Background
depression, preventionIn, apathy
DAWSON
Research Electronic Data Capture (REDCap) is a secure, browser-based web application available to approximately 2.3 million users in 151 countries. [Bio-behavioral interventions delivered by professionals in the real world setting normally involve a sequential and individualized approach in which interventions like prevention and treatment strategies are adapted and re-adapted over time in response to the specific needs and evolving status of the client. For instance, suppose a clinician starts a client who is suffering from depression in psychotherapy, an evidence-based intervention. After 30 days, the client has not experienced any improvement and has not been attending sessions consistently. The clinician needs to decide whether to continue the psychotherapy or add medication, another evidence-based intervention, to the treatment plan.Most health intervention clinical trials have focused on testing individual level interventions such as psychotherapy or specific pharmacological therapy on their dosing and format which are then offered to the general population after the successful completion of the clinical trials. [Recently, adaptive interventions have emerged as a new means of providing research-based prevention and treatment. [Sequential Multiple Assignment Randomization Trial (SMART) was established as a research strategy for developing and testing adaptive interventions. It was initially introduced as “biased coin adaptive within-subject designs” by Lavori and Dawson, with the general framework proposed by Murphy. [
What is the best sequencing of intervention components?Which tailoring variables should be used?How frequently, and at what times, should tailoring variables be reassessed and an opportunity for changing amount and/or type of intervention be presented?Is it better to assign treatments to individuals, or to allow them to choose from a menu of treatment options?The SMART approach enables intervention scientists to address such questions holistically and rigorously by considering the order in which intervention components are presented rather than considering each intervention component in isolation. In this way, a SMART approach provides an empirical basis for selecting appropriate decision rules and tailoring variables, with the end goal of developing evidence-based adaptive intervention strategies to be evaluated in subsequent RCTs. [There are two common SMART designs: (a) all participants are re-randomized following initial treatment; and (b) only participants who failed to respond to their initial treatment are re-randomized and the rest continue their initially assigned treatment. In Fig. 
COVID-19 Optimization Study Design Using SMART Method. Navigation: NS include assessment and support with service referrals. Each participant will meet with a peer navigator in person or on Zoom conferencing for 30 min to go over the results from their social and health needs assessment that is retrieved from the baseline survey. The navigator shares information about COVID-19, answers questions about testing, and makes. referrals to other needed services. Follow-up sessions occur as needed. *Brochure: A digital brochure will consist of a brochure containing CDC public health recommendations that is e-mailed or tested to participants immediately after randomization. The brochure includes information about COVID-19, testing, and vaccines. *Critical dialogue: CD includes three 1 h long, open-group sessions facilitated in person or online by a trained licensed facilitator. Group critical dialog is promoted by thematic images to foster a deeper understanding of how systematic stigma, feelings of rage as victims of discrimination, and/or apathy may impact participants’ beliefs and behaviors related to COVID-19 and empower participants to make critical choices to protect their health and the health of their communities. *Brief counseling: BC is a 15 min post-COVID-19 test session delivered by a trained licensed clinician in person or via Zoom conferencing. In the session, the clinician shares the test results and offers recommendations and information about COVID-19 treatment and preventionIn both designs, SMARTs are characterized by various treatment sequences. Automated randomizations can save time and reduce human error that can impede researchers’ ability to follow participants and engage them in research. However, automated implementation software solutions for SMARTs remain scarce. One significant challenge for SMART design study is the availability of affordable and accessible software capable of conducting automated randomization. [