ABSTRACT
In this chapter, lessons learned on the use of Sequential Multiple Assignment Randomized Trials (SMARTs) to optimize behavioral interventions for the management of chronic conditions are shared. SMARTs offer a transparent assessment of complex, multicomponent, behavioral interventions by comparing intervention options at each critical decision point. Nevertheless, the sample size required in SMARTs to detect differences among adaptive interventions is still often smaller than what would be required for a series of independent RCTs, each addressing only one intervention option at a time. A SMART is ideal for developing adaptive self-management interventions tailored to the level of support individuals need. Both pilot SMARTs assessed the feasibility, acceptability, and clinical significance of an adaptive self-management intervention. For instance, in the CVD SMART, response could be defined as lower stress (distal outcome) as well as learning and applying at least one stress management strategy (proximal outcomes).
