TY - JOUR AU - Thompson, Warren AB - Abstract Innovative methodological frameworks are needed in intervention science to increase efficiency, potency, and community adoption of behavioral health interventions, as it currently takes 17 years and millions of dollars to test and disseminate interventions. The multiphase optimization strategy (MOST) for developing behavioral interventions was designed to optimize efficiency, efficacy, and sustainability, while community-based participatory research (CBPR) engages community members in all research steps. Classical approaches for developing behavioral interventions include testing against control interventions in randomized controlled trials. MOST adds an optimization phase to assess performance of individual intervention components and their interactions on outcomes. This information is used to engineer interventions that meet specific optimization criteria focused on effectiveness, cost, or time. Combining CBPR and MOST facilitates development of behavioral interventions that effectively address complex health challenges, are acceptable to communities, and sustainable by maximizing resources, building community capacity and acceptance. Herein, we present a case study to illustrate the value of combining MOST and CBPR to optimize a multilevel intervention for reducing substance misuse among formerly incarcerated men, for under $250 per person. This integration merged experiential and cutting-edge scientific knowledge and methods, built community capacity, and promoted the development of efficient interventions. Integrating CBPR and MOST principles yielded a framework of intervention development/testing that is more efficient, faster, cheaper, and rigorous than traditional stage models. Combining MOST and CBPR addressed significant intervention science gaps and speeds up testing and implementation of interventions. Implications Practice: By combining MOST (multiphase optimization strategy) and CBPR (community-based participatory research) researchers can partner with practitioners and patients to develop behavioral health interventions and to improve community buy-in, efficiency, effectiveness, and sustainability. Policy: Policies seeking to improve adoption and quality of behavioral health interventions implemented in underserved communities should promote the use of MOST and CBPR principles in the development and implementation of behavioral health interventions. Research: Further inquiries are needed to document and improve the applications of CBPR principles and MOST in the development of behavioral health interventions. INTRODUCTION Innovative methodological frameworks are needed in the field of intervention science to increase efficiency, potency, and community adoption of behavioral health interventions. On average, it takes 17 years and 13 million dollars for an intervention to be tested and disseminated; even then, most are not successfully adopted [1]. Thus, we face several challenges in the field of intervention science with respect to the intervention development process, intervention uptake, and ultimate public health impact. Primary among these challenges is the need to improve the efficiency and potency of interventions and the need to better align interventions with community needs and perspectives [2, 3]. This paper describes and demonstrates a method that integrates community-based participatory research (CBPR) with the multiphase optimization strategy (MOST) to enhance behavioral intervention science. CBPR is a paradigm for engaging community members in every step of the research process in order to bring direct benefits to those communities and enhance the quality of research. This is accomplished through systematic knowledge-building activities within communities, such as trainings and critical group dialogue, which seek to merge experiential and scientific knowledge [4, 5]. MOST is a pioneering framework for developing behavioral interventions that uses engineering principles to optimize efficiency, efficacy, and sustainability [2]. Herein, we present an overview of existing intervention development models, and assert that combining MOST and CBPR provides user-friendly guidelines and principles for developing behavioral interventions that are efficient, effective, sustainable, and acceptable to communities. Combining CBPR and MOST can address significant intervention science gaps, speed up intervention testing and implementation, address sustainability barriers, and enhance the potency of these interventions by maximizing resources and building community capacity, while effectively addressing complex health challenges. To support our assertion, we provide a case study of the first implementation of combined MOST and CBPR principles to test and optimize a set of intervention components that form the basis of a new multilevel intervention that we call Community Wise. The components were designed to reduce substance misuse among formerly incarcerated men with substance use disorders. Findings from the optimization trial and input from community members, as described below, were used to inform decisions about which components to include in the optimized version of Community Wise. We conclude with a discussion of limitations and future research directions. Existing intervention development models Traditionally, behavioral interventions have been created and tested by following the three stages proposed by the intervention development program announced by the National Institutes of Health (NIH) [6]. The first stage involves the development of an intervention package (usually comprising multiple components), informed by a theoretical model and the literature (Stage I). This is followed by an efficacy test deploying rigorous and highly controlled randomized trial methodologies (Stage II), and concludes with a community-based effectiveness test deploying less controlled experimental methodologies (Stage III). This and similar models [7, 8] highlight a number of designs that can be used to test the interventions, with randomized controlled trials (RCT) considered to be the gold standard. Despite its importance, the RCT design has limitations. First, the RCT does not allow for the identification of mechanisms of change and interactions with precision. Importantly, RCTs are a useful design to establish causality. However, most behavioral health interventions include multiple components. For instance, some may include homework assignments, peer and professional co-facilitators, and drug therapy. The RCT is designed to show the effect of all the components as a whole on a given outcome. Consequently, if an intervention is found ineffective, it is not possible to determine if any of the components were “active,” or if any of the components had counterproductive effects on others. Further, using the RCT design to examine the main and interaction effects of multiple intervention components on a given outcome requires several trials with large samples. This approach would require resources that exceed the budget constraints of most NIH R01 series grants, and therefore, investigators typically examine the efficacy or effectiveness of a multicomponent intervention against a control in a two-armed trial. Further, as noted above, the lack of community buy-in for most interventions creates significant limitations to the development of behavioral health interventions and reduces their uptake in community settings. MOST The MOST framework was developed by Dr. Linda Collins and colleagues to help identify effective behavioral and biobehavioral interventions by improving the type and quality of data that intervention science produces [9, 10]. MOST is a framework implemented with a variety of research methods. It is grounded in resource management principles to maximize the reach of research dollars, and to create interventions that are efficient and effective. The scientific communities’ acceptance of the MOST framework is demonstrated by an estimated 57 unique federally funded MOST projects between 2012 and October of 2020 (NIH Reporter). The MOST framework includes all steps from the NIH intervention development model described above, with the addition of an optimization phase right after Stage I. Further, MOST provides research-informed, a-priori decision criteria to guide each stage. The first MOST stage starts with a preparation phase, where theory and prior research guide the development of a strong conceptual model that hypothesizes mediators and outcomes for each individual intervention component. This phase includes the development of an optimization criterion that determines the end-product to be achieved by optimizing the intervention. For instance, one may seek to identify the most promising components that can be delivered within a set number of sessions. The optimization criterion selected for the present study was the most potent intervention that can be conducted for ≤$250 per person. This cost ceiling was determined to maximize sustainability, and it was based on existing literature and market cost of outpatient substance use disorder treatment in New Jersey [11]. Next, in the optimization stage, a screening experiment is conducted to test the performance of the intervention components in changing the outcome within the constraints of the optimization criteria. Several methods such as factorial designs and adaptive interventions can be deployed [12]. Evaluating the effectiveness of individual intervention components, and their interactions, ultimately allows researchers to retain active components, and identify the best performing combination of components, within a set of parameters that meet the optimization criterion (e.g., a specific dollar amount or number of sessions). Once the intervention is optimized, the new packaged multicomponent intervention can be tested for efficacy and/or effectiveness using the RCT design. Thus, MOST allows for testing interaction effects (through the use of factorial screening experiments), requires consideration of practical constraints that can threaten sustainability, and offers rigorous data to further inform intervention component modification if none of the components are sufficiently useful [2]. In spite of these significant contributions to intervention science, MOST does not address all of the challenges mentioned above. For instance, MOST relies heavily in scientific methods, but does not include strategies that increase community buy-in of the intervention. CBPR, described in more detail below, addresses these challenges by including community voices in the research from the development stage, so that they can assist in developing intervention and research strategies that work for that particular community. CBPR In the early 2000s, substantial attention was given to the lack of representation of marginalized racial and gender groups in health treatment and research [13]. CBPR seeks to increase trust between community members and academics. CBPR researchers argued that members of marginalized communities accumulate invaluable experiential knowledge that had not been tapped by academic developers of interventions [3]. When community members and researchers work together to design and develop interventions, community input can shed light on potential obstacles (e.g., translation barriers) that would not otherwise be uncovered until Stage III research, or even later. With community/academic partnerships that follow CBPR principles, community service providers are more likely to trust the interventions and implement them into their practice. These interventions are more likely to include components that resemble social activities familiar to the community, making it easier for people to understand the activities and incorporate them into their daily lives [3]. Additionally, government officials and members of the business community, who contributed to the development of interventions, may be more willing to raise funds necessary to sustain these interventions once the research grants end. Research that follows CBPR principles has also been shown to improve participant recruitment, retention, and protocol adherence due to extensive training, contact hours among the research team and community members, and capacity building [14]. It is important to note that CBPR is not a research method. It is a paradigm that prescribes a set of principles guiding the implementation of myriad research methods. It has application with epidemiological, intervention, quantitative, or qualitative methodologies. CBPR principles guide researchers and community partners to include the voice of communities in every stage of the research process. This shared power helps build community capacity, ensure that community research is disseminated within and by the communities themselves, and promotes sustainability of the benefits resulting from the research [4]. Below we offer a case study that describes how we integrated MOST and CBPR to address the challenges described above. CASE STUDY: INTEGRATING AND IMPLEMENTING MOST AND CBPR PRINCIPLES In the case study presented in this paper, CBPR was implemented through the establishment of the Newark Community Collaborative Board (NCCB), a group of up to 20 members that included a number of stakeholders relevant to the board’s mission of improving health in the city of Newark, NJ. The board included service providers, interested community residents, drug treatment consumers, and researchers interested in combating health inequalities. The NCCB received training and oversaw all aspects of every study conducted by our research team following CBPR and MOST principles [15]. Over the past 10 years, the NCCB engaged the community in dialogue, identified community health problems, and developed candidate components for Community Wise following MOST. In Fig 1, we display the modified MOST mapping tool that we used to incorporate CBPR principles and best practices for efficient and effective intervention development. Below, we outline the CBPR/MOST steps we followed in each stage, to complete the Community Wise preparation and optimization phases (Stages 1 through 3 above). Fig 1 Open in new tabDownload slide | Mapping tool for the application of CBPR (community-based participatory research) and MOST (multiphase optimization strategy). Fig 1 Open in new tabDownload slide | Mapping tool for the application of CBPR (community-based participatory research) and MOST (multiphase optimization strategy). Preparation phase (Stages 1 and 2) Stage 1: Community engagement and infrastructure building In 2009, the first author decided to build a CBPR agenda, and identify health challenges related to substance misuse in Newark, NJ. The first step was to join community organizations and seek pilot funding for a small-scale project that promoted relationship building while gathering data about community needs and resources [16]. This work led to the formation of the NCCB, composed of researchers, service providers, consumers, and stakeholders, some of whom had personal histories of substance use and incarceration. The goal was to have a body as authentic as possible with respect to the aims of Community Wise [17]. Consistent with CBPR principles that balance experiential and scientific knowledge, the NCCB developed bylaws and received training on critical consciousness theory, grant writing, intervention development methods, and community issues. The NCCB includes a governance committee that is responsible for policy implementation and oversight, an engagement community responsible for community engagement activities and dissemination, and a sustainability committee responsible for bringing in new projects and working on grant proposals. All NCCB members received training in research ethics and were included as part of the research team for all applications submitted to the Institutional Review Board (IRB) at each partnering organization. All projects were approved by IRBs at partnering institutions, and only individuals providing either verbal or written informed consent were included in the research projects. Figure 2 illustrates the NCCB’s path for implementing CBPR and MOST principles. Fig 2 Open in new tabDownload slide | CBPR (community-based participatory research)/MOST (multiphase optimization strategy) integrated framework. Fig 2 Open in new tabDownload slide | CBPR (community-based participatory research)/MOST (multiphase optimization strategy) integrated framework. Stage 2: Intervention component development and pilot testing Between 2009 and 2014, the NCCB completed the preparation phase to gather community input and data about community health needs, and obtain funding to develop and test the intervention’s candidate components. These preparatory phase research projects included an ethnography on addiction among Black urban families, a community needs assessment, focus groups, photo-voice, and another ethnography about the transition from incarceration into the community [16, 18, 19]. Individual Committees, comprised of NCCB members, were established to implement these projects. Taskforces were established to accomplish specific goals, such as the development of the manual, recruiting committee members, developing measures, or writing a manuscript. Findings from NCCB’s research identified alcohol and illicit drug use, HIV infection, and incarceration as major challenges in Newark’s marginalized communities. Thus, Community Wise components addressed health inequalities stemming from substance misuse [20]. These included, but were not limited to, overrepresentation of racial minorities in the criminal justice system and HIV infection rates. Social determinants of health and critical consciousness theory informed Community Wise components. Thus, the intervention bundles recognized that substance use disorders and criminalized behaviors are caused by individual choices and structural barriers, such as discrimination. Race conflates with poverty in the USA, and formerly incarcerated people often return to economically distressed neighborhoods. Stigmatization and structural oppression pose major barriers to successful reentry and recovery and are not addressed by most interventions. Together, Community Wise components incorporated these structural barriers and individual behaviors into a multilevel group intervention delivered over the course of 15 weeks. The group intervention aimed to reduce the frequency of substance use among formerly incarcerated people, and empowered them to mobilize their communities to combat social determinants of health inequality. The group intervention, which was driven by critical consciousness theory, included a core component and three active components. The core component set the foundation for the active components to work. It included the first introductory session, an educational session about critical thinking, and the termination session. A critical-dialogue, a quality-of-life-wheel, and a capacity-building-project represented the three active components. In 2012, after working together for 2 years to develop intervention components and receive training, the NCCB secured a competitive grant funded by the Center for Behavioral Health Services and Criminal Justice Research at Rutgers University, which was funded by the National Institute on Mental Health. The pilot study tested all components as one, multicomponent, Community Wise intervention with 56 formerly incarcerated men and women with a history of substance use disorders. The grant application was conceptualized by the entire board. The subsequent proposal was drafted by two members of the NCCB, revised by four other board members, and approved by consensus by the entire board. The first Community Wise intervention manual, written by an NCCB task force, provided detailed instruction guidelines for delivery of 12 weekly sessions facilitated by licensed social workers who were NCCB members. A pre-experimental successive cohort design study tested the intervention feasibility with three groups: a female-only group, a male-only group, and a mixed-gender group. The second cohort tested a revised combination of components, informed by the first cohort, with a male-only group and a female-only group. Data were collected weekly, and focus groups were conducted at the end of the intervention. The findings were promising, showing moderate to large reductions of drug use over time, and high levels of intervention completion [15, 17]. Following CBPR principles, the NCCB revised the manual to incorporate findings from the second cohort data, following the same strategy used in the grant writing process. The intervention components were then operationalized separately. The intervention’s conceptual model was developed by the NCCB over the course of 6 months through a task force that met regularly, received training on intervention optimization, and consulted with a MOST expert. The NCCB reviewed relevant scientific literature and deployed experiential knowledge to collaboratively identify the target problem, the population of interest, the outcome, the environmental constraints and methodology, and to develop the intervention components and optimization criterion. Following the MOST framework guided by CBPR principles, the NCCB implemented a lean start-up model to conduct a market survey with stakeholders to identify contextual constraints to inform the optimization criterion and intervention implementation barriers. Stakeholders included service providers, state and federal government employees, consumers, and potential intervention funders. Intervention cost, complexity, and training requirements were identified as major implementation barriers. All members of the NCCB revised the intervention to ensure the manual was comprehensive enough to be implemented by peer facilitators. If successful, this would drive intervention costs down, create new employment opportunities for a hard-to-employ population, and simplify implementation. To ensure that Community Wise could be marketed according to best practices, and for a reasonable price, the NCCB also reviewed different models that were previously used to fund health interventions, such as substance use disorder treatments and HIV prevention. The involvement of community members in determining community constraints and identifying intervention components was critical to enhancing sustainability and making implementation feasible. The preparation phase was completed, and the intervention was ready to be optimized. The selection of optimization intervention components took place during NCCB meetings. NCCB members based their decisions on our current understanding of critical consciousness theory, the existing literature, the cost of delivery, the possible burden on participants, and qualitative data collected from Community Wise pilot session videos. Specifically, we selected the components: (1) that were identified by qualitative analysis of session videos as critical activities for increasing critical consciousness and reducing alcohol and illicit drug use among participants; (2) that had a clear financial cost; and (3) whose individual contribution to reduced substance misuse was unclear. These were developed into the three active components of Community Wise: (1) critical-dialogue; (2) quality-of-life-wheel, and (3) capacity-building-projects [20]. When the optimization criterion was selected, and Community Wise components were found to be feasible and safe, the research progressed to Stage 3. Optimization phase Stage 3: Optimization trial In 2014, the NCCB started work on a federal grant application that was funded by the National Institute on Minority Health and Health Disparities in 2016. Four members of the NCCB wrote the application, along with a methodologist and a statistician with expertise in factorial designs. All members of the NCCB reviewed the proposal prior to submission, revised the content, and approved the final project. The Community Wise optimization trial protocol has been published, and it contains a detailed description of the intervention components and trial’s methodology [20]; thus, here we only provide a brief summary. In MOST, discrete components were selected for testing. A component is any part of an intervention that can be separated out for study. In the present study, each component had two levels: “on” (i.e., the participant receives the component) or “off” (the participant does not receive this component). In Community Wise, we tested the following components: (a) critical-dialogue (6-weekly, 2-h-long group sessions); (b) quality-of-life-wheel (6-weekly, 1-h-long, group goal setting sessions); and (c) capacity-building-project (6-weekly, 1-h-long community organizing sessions). Moreover, we compared the effects of these components as delivered by peer versus licensed facilitators. We implemented a factorial design with four components, the three active intervention components in addition to the type of facilitator. Each of these four components had two levels. This generated a 2 × 2 × 2 × 2 design that yields a test of all 16 possible combinations of components. Participants were randomly assigned to one of 16 conditions, and each condition had a different combination of components. For instance, those randomized into condition 1 of 16 only received the Critical-Dialogue component, while those randomized to condition 16 received all three components. We used a screening experiment to detect the effects of individual components, and four-way interactions. Enrollment ended in September of 2019 with a sample of 604 formerly incarcerated men with a history of substance use disorder. Data from 5-monthly follow-up interviews were collected via Research Electronic Data Capture (REDCap) tools hosted at the University of Michigan (Grant #UL1TR002240). Data included standardized measures of substance use frequency, critical consciousness, self-efficacy, and demographics. Substance use frequency was the primary outcome. The NCCB played a major role in developing the optimization trial’s aims, including operationalizing intervention components, developing the theoretical framework, and identifying implementation constraints (in this case, the cost of intervention delivery and facilitator type). The NCCB participated in a full-day training on MOST, and conducted a retreat to develop the conceptual model. A task force consisting of five NCCB members assisted with operationalizing the components in consultation with the methodologist and statistician and writing up the manuals for delivery of each component. Each NCCB member who volunteered to participate in a task force, had the necessary skills to contribute, based on formal training or experiential knowledge. Another task force composed of 4 NCCB members vetted study staff, developed the recruitment protocol, and disseminated the study in the community. NCCB members had access to project data as needed to execute their tasks. The full board met every other month to learn about study progress, provide feedback, and consider new projects. The NCCB Engagement Committee helped create a Community Wise alumni group that was charged with sustaining community-based projects. Community Wise alumni can apply to become NCCB members and receive training on becoming Community Wise peer facilitators. Four alumni from the project became NCCB members. The NCCB is currently writing manuscripts, making presentations at conferences, and developing a continuing renewal grant application proposal to design and test the effectiveness phase of the MOST framework. Findings with a sample of 604 men indicated that the optimized manual should only include the critical-dialogue and capacity-building-project components delivered by a peer facilitator. Thus, we developed an optimized multicomponent intervention that warrants future testing on the outcome of substance use frequency among formerly incarcerated men. The next step (Stage 4) will test the intervention’s effectiveness against a comparison group, and develop implementation materials; this stage has not yet been completed. Effectiveness phase Stage 4: Effectiveness/implementation hybrid RCT In this stage, the NCCB will design a RCT informed by estimated effects, methodology, and intervention findings from the screening experiment. We are currently preparing a competing-continuation-renewal grant application to conduct the trial at multiple agencies. The goal of this grant application is to examine efficacy while expanding generalizability. Given resource management principles, and CBPR’s expectations to provide benefits to the community as early as possible, it is important to keep the time required for intervention development to a minimum. This is accomplished through: (1) the screening experiment, which is very useful for identifying potential methodology pitfalls and challenges, training staff in the community, and estimating effect sizes for the RCT and (2) by conducting research in the community, thereby maximizing the probability that intervention effects on outcome are likely to reflect real-world effects, and generate high-quality data to support the intervention. If the intervention is effective, it is ready for release. If not, it will have to go back to Stage 2 or Stage 3 for continued development (Fig 1). Funding CBPR and MOST The factorial design allowed us to optimize the intervention to minimize the cost of delivery and maximize the potency of the intervention. In order to identify the most appropriate constraints we would set for the optimization phase, the NCCB conducted interviews with service providers, insurance providers, and government employees who funded interventions in New Jersey. If further cost cuts are needed, the data can be used to determine the best combination of components to deliver the intervention within the revised budget. This maximizes the likelihood that agencies will adopt, and sustain, the intervention in the future. Thus, CBPR and MOST complement one another because both give equal consideration to scientifically rigorous information (e.g., intervention effects), and environmental needs and/or constraints (e.g., sustainability requirements such as cost, dosage, and feasibility). By combining CBPR with MOST, we (1) include the needs of the community as operationalized by the community, (2) employ rigorous and systematic scientific methods including a factorial design and, subsequently, a rigorous RCT to optimize and test the intervention’s efficacy, and (3) reduce participant burden and use of resources by selecting designs that emphasize efficiency. Over the past 9 years, the NCCB was able to secure approximately 3 million dollars to develop and optimize Community Wise. The next phase, the effectiveness/implementation hybrid trial, will last 5 years and likely cost another 4 million dollars. If the next project shows that Community Wise is effective, it will have taken 14 years from conceptualization to dissemination and 7 million dollars to develop, test, and disseminate the intervention. However, this was an underfunded process. We recommend at least 9 million dollars for development, optimization, and implementation testing of brand new interventions over 14 years. Because of advancements in MOST methodology, our original optimization sample size of 320 had to increase to 604 people in order to have enough power accounting for intra-class correlations. The NCCB had to figure out how to stretch the funding to cover the nearly doubled sample. One solution was to add a component to the design to examine if peer facilitators would be as effective as licensed facilitators, which reduced delivery costs. We also cut the research staff as much as possible. We have one project director who also served as the licensed facilitator, one outreach worker, and one peer facilitator who also assisted in outreach activities. Everyone assisted with data collection, and NCCB members stepped in as needed. These strategies significantly reduced the study’s costs. When comparing the development of Community Wise with the traditional intervention development model, we were able to save 5.5 million dollars and complete the work 4 years ahead of schedule. Figure 3 offers an illustrated comparison of the time and cost comparison of both models. Fig 3 Open in new tabDownload slide | Time and cost comparison between CBPR(community-based participatory research)/MOST (multiphase optimization strategy) and the traditional model. Fig 3 Open in new tabDownload slide | Time and cost comparison between CBPR(community-based participatory research)/MOST (multiphase optimization strategy) and the traditional model. Discussion Our experience showed how integrating MOST and CBPR made it possible to maximize sustainability and uptake by engaging the community and conducting community-based research during the first stages of intervention development and testing. Integrating CBPR and MOST principles yielded a framework of intervention development and testing that is more efficient, faster, cheaper, and rigorous than the traditional stage model. This integration merged experiential and cutting-edge scientific knowledge and methods, built community capacity, and promoted the development of an efficient intervention. This intervention only included effective components that could be delivered within the contextual constraints identified early on by community members and scientists. Perhaps one of the biggest challenges of intervention development is the need to sustain funding over several decades. Combining CBPR and MOST reduces this time and cost significantly by involving the community in all stages of the process, reducing implementation barriers, and optimizing interventions before testing for efficacy [2, 21]. MOST emphasizes efficiency and careful management of resources in the development of multicomponent behavioral interventions. By optimizing interventions through a screening experiment, researchers maximize study power to test the effects of various intervention components on an outcome. Then, only the most efficacious combination of components, given specific constraints, are retained in the efficacy trial. The data generated through this framework will go beyond the traditional efficacy data to include the ability to tease out individual contributions of specific intervention components and process and qualitative data informed by consumers and service providers alike at every stage of the process. Many of the challenges we faced while field-testing Community Wise under the CBPR and MOST frameworks are found in traditional intervention development models. However, merging CBPR and MOST facilitated the solutions because we had immediate access to community expertise, resources, and community partners who were ready and able to step in when necessary. The trust we developed in the Newark community over the past 10 years expanded our access to community resources, reduced the amount of time required to successfully launch the project, and offered us consultation with several knowledgeable individuals with complementary skills. In turn, we have been able to impact the community by writing articles and reports that illuminated challenges the community faces and revealed potential solutions. We have provided significant training to a large number of people who have joined community activities, and engaged in dialogue about social determinants of health and health inequalities. To date, we have had seven graduates of Community Wise serve as NCCB members. Another three worked as group facilitators. Their participation in making decisions about addressing challenges was uniquely valuable because of their familiarity with the intervention and with the community. The Community Wise optimization study highlights community members as effective partners in scientific research. Through the NCCB, researchers and community members were able to develop relationships that fostered trust. Through training, all NCCB members were able to grasp the concepts of randomization, testing combinations of components, participant confidentiality, and optimization. Working together facilitated the development of practical intervention components and the optimized intervention while also improving the quality of data generated. The optimization phase resulted in rich data that will inform future studies. Acknowledgments The authors acknowledge the contributions of the Newark Community Collaborative Board and research staff including Steve Morris, Darris Hawkins, and Letitia McBride. We also acknowledge Chris Papasian’s editorial contributions to this paper. Funding Research reported in this publication was supported in full by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under award number 5R01MD010629. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Compliance with Ethical Standards Conflicts of Interest: The authors declare that there is no conflict of interest. Author Contributions: Dr. Windsor served as principal investigator (PI) in all studies described in the case study; developed the initial outline for the paper; and took charge of coordination of the manuscript development and submission. Dr. Benoit served as PI in the optimization phase, and assisted developing the CBPR sections. Dr. Pinto served as co-investigator and assisted with development of the CBPR and intervention science topics. Dr. Gwadz serves as an advisor on the optimization study and co-wrote all MOST sections of the paper. Mr. Thompson is a member of the NCCB and assisted with describing the process and community perspective throughout the paper. All authors contributed to the overall arguments and editing of the paper. Human Rights: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent: Informed consent was obtained from all individual participants included in the study. 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All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) TI - Enhancing behavioral intervention science: using community-based participatory research principles with the multiphase optimization strategy JF - Translational Behavioral Medicine DO - 10.1093/tbm/ibab032 DA - 2021-04-10 UR - https://www.deepdyve.com/lp/oxford-university-press/enhancing-behavioral-intervention-science-using-community-based-7fJvPgPnTG SP - 1 EP - 1 VL - Advance Article IS - DP - DeepDyve ER -