Editor's Note
May 28, 2024
Value in Optimizing the Components of App Interventions Before Final Testing
Heather Gwynn Allore, Mitchell H. Katz
JAMA Intern Med. Published online May 28, 2024. doi:10.1001/jamainternmed.2024.0833
Intensive care unit survivors are at increased risk of psychological distress, but few scalable interventions have been found effective. Interventions in behavioral health often have multiple components that may include how it is introduced, how often it is used, and how to respond when persons are worsening. A challenge in developing and testing these interventions is determining which aspects of the intervention are most useful.
Cox et al1 used a multiphase optimization strategy (MOST) methodological framework to assess which components of a mindfulness application (app) would be effective in reducing distress. Distress was based on the Patient Health Questionnaire. They found that twice-daily mindfulness training was more effective than once daily, but how the app was introduced and whether a person or the app responded to increased distress of the person did not affect distress at 1 month postdischarge.
Although the MOST framework was introduced more than a decade ago,2 it may be unfamiliar to many readers; it is a rigorous method for testing interventions with multiple components. The final step of the MOST framework is to conduct a randomized confirmatory trial that compares the optimized intervention to standard of care, which the authors of this article intend to do. While the MOST framework may seem cumbersome in requiring multiple studies, it may be the most efficient way of ultimately identifying an effective intervention.
