decision rules linking characteristics of the individual with specific levels and types of

Adapting judicial supervision to the risk level of drug offenders: Discharge and 6-month outcomes from a prospective matching study

“…Adaptive interventions adjust the dosage and type of services that are administered to clients in response to clients' clinical presentation or performance in treatment (e.g., Collins et al, 2004;Murphy, 2005). Matching services to clients' pretreatment characteristics is perhaps the simplest form of adapting treatment to the needs of the individual.…”

Using engineering control principles to inform the design of adaptive interventions: A conceptual introduction

“…Interest in adaptive techniques is significant not only in the treatment of substance abuse (Sobell and Sobell, 1999;Velicer and Prochaska, 1999;Brooner and Kidorf, 2002;Murphy andMcKay, Winter 2003/Spring 2004) but also in the treatment of hypertension (Glasgow et al, 1989), depression (Rush et al, 2004), Alzheimer's disease (Schneider et al, 2001) and infectious diseases (Rosenberg et al, 2000). Collins et al (2004) articulated a general conceptual framework for the design of an adaptive intervention; however, their article did not address strategies for arriving at an intervention design that will produce the desired prevention and/or treatment outcomes. As adaptive strategies play an increasingly prominent role in addressing many important prevention and treatment problems, it is evident that much research is needed on adaptive intervention design and implementation.…”

“…Process control systems are widely used in the chemical industries to adjust flows to maintain level and product compositions at desired values (Ogunnaike and Ray, 1994). Effective adaptive interventions have goals similar to those of well-designed process control systems, in that both seek to 1) reduce negative effects, 2) increase intervention potency and 3) reduce waste (Collins et al, 2004). In this paper, the process control problem associated with maintaining liquid level in a tank (a.k.a., a fluid analogy) is proposed for modeling the dynamic behavior of adaptive interventions, and this class of models serves as the basis for decision policies evaluated using control engineering principles.…”

Constructing evidence-based treatment strategies using methods from computer science

“…Clinical guidelines individualize treatment by recommending treatment type, dosage, or duration depending on the patient's history of treatment response, adherence, and burden. Adaptive treatment strategies Dawson, 1998,2003;Lavori et al, 2000;Murphy, 2003;Murphy and McKay, 2004;Collins et al, 2004) are operationalized clinical guidelines. These strategies consist of a sequence of "decision rules" which individually tailor a sequence of treatments for individual patients.…”