Abstract
BackgroundGuidelines on public health and health system interventions often involve considerations beyond effectiveness and safety to account for the impact that these interventions have on the wider systems in which they are implemented. This paper describes how a complexity perspective may be adopted in guideline development to facilitate a more nuanced consideration of a range of factors pertinent to decisions regarding public health and health system interventions. These factors include acceptability and feasibility, and societal, economic, and equity and equality implications of interventions.Main messageA 5-step process describes how to incorporate a complexity perspective in guideline development with examples to illustrate each step. The steps include: (i) guideline scoping, (ii) formulating questions, (iii) retrieving and synthesising evidence, (iv) assessing the evidence, and (v) developing recommendations. Guideline scoping using stakeholder consultations, complexity features, evidence mapping, logic modelling, and explicit decision criteria is emphasised as a key step that informs all subsequent steps.ConclusionsThrough explicit consideration of a range of factors and enhanced understanding of the specific circumstances in which interventions work, a complexity perspective can yield guidelines with better informed recommendations and facilitate local adaptation and implementation. Further work will need to look into the methods of collecting and assessing different types of evidence beyond effectiveness and develop procedural guidance for prioritising across a range of decision criteria.
Highlights
Step 1: guideline scoping Whether to take a complexity perspective is a decision that should be made by considering the topic and aims of a guideline and the needs of guideline users
We believe that a complexity perspective facilitates a more nuanced consideration of a range of questions that are pertinent to decisions regarding public health and health system interventions
Public health and health systems interventions often interact with and adapt to the system in which they are implemented; in assessing their impact, it is important to consider this wider system. In this step-by-step guide, we emphasise and recommend that guideline panels make investment in the early phase of guideline scoping. This will set the stage for subsequent steps, including timely collection, synthesis, and assessment of evidence
Summary
In this paper we describe the process and methods for developing guidelines from a complexity perspective. Public health and health systems interventions often interact with and adapt to the system in which they are implemented; in assessing their impact, it is important to consider this wider system In this step-by-step guide, we emphasise and recommend that guideline panels make investment in the early phase of guideline scoping. This paper provides general guidance on when and how to take a complexity perspective in guideline development It draws on examples of guidelines on public health and health system interventions and is likely to be of most relevance for guideline panels working on these types of interventions, the described steps can be applied to guidelines on clinical interventions if a guideline panel thinks that taking a complexity perspective may add value. As complexity is an evolving topic in public health and health systems research, more examples are needed of guidelines taking such a perspective
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