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Table 4 Actions within designing and creating (based on all approaches in taxonomy)

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




3. Designing

9. Generate ideas about solutions, and components and features of an intervention [7, 17, 25,26,27, 30, 32, 33, 39, 40, 42]

Ways of generating ideas for the intervention differ based on the category of approach to intervention development:

Work with stakeholders creatively

Partnership and target population-centred approaches recommend bringing together a number of groups (e.g. patients, service providers and product designers) to generate diverse ideas for solutions from different perspectives. This is the central tenet of a co-design approach where patients are equal partners in the whole process rather than simply having their views sought [39,40,41]. Authors of partnership approaches propose that listening to all voices is important, that processes to ensure that this is undertaken in a meaningful way may be needed [40] and that active engagement of diverse groups of stakeholders is ongoing throughout the whole process [25, 42, 44, 45]. Encouraging all members of the development team to interact directly with members the target population can guide the development of solutions that are more relevant and acceptable to the target population [30]. Methods to engage stakeholders may involve the use of games/exercises/tasks to promote creativity [25, 30, 33, 40] and the iterative use of prototypes (see step 4).

Target population involvement in intervention development at this design domain is essential for authors of a range of approaches [7, 17, 25, 27, 30, 31, 42] with a proposal to make this involvement short and creative for busy people [25]. Starting with divergent thinking and moving to convergent thinking is proposed as a way of maximising the potential to identify the most powerful solutions [30].

Use theory

Theory and evidence-based approaches to intervention development recommend mapping behavioural determinants to behaviour change techniques. This is a key focus of the Behaviour Change Wheel, where lists of behaviour change techniques are given so that developers can identify intervention functions such as education or persuasion that can address the selected behaviours [26]. This is also a core action in Intervention Mapping with the construction of matrices to facilitate this action [27]. Matrices have been constructed by a group of experts for a specific behaviour change for a specific age group so that developers who are not experts in psychological theory can undertake this action [32]. Authors of some theory-based approaches advocate creative thinking as well as use of theory at this action [27]. A variety of theories rather than a single theory may be considered because one theory cannot explain everything of relevance [27]

10. Re-visit decisions about where to intervene

This can involve consideration of the different levels at which to intervene, and the wider system in which the intervention will operate [7, 17, 24, 26,27,28,29, 34, 54,55,56]

Consideration of where to intervene starts earlier at Action 4 but at this point final decisions need to be made. The authors of some approaches propose that this will require several team meetings but they are not always clear about who should be involved in these meetings. The ‘planning group’ [27] or ‘editorial group’ [31] may do this. Decisions are made about:

• the scope of the intervention

• the target population (this may be narrower or broader than at the Conception and Planning steps)

• levels at which the intervention is aimed: individual, community or population

• key features of the intervention (which may be components of other interventions)

• the components that will address the change required

• the amount of exposure needed to obtain effect

11. Make decisions about the content, format and delivery of the intervention [24, 26,27,28, 30, 31, 47, 48, 54, 55]

Ideas generated in Action 9 are prioritised for inclusion in the intervention. Decision-making can be guided by the involvement of stakeholders, and theory and evidence including theories on what motivates people to engage in processes as well as produce outcomes, and use of taxonomies of modes of delivering interventions and evidence of effectiveness of these modes. Spencer [40] recommends using small ‘action groups’ of stakeholders who can use their relevant expertise to build the solution to the problem identified. Feasibility, budget and time constraints can inform choices [27]. Authors of only one approach recommend a formal consensus exercise for decisions in the specific case where published research evidence is summarised within the intervention [31]. Issues identified for consideration here, based on a range of different approaches, include:

• what will be delivered (content)

• who will deliver it

• where it will be delivered

• how it will be delivered (format)

• how many times it will be delivered

• the point in any treatment or illness trajectory it will be delivered

• the order in which different parts of the intervention will be delivered

• the time period over which it will be delivered

• interactions between components

• how users will be recruited

• the resources available for delivery

• how implementers will be trained

• the potential for harm

• the meaning of fidelity

12. Design an implementation plan, thinking about who will adopt the intervention and maintain it [27, 48]

Consideration is given to implementation at the Planning domain (Action 7 earlier) but this action relates to establishing a formal implementation plan once the content, format and delivery of the intervention is known. Some authors recommend that this plan is based on the formative research undertaken earlier to understand barriers to implementation [48]. Others recommend basing this plan on a combination of theory and evidence from implementation science, and participation of stakeholders, to promote the use of the intervention in the real world [27]

4. Creating

13. Make prototypes or mock-ups of the intervention, where relevant [17, 25, 27, 30, 31, 33, 39, 40, 53, 54, 56, 59]

This action starts in the Design domain, and indeed is seen as an essential action in the Design domain by authors of some approaches. It is identified as a separate domain here because it is identified as such a key part of the process of intervention development by some authors. Testing prototypes can help developers to make decisions about the content, format and delivery of the intervention. It also continues into the Refining domain where refinements are made to prototypes as feasibility and acceptability is assessed. Authors of approaches to digital interventions recommend creating an early prototype of any physical intervention to get feedback from the target population using think aloud, usability testing, interviews or focus groups [17, 30, 57]. The prototype can be rough, e.g. paper copies of what a digital application could look like, and can be changed rapidly after feedback from stakeholders. These prototypes can generate further ideas for different prototypes as well as refine a current prototype. In some user-centred and digital approaches, authors recommend producing multiple rough and cheap prototypes at first and then reducing these down to a single prototype after stakeholder feedback [30, 33, 59]. They do this rather than focus on a single prototype too soon and call them ‘build to think’ prototypes [59].

If commercial designers are involved in creating prototypes, then differences in language and values between academia and commercial designers will need to be discussed, a contract established and decisions defined [53]