Abstract
Purpose Models of integrated care are prime examples of complex interventions, incorporating multiple interacting components that work through varying mechanisms to impact numerous outcomes. The purpose of this paper is to explore summative, process and developmental approaches to evaluating complex interventions to determine how to best test this mess. Design/methodology/approach This viewpoint draws on the evaluation and complex intervention literatures to describe the advantages and disadvantages of different methods. The evaluation of the electronic patient reported outcomes (ePRO) mobile application and portal system is presented as an example of how to evaluate complex interventions with critical lessons learned from this ongoing study. Findings Although favored in the literature, summative and process evaluations rest on two problematic assumptions: it is possible to clearly identify stable mechanisms of action; and intervention fidelity can be maximized in order to control for contextual influences. Complex interventions continually adapt to local contexts, making stability and fidelity unlikely. Developmental evaluation, which is more conceptually aligned with service-design thinking, moves beyond these assumptions, emphasizing supportive adaptation to ensure meaningful adoption. Research limitations/implications Blended approaches that incorporate service-design thinking and rely more heavily on developmental strategies are essential for complex interventions. To maximize the benefit of this approach, three guiding principles are suggested: stress pragmatism over stringency; adopt an implementation lens; and use multi-disciplinary teams to run studies. Originality/value This viewpoint offers novel thinking on the debate around appropriate evaluation methodologies to be applied to complex interventions like models of integrated care.
Highlights
Integrated care is a prime example of a complex intervention
Complex interventions like integrated care include multiple interacting components which impact on variable outcomes through multiple mechanisms of Emerald Publishing Limited 1476-9018
While incorporating process evaluations alongside trials may be useful to capture the many interacting components driving complex interventions, the underlying assumption of these approaches that we can clearly identify stable mechanisms of action; and get to a point, where we maximize fidelity in order to control for contextual influences, is problematic
Summary
Integrated care is a prime example of a complex intervention. These models seek to integrate services within and across organizational and professional boundaries, through the use of governance, system structures and innovative technology. While incorporating process evaluations alongside trials may be useful to capture the many interacting components driving complex interventions, the underlying assumption of these approaches that we can clearly identify stable mechanisms of action; and get to a point, where we maximize fidelity in order to control for contextual influences, is problematic.
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