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Table 2 Description of different approaches to intervention development

From: Taxonomy of approaches to developing interventions to improve health: a systematic methods overview

Category Approach Rationale Context specified by authors Steps, activities or actions specified by authorsa Strengths specified by authors of approach, authors of other approaches and the overview team INDEX (source in brackets) Limitations
1. Partnership Co-creation, co-production, co-design [38] Active involvement of end users in various stages of the production process produces more effective and efficient services with higher user satisfaction [38, 40]
A key issue is an equal relationship between the end users (and their families and communities) and professionals, with shared decision-making [40]. It can also be seen as ‘user-led innovation’ [39]. Requires a shift in power from professionals to community or end users [40]
Co-creation produces sustainable competitive advantage [39]
Customises solutions to specific contexts [39]
Delivers services appropriate to the needs of patients and advances equality [40]
Quality improvement in health and social care
Social innovation in public sector services
Radical innovation—as opposed to incremental—in health services
Six steps:
1. Identify and build an initial team including end users and people important to the service, developing inclusive communication processes. Use joint and equal involvement of staff, patients, researchers, people leading improvement, and design professionals
2. Define and share assets—knowledge, experience, skills and abilities, influence and connections. Understand the current problem through non-participant observation, patient interviews, log books, films, local press, use of cameras, workshops, storytelling, etc.
3. Co-create the vision by listening to all voices
4. Co-design the solution using qualitative research, rapid ethnography and prototyping. Use tools to generate creative thinking. Open up a range of potential solutions as described in user and human centred approaches below.
5. Build the solution possibly using small action groups who can use their relevant expertise. Make use of prototyping methods.
6. Measure outcomes together and plan this as an integral part of the process
There are examples of changes made to services based on this approach [25] and reductions in the cost of health care provision [40]
Studies what people do rather than what they say they do [39]
A detailed guide is available [40]
Attention has not been paid to the outcomes of co-creation [38]
Quantitative methods need to be used because qualitative evaluation of co-creation is dominant [38]
[38] is a systematic review of the use of co-creation discussing different levels of involvement of end users including co-design (the developers lead the process in partnership with the end users), co-implementation (end users implement a service with formal service providers) and initiation (end users develop and implement innovation). They offer insights into the process rather than a tool-kit (INDEX)
User-driven [25] A participatory approach goes beyond user-centred design, with users as active participants in generating design ideas and decision-making. In co-operative design, users and designers work together to come up with a design and further refinements. In user-driven design, the users lead the creative thinking and the designers facilitate the process.
End user involvement is critical to the adoption of information systems because it increases functionality and the quality of the system
Involvement empowers users
Information systems in health Proposes three levels of participation in design: user-centred (see next group in this table), cooperative (see co-production earlier) and user-driven.
Important activities include:
1. Establish co-operation between users and designers
2. Gain insight into current problems and needs and generating visions for future solutions. This may involve ‘design games’ to free minds and creativity.
3. Continual and iterative input from end users
4. Develop prototypes and undertake usability testing of them in real life environments or a simulation of this to identify interactions with wider users and activities affecting use.
5. Bring the users who were observed using the prototypes into further design meetings for active participation in refinement of prototype
Can be low cost and rapid and thus increase dissemination of new designs [25]
Shown to be successful at improving future prototypes and preventing the introduction of systems that fail [25]
How, when and where to engage users remains open to question [25]
Ensuring the users involved are representative of the target population is challenging [25]
Reaching consensus when there are differing voices is challenging [25]
Difficult for clinical staff to give time for design but there are ways of working rapidly to alleviate this [25]
The ‘interventions’ are not necessarily intended for evaluation in an RCT but may be used immediately in the real world (INDEX)
Experienced based co-design (EBCD) and accelerated experience based co-design (AEBCD) [41, 42] Need in-depth patient experience (narrative) to take action and make improvements to services
Patient accounts generate priorities and solutions that service providers may not think of
Patient narratives can help patients and staff reflect on how to improve services and establish an emotional connection between staff and patients
Patients as equal partners in co-design can generate improvement
AEBCD is more feasible than EBCD in the complex cash-strapped real world and offers a rigorous and effective approach to quality improvement
Service improvement specific to a single service in a single setting Core ‘strands’ are:
-Participatory action research
-User centred
-Reflective practice
-Narrative
There are six steps in two phases:
Phase 1 Discovery
1. Project management established
2. Local staff are interviewed about their experiences.
3. Local patients are interviewed about experiences to produce a ‘trigger film/video’ to prompt discussion amongst patients and staff about improvements needed. In AEBCD, the film is based on a national archive rather than gathering local patient experiences. Patients and carers are invited to view the video and identify priorities.
Phase 2 co-design where family, patients and staff are equal partners in small working groups
4. The priorities of staff and patients, and the video, are considered by patients, carers and staff in a workshop meeting to identify priorities for improvement.
5. Small co-design groups established to implement improvements.
6. Small groups re-convene to celebrate and review progress.
Draws on rigorous narrative-based research with a broad sample of patients rather than a narrow group of people [42]
Active partnership between patients and staff and focus on tangible results produces results [42]
Evaluation shown to be successful at producing improvements in the target service and in wider aspects of the hospital [42]
Hospitals commit investment to doing this again so they see it as successful [42]
Online training toolkit is available (INDEX)
Discovery phase is time consuming so not practical in real world of health care. Therefore, AEBCD preferable [42]
Some patients found the video more negative than their own experiences; there was a heavy workload for local facilitators but they obtained wider benefits such as capacity building [42]
Useful for local service improvement rather than developing a generalizable intervention (INDEX)
2. Target population based Person-based approach [17, 57] Enhances acceptability and feasibility of an intervention at early stages of development and evaluation
Systematic investigation
In depth understanding of users leads to interventions that are more relevant, persuasive, accessible and engaging
Complements theory-based and evidence-based design
Matches fundamental design to needs and goals of users
Digital health-related behaviour change interventions and illness management interventions because people use e-health independently
Has also been used outside digital interventions for self-management
Behaviour change interventions
Early stages of development and evaluation
Uses mixed methods research and iterative qualitative studies to investigate beliefs, needs, attitudes and context of target population
Two elements: First, a developmental process using qualitative research with a diverse sample of target population. Goes beyond acceptability, usability and satisfaction to understand the psycho social context of the user so can make intervention relevant to them. Second, identify ‘guiding principles’ to guide intervention development. These elements are used at four stages of the process:
1. At the planning stage undertake synthesis of qualitative studies or qualitative research to prioritise what is important or identify new components of an intervention
2. At the design stage identify the intervention objectives and features of the intervention required to deliver them
3. When the prototype is available, evaluate acceptability and feasibility
4. Implement in real life setting to further modify intervention
Systematic way of gaining in depth understanding of users’ perspectives to make the intervention more relevant and engaging [17, 57]
Shown to be successful because interventions have been effective in RCTs [17, 57]
Advantage over co-design is that people are basing views on actual use of the intervention [17, 57]
Different from user-centred approach used in computer-based research because looks beyond usability and technical issues [17, 57]
Reasonable amount of detail given, with examples (INDEX)
Iterative approach may be hard to respond to quickly in practice [17, 57]
User-centred design [43] Making delivery more efficient and equitable by putting people at the centre of any problem to develop solutions that better fit their everyday lives, activities and context
Must design interventions to fit users’ needs and context to facilitate translation of evidence into the real world
May need new approaches to address complexity
Innovation in organisations
Improving health care delivery
Early and continuous stakeholder engagement, including having stakeholders as part of research team to undertake contextual inquiry. Three phases:
Phase I Defining design requirements: Use of role play and observation to identify issues rather than only qualitative interviews; develop prototypes to get specific views on the intervention
Phase II Develop a prototype and refine in iterative interviews: e.g. rank priority of concepts; converse with stakeholders to improve fit
Phase III Evaluate stakeholder preferences: e.g. compare with alternatives and get quantitative feedback, card sorting of statements to obtain views
Multi-stakeholder driven [44, 45]
Focuses on what users and practitioners actually do, not simply on what they say they do [44, 45]
Shifts focus from content of intervention to delivery in context so helps to overcome barriers to implementation in the real world [44, 45]
Uses prototypes to get specific rather than generic feedback [44, 45]
Focus is on utility, fit and engagement of key users of the intervention [44, 45]
Although there is a book as well as journal articles, more details could be given about how to achieve each action (INDEX)
Human-centred design [33] Study people and take their needs and interests into account so that technology and appliances meet the needs of people including that it is enjoyable and useable Design of machines, appliances, technology for everyday use
Not health
Four activities are proposed, working within a multidisciplinary team:
1. Observing—Philosophy of early focus on observing the target users and tasks rather than asking users what they want. Good designers do not start by trying to solve the proposed problem but by trying to understand what the real issues are.
2. Ideation—Consider a wide range of potential solutions and be creative
3. Prototyping—build quick rough prototypes to continue to understand the problem
4. Testing and undertaking rapid testing of ideas/prototypes with the target population in real circumstances and modifying approach after each iteration
Throughout, consider wider issues such as the cost of the object or stigma
Attached to using it
The focus on the starting point of the process, and not closing down questioning and ideas too early are important actions not articulated well in other approaches (INDEX) Working within time, budget and other constraints [33]
3. Theory and evidence based MRC Framework for developing and evaluating interventions [7, 15] Spending time developing interventions systematically based on evidence and theory produces interventions which have a reasonable chance of having a worthwhile effect Complex interventions in health care, public health and social policy Three functions:
1. Identifying the evidence base
2. Identifying/developing theory
3. Modelling process and outcomes
Questions are also identified for researchers to ask themselves, such as ‘Have you used this theory systematically to develop the intervention?’ and ‘Can you describe the intervention fully, so that it can be implemented properly for the purposes of your evaluation, and replicated by others?’
Not prescriptive [7]
Well cited and used in grant proposals [58]
Used by many researchers in primary research (INDEX)
Little detail [28, 47], INDEX
Issues were under intense development and debate at time of writing guidance [7]
Lacks attention to complexity science [58]
Behaviour Change Wheel (also action by action approach) [26] Comprehensive and systematic approach, encouraging designers to consider the full range of options through systematic evaluation of theory and evidence Behaviour change interventions in health and can be used in other settings Eights steps in three stages:
1. Understanding the behaviour
i. Define the problem in behavioural terms
ii. Select the behaviours you are trying to change
iii. Specify the target behaviour, i.e. who needs to do what differently and when
iv. Identify what will bring about the desired behaviour change using COM-B or Theoretical Domains Framework
2. Identify intervention options that will bring about change
i. Identify intervention functions
ii. Identify policy categories
3. Identify content and implementation options
i. Identify behaviour change techniques from list of 93, e.g. goal setting
ii. Identify mode of delivery
As well as aiding intervention design it improves evaluation and theory development by helping to understand why interventions have failed or how they have worked [26]
Explicitly draws attention to the different levels at which an intervention may need to work [26]
Clear and detailed explanation of each action with multiple examples ([32], INDEX)
Well known [32]
Popular in that used by many researchers in primary research (INDEX)
Acknowledges that judgements are required where there is no evidence but does not say who should be involved in making these judgements e.g. stakeholder groups (INDEX)
Although reference is made to working with stakeholders, the emphasis is on behaviour change (INDEX)
Needs more emphasis on the target population being involved in process [56]
Requires substantial knowledge of psychological processes [32]
Intervention mapping [27] A systematic and thorough approach using theory and evidence will produce an effective intervention Health promotion
Public health
Complex problems
Addresses planning, implementation and evaluation.
6 steps:
1. Undertake a needs assessment to develop a logic model of the problem
2. Produce a logic model of the change process that leads to outcomes
3. Design the scope, sequence, methods and practical applications of the program
4. Produce the program including the materials
5. Plan implementation and maintenance of the program
6. Develop an evaluation plan
Using with a community-based participatory approach may help external validity
Extremely rigorous and elaborate approach to intervention development ([28], INDEX)
Used by many researchers [32] and cites a long list of published interventions developed with this approach (INDEX—see p34–38 of book)
Addresses environmental as well as personal factors affecting the problem [32]
Highly technical, prescriptive, can require years to implement, and difficult to operationalise [28]
Does not cover the full range of intervention options available [26]
So comprehensive that it requires time resources that make it unfeasible for use by many developers [32]
Matrix Assisting Practitioner’s Intervention Planning Tool (MAP-IT) [32] Making the use of theoretical knowledge and empirical evidence easy can help practitioners to develop effective interventions at low cost Health promotion
Behaviour change complex health interventions
A matrix is determined by a small group of expert researchers focused on a specific behaviour change for a specific age group, e.g. promoting physical activity in older adults. The experts create a matrix of personal and environmental mechanisms that promote positive behaviour, relevant theories and functions of an intervention that could address each mechanism. This matrix can then be used by practitioners to develop a theory-driven and evidence-based intervention It undertakes one part of intervention development for behaviour change so that developers do not have to understand psychological theory in depth (INDEX)
Links scientific research with practical real world applications [32]
Offers a feasible and low cost approach for practitioners developing interventions [32]
Synthesises concepts in other well-known approaches [32]
One matrix is presented here. Matrices need to be produced for other conditions/risk factors in a variety of age groups [32]
It is insufficient because it does not take the context in which the intervention will be used into account [32]
It facilitates one part of intervention mapping rather than offering a full approach to intervention development (INDEX)
Normalisation Process Theory (NPT) [46] Using theory about normalising interventions in routine practice can help develop and evaluate interventions that will be implemented in the real world if found to be effective Complex interventions in health and health care The components of the theory can help to
1. Describe the context in which the proposed intervention will be implemented
2. Define the intervention using literature reviews, observation, interviews and surveys
Focuses on wider system issues and interactions between different groups of staff and patients, addressing both individual and organisational level factors [46]
Addresses a neglected aspect of intervention development (INDEX)
Focuses on one aspect of intervention development (INDEX)
No detail about how to develop interventions (INDEX)
Theoretical Domains Framework (TDF) [47] Using a theoretical framework in a systematic way to develop an intervention will help to make hypothesised mechanisms of change explicit and change clinical practice Complex interventions
Clinical behaviour change
Implementation interventions to get evidence into practice
Quality improvement
A four-step systematic method based on guiding questions:
1. Who needs to do what, differently?
2. Which barriers and enablers need to be addressed (using a theoretical framework)?
3. Which components could overcome modifiable barriers and enhance enablers?
4. How can behaviour change be measured and understood?
A conceptual aid and not a rigid prescription [47]
Uses theory, evidence and mixed methods research [47]
Using a broadly based theoretical framework for behaviour change is better than using a single theory [47]
Requires considerable time and resources but spending this time and resource may be a good investment [47]
No detail about to how to undertake each action (INDEX)
4. Implementation-based Reach, Effectiveness, Adoption, Implementation, Maintenance [48] To encourage intervention planners and other stakeholders to pay more attention to external validity to improve the sustainable adoption and implementation of effective interventions
To help plan interventions and improve their chances of working in ‘real-world’ settings.
To facilitate translation of research to practice
Health behaviour interventions The RE-AIM Planning Tool [48] is a series of questions which serve as a checklist for key issues to consider when planning an intervention. The questions are within five groups:
1. Planning to improve reach to the target population
2. Planning for effectiveness
3. Planning to improve adoption by target staff, settings, or institutions
4. Planning to improve implementation
5. Planning to improve maintenance of intervention effects in individuals and settings over time
The approach has been used to evaluate and report a wide range of interventions [48]
The emphasis on developing interventions that will be used in the real world if effective is complementary to some existing approaches to intervention development (INDEX)
RE-AIM [48] was originally developed as a framework for consistent reporting of research results and then as a framework for evaluating interventions. As such, there is little detail about how to develop interventions (INDEX)
5. Efficiency-based Multiphase Optimization Strategy (MOST) [49] Conceptually rooted in engineering, MOST emphasises efficiency and careful management of resources to move intervention science forward systematically
Randomised experimental approaches to optimisation leads to more potent interventions
Multicomponent behavioural interventions in public health There are three phases:
1. Preparation: information from sources such as behavioural theory, scientific literature and secondary analyses of existing data is used to form the basis of a theoretical model.
2. Optimisation: randomised experiment to test the effectiveness of different components. Fractional factorial experiments (see below) sequential multiple-assignment randomised trials (SMARTs) or micro-randomised trials (see below) may be used here.
3. Evaluation: standard RCT.
A continuous cycle of optimisation and evaluation can occur
A number of projects using MOST have been funded by national funding agencies [49] Focuses on a narrow aspect of intervention development, occurring after the components of the intervention have been assembled or designed (INDEX)
Multi-level and fractional factorial experiments [50, 51] Simultaneous screening of candidate components of an intervention to test for active components offers an efficient way of optimising interventions Multi component interventions with behavioural, delivery or implementation factors and where there is clustering Conduct a ‘screening experiment’ to determine which components go forward to experimental evaluation. Starts with a number of potential components and removes the least active ones. Uses fractional factorial design to screen out inactive components rather than evaluate the utility of a combination of components over a single component. Focuses on main effects and a few anticipated two-way interactions Superior to mediational analyses from first RCT followed by second RCT [50] Lack of statistical power to do this at the development phase (INDEX)
Focuses on a narrow aspect of intervention development, occurring after the components of the intervention have been assembled or designed (INDEX)
Micro-randomised trials [52] Delivering the right intervention components at the right times and locations can optimise support to change individuals’ health behaviours ‘Just in time adaptive interventions’ (mobile health technologies)
Behaviour change
Multiple components are randomised at different decision points for an individual. An individual may be randomised hundreds of times over weeks or months. Intermediate outcomes can be measured rather than primary outcomes   Only suitable for some types of intervention where participants are prompted to do something, where events are common and where measurement of intermediate outcome is low burden [52]
Focuses on a narrow aspect of intervention development, occurring after the components of the intervention have been assembled or designed (INDEX)
6. Stepped/phased Six essential Actions for Quality Intervention Development (6SQuID) [28] To guide researchers
Practical, logical, evidence based approach to maximise effectiveness of interventions
To reduce waste of public money by not evaluating useless interventions
Public health but authors say wider relevance 1. Define and understand problem and its causes
2. Identify which causal or contextual factors are modifiable, and which have the greatest scope for change
3. Identify how to bring about change (the mechanisms of action)
4. Identify how to deliver the mechanisms of change
5. Test and refine the intervention on a small scale
6. Collect enough information about effectiveness to proceed to full evaluation
Systematic, logical and evidenced to maximise likely effectiveness [28]
Practical guidance where none exists [28]
Attention to both early and later stages of the development process (INDEX)
Based on experience of development and evaluation of interventions (INDEX)
Offers an overview rather than detail (INDEX)
Although authors recommend taking some of the actions with involvement from stakeholders, and using qualitative research at later stages, little attention needed to involvement of those receiving and delivering the intervention (INDEX)
Five action model in intervention research for designing and developing interventions [24, 29] A systematic process of developing a manual leads to interventions that change practice
A detailed manual allow replication of effective interventions
Social work
Social and public health programs
Based on developing and testing interventions in child development
The focus is on creating the intervention and then refining it during evaluation There are five steps:
1. Develop both problem theory and program theory: specify the problem, the rationale for the intervention and the theory of change
2. Design intervention materials to articulate strategies for changing malleable mediators. Develop first draft of manual specifying the format of manual (content, order of content and who delivers it). Revisions and adaptations to the manual occur throughout the further actions.
3. Refine and confirm program components in efficacy tests. Submit manual for review by relevant stakeholders including target population and those delivering the intervention. Undertake mixed methods feasibility testing.
4. Test effectiveness in a variety
of practice settings
5. Disseminate program findings and materials
Specifies link between the problem theory and the intervention content [29]
Specifies process of developing treatment manuals [29]
The five actions cover evaluation as well as development so there is not as much detail about the development stage as in other approaches (INDEX)
Although practitioners are considered early in the process, the target population is considered late in the process of development (INDEX)
Obesity-Related Behavioural Intervention Trials (ORBIT) [34] A systematic, progressive framework for translating basic behavioural science into treatments that address clinical problems in a way that strengthens the treatments and encourages rigorous evaluation Clinical
Behavioural treatments for preventing and treating chronic diseases
Flexible and progressive process making use of iterative refinement and optimisation. The five steps are:
1. Identification of a significant clinical question
2. Phase 1a Design: Develop a hypothesised pathway from behaviour treatment to a solution for the clinical problem
3. Phase 1b Refine: Optimise content and delivery of an intervention, and tailor to sub-groups
4. Phase IIa Proof of concept: When treatment manual is available, undertake study on small numbers to see if it merits more rigorous and costly testing
5. Phase IIb Pilot testing: Look for benefits achieved over and above a control group or consider the feasibility of a full evaluation
Clinically relevant and uses language from drug development to appeal to medical stakeholders [34]
Constructed for use with a broad number of chronic diseases rather than a single category of disease [34]
Details milestones needed at the end of one phase prior to moving on to next phase (INDEX)
Takes a similar approach to MRC Guidance by using the phases of drug trials in an iterative phased approach. Only focuses on the first phases of drug trials and although there is more detail about development than the MRC guidance, there is still a lack of detail compared with other approaches (INDEX)
7. Intervention-specific Digital: IDEAS (Integrate, Design, Assess, and Share) Framework for digital interventions for behaviour change [48] Guiding intervention development using the best combination of approaches helps to deliver effective digital interventions that can change behaviour
Need a combination of behavioural theory and user-centred design thinking to develop effective interventions. These must be evaluated and disseminated to maximise benefit
Digital
Behaviour change
Covers development and evaluation. Ten phases in four stages
1. Integrate insights from users and theory
i. Empathise with target users
ii. Specify target behaviour
iii. Ground in behavioural theory
2. Design iteratively and rapidly with users
iv. Ideate implementation strategies
v. Produce prototype
vi. Obtain user feedback
vii. Create a product
3. Assess rigorously
viii. Pilot test to assess potential efficacy and usability
ix. Evaluate in RCT
4. Share
x. Share intervention and results
Offers action by action guide about combining behaviour theory and design thinking [48]
Strikes a balance between offering sufficient detail without being overly prescriptive [48]
Less experienced users may find it difficult to apply [48]
There may be disagreements amongst team members that are challenging to manage [48]
Digital—practical advice for internet-based health interventions [53] Concrete examples from experience of digital intervention development can complement best practices guidance Online health interventions
Public Health
Based on the views of researchers and practitioners:
1. Hire the right research team, e.g. include computer science experts
2. Know the needs of the target population
2. Plan the process before engaging a web designer
3. Recognise that different stakeholders have different values and language e.g. researchers and web designers
4. Develop a detailed contract
5. Document all decisions
6.Use a content management system
7. Allow extra time for testing and refining
Based on views of researchers with experience and offers complementary knowledge of intervention development to existing published sources [53] The focus is largely on how to work with commercial web designers in the context of a digital intervention (INDEX)
Web-based decision support tools for patients [31] A clear project management and editorial process will help to balance different priorities of variety of stakeholders [31]
Need close consultation with target users and iterative development process to develop accessible and useful intervention [31]
Decision aids available in web-based versions A process map for developing decision aids addressing two areas:
First, content specification by combining scientific evidence and patient perspectives. Second creative design to tailor it to specific audiences by considering presentation of information, help for patients to assess how they feel about future events and allow patients to formulate a preference
Five groups are established: a project management group of 3–4 people to drive the process; an advisory group of 6–10 stakeholders who advise but do not have editorial rights; a virtual scientific reference group of experts to review evidence synthesis and the evolving tool; a technical production group which will create and host the website; and stakeholder consultations with a series of prototypes including patients undergoing the decision and practitioners who interact with patients
Overlapping steps are:
1. Identify patients’ needs using qualitative research
2. Evidence synthesis
3. Consensus on evidence
4. Construct storyboard
5. Undertake sandpit testing with experts
6. Undertake usability testing
7. Undertake field testing with real patients
Use of creative design and consultation as well as scientific evidence [31]
Close liaison with target users [31]
Iterative method of refinement [31]
Time consuming [31]
One action dependent on earlier actions so can be delays [31]
Can be disagreements between experts, and between health professionals and patients [31]
Patient decision aids [54] Systematic and transparent process of development allows users to check validity and reduce chance of causing harm and increase chance of benefit. Explicit that there is no hard evidence to support this rationale Decision support Based on a review of different approaches to developing decision aids, core features common to all are:
1. Scoping and design
2. Development of a prototype
3. Iterative ‘alpha’ testing by patients, clinicians and other stakeholders involved in the development
4. Iterative ‘beta’ testing in real-life contexts with patients and clinicians not involved in the development
5. Production of final version
The process is overseen by a multi-stakeholder group
More comprehensive than previous guides [54] Uncertainty remains about how best to address the individual elements of the guide [54]
Lack of detail about how to undertake different actions (INDEX)
Group interventions [55] More systematic approach to designing interventions Health improvement interventions or behaviour change interventions occurring in a group setting in public health and primary care Interventions are complex adaptive social processes with interactions between the group leader, participants, and the wider community and environment. When designing them consider:
1. What the intervention is and the quantity delivered
2. How someone becomes a group member
3. The social and behavioural theories that inform the intervention
4. How the group influences members’ attitudes, beliefs and behaviours. Existing theories may inform this, e.g. social support theory
5. The intended outcomes
6. Who should be the target population
Fills a gap in the evidence base [55]
Can be used in conjunction with another approach when delivery to groups is required (INDEX)
Framework also covers evaluation so there is a lack of detail about development (INDEX)
Details issues to think about rather than how to develop the intervention (INDEX)
8. Combination Participatory Action Research process based on theories on Behaviour Change and
Persuasive technology (PAR-BCP) [56]
Aids the integration of theories into a participatory action research design process because behaviour is hard to change Behaviour change systems for health promotion (possibly in digital health) Combines theory from two fields (behaviour change and persuasive technology) with a participatory action research methodology. A checklist includes
1. Understand and define the behaviour to target
2. Understand the target group’s experiences and attitudes towards the behaviour and intervention
3. Consider ease of use of intervention
4. Understand what kind of proactive feedback is needed to change behaviour
5. Understand how to visualise progress
6. Explore what about the patient-health professional relationship builds trust
7. Describe how social interactions can promote behaviour change
8. Evaluate prototypes
Brings together two categories of approach to intervention development: partnership and theory-based (INDEX) No detail on how to undertake actions (INDEX)
Although the label ‘participatory action research’ is used, some examples describe a target population centred approach (INDEX)
  1. aThese actions are summaries and readers are advised that source documents should be read to understand the detail of each approach