Developing a Psychological-Behavioral Intervention in Cardiac Patients Using the Multiphase Optimization Strategy: Lessons Learned From the Field

Ann Behav Med. 2020 Feb 21;54(3):151-163. doi: 10.1093/abm/kaz035.


Background: The Multiphase Optimization Strategy (MOST) is an approach to systematically and efficiently developing a behavioral intervention using a sequence of experiments to prepare and optimize the intervention.

Purpose: Using a 6 year MOST-based behavioral intervention development project as an example, we outline the results-and resulting decision-making process-related to experiments at each step to display the practical challenges present at each stage.

Methods: To develop a positive psychology (PP) based intervention to promote physical activity after an acute coronary syndrome (N = 255 across four phases), we utilized qualitative, proof-of-concept, factorial design, and randomized pilot experiments, with iterative modification of intervention content and delivery.

Results: Through this multiphase approach, we ultimately developed a 12 week, phone-delivered, combined PP-motivational interviewing intervention to promote physical activity. Across stages, we learned several important lessons: (a) participant and interventionist feedback is important, even in later optimization stages; (b) a thoughtful and systematic approach using all information sources is required when conflicting results in experiments make next steps unclear; and (3) new approaches in the field over a multiyear project should be integrated into the development process.

Conclusions: A MOST-based behavioral intervention development program can be efficient and effective in developing optimized new interventions, and it may require complex and nuanced decision-making at each phase.

Keywords: Intervention development; Motivational interviewing; Multiphase optimization strategy; Optimization; Physical activity; Positive psychology.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Coronary Syndrome / rehabilitation*
  • Exercise*
  • Feasibility Studies
  • Humans
  • Motivational Interviewing* / methods
  • Outcome and Process Assessment, Health Care*
  • Pilot Projects
  • Proof of Concept Study
  • Psychology, Positive* / methods
  • Psychosocial Intervention* / methods
  • Qualitative Research