Testing Psychosocial Interventions in the Contexts They Are Meant to Be Delivered

Prevention and intervention science often follow the linear pathway of preclinical or preintervention research—efficacy trials, effectiveness trials, and implementation studies—with the assessment of translation into public and population health impact occurring at the end (see Figure 1). This linear translational pathway follows stages developed for ascertaining safe, efficacious, and effective dosages for biological compounds (Fisher et al., 2015). This approach has created limitations in our need to rapidly deploy complex, multicomponent, multilevel approaches to change behavior and improve health into widespread practice for diverse clinical and public health settings. While it is important to use efficacy trials when safety is yet to be established, when the risks are identified to be low, as is often the case for psychosocial interventions, we can go faster to achieve equitable population health impact. We recommend that clinical trialists engaged in intervention development incorporate two considerations in the next generation of prevention and intervention research. First, consider moving right to effectiveness or pragmatic trials, as the most valid test of an intervention is the test of that intervention in the context(s) in which it is intended. Second, when designing effectiveness studies, consider investigating questions related to both effectiveness (i.e., does the intervention improve clinical outcomes) and implementation (i.e., what supports are needed to deploy the intervention routinely in that context) to accelerate impact (Curran et al., 2012, 2022).