Table 1 Key characteristics that distinguish health interventions, adjunctive interventions, and implementation strategies
Characteristics | Clinical/preventive/health intervention | Adjunctive intervention | Implementation strategy |
|---|---|---|---|
Target | • Directly influences recipients’ disease/condition outcomes of interest | • Influences recipient behaviors and may be needed to enable interaction with the intervention | • Influences implementer behaviors or the implementing system operations |
Primary outcomes | • Symptoms, biomarkers, infection, diagnosis, other health outcomes | • Recipient acceptability, uptake, utilization, adherence, completion, maintenance of the intervention | • Implementer adoption, reach, feasibility, fidelity, sustainment of the intervention |
Actions and causal processes | • Changes targets of disease/condition among recipients • Direct, proximal cause of change to the endpoint health outcome | • Changes recipients’ behavior/motivation/access to and/or enhances/facilitates engagement with the intervention • Distally impacts endpoint health outcome through receipt, adherence, and/or maintenance of the intervention, inert on its own | • Changes the way services and interventions are carried out as a result of implementer actions or system changes • Inert on endpoint health outcome, requires the health intervention to have impact |
Hierarchy/level | • Delivered by implementers in a delivery system • Requires the use of implementation strategies • Effects for some recipients may be enhanced by adjunctive interventions | • Delivered by a variety of different individuals (e.g., implementers, peers) and is commonly delivered using digital methods (e.g., text message, apps) • Requires the use of implementation strategies to support delivery • May be indicated for only a subset of health intervention recipients | • Actors of implementation strategies are wide ranging and can include individuals in the delivery system, external entities, and others • Supports the implementation of either/both the health intervention and the adjunctive intervention |
Indications | • Biomarkers/health indicators/risk assessment | • Innovation determinants (client-level barriers/facilitators) | • Implementation determinants (system-level barriers/facilitators) |