scholarly journals Understanding the complexity of population health interventions: assessing intervention system theory (ISyT)

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Linda Cambon ◽  
François Alla
Keyword(s):  
System Theory ◽  
Population Health ◽  
Complex Intervention ◽  
Causal Theory ◽  
Black Box ◽  
Health Interventions ◽  
Evaluation Design ◽  
Intervention Evaluation ◽  
Dependent Theory ◽  
Action Model

AbstractGiven their inherent complexity, we need a better understanding of what is happening inside the “black box” of population health interventions. The theory-driven intervention/evaluation paradigm is one approach to addressing this question. However, barriers related to semantic or practical issues stand in the way of its complete integration into evaluation designs. In this paper, we attempt to clarify how various theories, models and frameworks can contribute to developing a context-dependent theory, helping us to understand the black box of population health interventions and to acknowledge their complexity. To achieve this goal, we clarify what could be referred to as “theory” in the theory-driven evaluation of the interventional system, distinguishing it from other models, frameworks and classical theories. In order to evaluate the interventional system with a theory-driven paradigm, we put forward the concept of interventional system theory (ISyT), which combines a causal theory and an action model. We suggest that an ISyT could guide evaluation processes, whatever evaluation design is applied, and illustrate this alternative method through different examples of studies. We believe that such a clarification can help to promote the use of theories in complex intervention evaluations, and to identify ways of considering the transferability and scalability of interventions.

scholarly journals Understanding the complexity of population health interventions: assessing intervention system theory (ISyT)

2020 ◽  
Author(s):  
Linda Cambon ◽  
François ALLA
Keyword(s):  
System Theory ◽  
Grounded Theory ◽  
Population Health ◽  
Complex Intervention ◽  
Black Box ◽  
Health Interventions ◽  
Evaluation Design ◽  
Intervention Evaluation ◽  
Complete Integration ◽  
The Way

Abstract BackgroundA better understanding of what is happening inside the ”black box” of population health interventions is needed because of their inherent complexity. The theory-driven intervention/evaluation paradigm is one approach used for this purpose. However, barriers related to semantic or practical issues stand in the way of its complete integration into evaluation designs.Methods and discussionIn this study, we aimed to clarify how various theories, models, and frameworks could contribute to conceiving a grounded theory, called interventional system theory (ISyT), suitable for understanding the black box of population health interventions and acknowledging their complexity. We suggest that this interventional system theory (ISyT) could guide evaluation processes, whatever evaluation design is applied.ConclusionWe believe that such clarification could contribute to encouraging the use of theories in complex intervention evaluations, and to identifying ways to consider the transferability and the scalability of interventions.

scholarly journals OP80 Guidance for adapting evidence-informed population health interventions for new contexts: The ADAPT study

2020 ◽  
Author(s):  
G Moore ◽  
L Copeland ◽  
A Movsisyan ◽  
M Campbell ◽  
P Craig ◽  
...  
Keyword(s):  
Population Health ◽  
Health Interventions

scholarly journals ADAPT study: adaptation of evidence-informed complex population health interventions for implementation and/or re-evaluation in new contexts: protocol for a Delphi consensus exercise to develop guidance

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038965
Author(s):  
Mhairi Campbell ◽  
Graham Moore ◽  
Rhiannon E Evans ◽  
Dmitry Khodyakov ◽  
Peter Craig
Keyword(s):  
Population Health ◽  
Expert Opinion ◽  
Health Interventions ◽  
Institutional Research ◽  
Delphi Consensus ◽  
Policy Makers ◽  
Delphi Exercise ◽  
Complex Population ◽  
Methodological Considerations ◽  
The University

IntroductionComplex population health interventions that are effective in one context may not be effective elsewhere, and may even be harmful. As such, an intervention may require adaptation to ensure it fits with a new context. To date, there is no overarching guidance to help researchers to adapt and evaluate interventions in new contexts, and no criteria to support research funders or journals assess proposed or reported adaptations or evaluation. There is limited assistance for policy-makers and practitioners to decide if evidence-informed interventions are appropriate to their context, or if adaptation and further evaluation is needed. This Delphi exercise will contribute to the development of guidance for these communities to support the adaptation, implementation and/or re-evaluation of complex population health interventions in new contexts.MethodsWe will conduct a Delphi consensus exercise to gather expert opinion from researchers, research funders, journal editors and policy-makers. Expert opinion will be sought on: appropriate definitions and concepts, identifying key methodological considerations and establishing adaptations and processes to be undertaken during adaptation of complex population health interventions in new contexts.Ethics and disseminationEthics approval for the Delphi exercise has been obtained from the University of Glasgow and and the RAND institutional research board. Dissemination of the results of this study will be through peer-reviewed publications, workshops at national and international conferences, and a summary of the guidance developed for key organisations and stakeholders.

scholarly journals Using natural experimental studies to guide public health action: turning the evidence-based medicine paradigm on its head

2019 ◽  
Vol 74 (2) ◽  
pp. 203-208 ◽  
Author(s):  
David Ogilvie ◽  
Jean Adams ◽  
Adrian Bauman ◽  
Edward W. Gregg ◽  
Jenna Panter ◽  
...  
Keyword(s):  
Public Health ◽  
Population Health ◽  
Controlled Trial ◽  
Experimental Studies ◽  
Health Interventions ◽  
Evidence Based ◽  
Natural Experiments ◽  
Public Health Action ◽  
Randomised Study ◽  
Health Action

Despite smaller effect sizes, interventions delivered at population level to prevent non-communicable diseases generally have greater reach, impact and equity than those delivered to high-risk groups. Nevertheless, how to shift population behaviour patterns in this way remains one of the greatest uncertainties for research and policy. Evidence about behaviour change interventions that are easier to evaluate tends to overshadow that for population-wide and system-wide approaches that generate and sustain healthier behaviours. Population health interventions are often implemented as natural experiments, which makes their evaluation more complex and unpredictable than a typical randomised controlled trial (RCT). We discuss the growing importance of evaluating natural experiments and their distinctive contribution to the evidence for public health policy. We contrast the established evidence-based practice pathway, in which RCTs generate ‘definitive’ evidence for particular interventions, with a practice-based evidence pathway in which evaluation can help adjust the compass bearing of existing policy. We propose that intervention studies should focus on reducing critical uncertainties, that non-randomised study designs should be embraced rather than tolerated and that a more nuanced approach to appraising the utility of diverse types of evidence is required. The complex evidence needed to guide public health action is not necessarily the same as that which is needed to provide an unbiased effect size estimate. The practice-based evidence pathway is neither inferior nor merely the best available when all else fails. It is often the only way to generate meaningful evidence to address critical questions about investing in population health interventions.

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