Components Of Complex Interventions Research Articles

Exploring synergistic interactions and catalysts in complex interventions: longitudinal, mixed methods case studies of an optimised multi-level suicide prevention intervention in four european countries (Ospi-Europe).

BackgroundThe Medical Research Council (MRC) Framework for complex interventions highlights the need to explore interactions between components of complex interventions, but this has not yet been fully explored within complex, non-pharmacological interventions. This paper draws on the process evaluation data of a suicide prevention programme implemented in four European countries to illustrate the synergistic interactions between intervention levels in a complex programme, and to present our method for exploring these.MethodsA realist evaluation approach informed the process evaluation, which drew on mixed methods, longitudinal case studies. Data collection consisted of 47 semi-structured interviews, 12 focus groups, one workshop, fieldnoted observations of six programme meetings and 20 questionnaires (delivered at six month intervals to each of the four intervention sites). Analysis drew on the framework approach, facilitated by the use of QSR NVivo (v10). Our qualitative approach to exploring synergistic interactions (QuaSIC) also developed a matrix of hypothesised synergies that were explored within one workshop and two waves of data collection.ResultsAll four implementation countries provided examples of synergistic interactions that added value beyond the sum of individual intervention levels or components in isolation. For instance, the launch ceremony of the public health campaign (a level 3 intervention) in Ireland had an impact on the community-based professional training, increasing uptake and visibility of training for journalists in particular. In turn, this led to increased media reporting of OSPI activities (monitored as part of the public health campaign) and also led to wider dissemination of editorial guidelines for responsible reporting of suicidal acts. Analysis of the total process evaluation dataset also revealed the new phenomenon of the OSPI programme acting as a catalyst for externally generated (and funded) activity that shared the goals of suicide prevention.ConclusionsThe QuaSIC approach enabled us to develop and refine our definition of synergistic interactions and add the innovative concept of catalytic effects. This represents a novel approach to the evaluation of complex interventions. By exploring synergies and catalytic interactions related to a complex intervention or programme, we reveal the added value to planned activities and how they might be maximised.

Conceptual decomposition of complex health care interventions for evidence synthesis: a literature review.

The clarity of pivotal concepts is an important prerequisite for the development, evaluation and exchange of scientific ideas. The term 'complex intervention' is increasingly used in the health care literature, although it often remains unclear what is actually meant by this concept. Therefore, our aim was to analyse the literature regarding definitions of the terms 'complex intervention' and 'components' of such interventions. To identify the methodological publications, systematic and snowballing techniques were combined for the literature search. Relevant units of meaning were extracted from 68 included publications. Afterwards, we deduced categories and related frequencies by inductive and quantitative content analysis techniques. Several types of complexity were distinguished in the literature. Most authors viewed complex interventions as multicomponent interventions that are characterized by interactions between the components themselves, with the context or as systemic interventions. Components of complex interventions were described in the publications as having the potential to causally influence outcomes, thus being essential for achieving an effect. Other definitions and inconsistencies among the definitions are highlighted and discussed. From our synthesis, we derived definitions of the central health care-related concepts 'complex intervention' and 'components' of an intervention. Although we found numerous diverse definitions, they could be reduced to a defined number of core characteristics. These characteristics may facilitate communication regarding complex interventions and enable the deduction of methodological approaches for evidence synthesis.

Mediation analysis of an adolescent HIV/STI/pregnancy prevention intervention

Most interventions designed to prevent HIV/STI/pregnancy risk behaviours in young people have multiple components based on psychosocial theories (e.g. social cognitive theory) dictating sets of mediating variables to influence to achieve desired changes in behaviours. Mediation analysis is a method for investigating the extent to which a variable X (e.g. intervention indicator) influences an outcome variable Y (e.g. unprotected sex) by first influencing an intermediate variable M (e.g. self-efficacy to use a condom) and provides a way for empirically validating theoretical hypothesised mediators. In this way, mediation analysis is a critical tool for suggesting which components of complex interventions should be the focus of more efficient and effective interventions in the future. The present study applied multilevel mediation analysis to outcome data from the All4You2! study to begin to examine the relationships between a theory-based HIV/STI/pregnancy prevention curriculum for students attending alternative high schools who were at risk of educational failure. The study targeted psychosocial mediating variables and the primary outcome unprotected sex in the past three months. Results suggest helping young people attending alternative schools identify and avoid exposure to risky situations and improving their self-efficacy to refuse sex should be focal points of future interventions.

Laparoscopic Sleeve Gastrectomy: An Ideal Procedure for Control of Morbid Obesity

Background: Sleeve gastrectomy is becoming increasingly popular within bariatric surgery. Initially introduced as a component of complex interventions and later as part of a twostage operation in high-risk patients, the procedure is now more common as one-stage operation and subject of avid scientific discussion. However, the concept of longitudinal gastric resection is not new. The procedure was already established in ulcer surgery but soon faded into insignificance. This article aims to trace the historical development of resection of the greater curvature and review the current value of sleeve gastrectomy within the spectrum of bariatric surgical procedures. Materials and methods: Extensive review of literature of articles published in english language was conducted using the following search engines: Google, Yahoo, Medline, PubMed, Medscape, HighWire press and the SpringerLink library available at the World Laparoscopy Hospital, Gurgaon, India. Articles that matched the criteria were selected for review. Results: Six reviews and 90 articles were selected and reviewed and analyzed to reach the conclusions. Conclusion: Laparoscopic sleeve gastrectomy is a safe and effective weight loss procedure. Resolution of comorbidity, healthrelated quality of life and food tolerance were comparable with that of Roux-en-Y gastric bypass with lower incidence of complications comparable to gastric banding. However, there is need for standardization of the procedure and long-term results are yet to be analyzed.

Fighting back or fighting themselves?: Community coalitions against substance abuse and their use of best practices

Ever the optimists (if not positivists), we continue to look to research to vindicate community health strategies in relation to chronic diseases, complex lifestyle changes and social problems, as they were vindicated in earlier decades against communicable diseases. If we had vaccines to deliver against chronic diseases and substance abuse behaviors, perhaps this hopefulness would be justified. The paper by Hallfors et al. in this issue of the AJPM describes an evaluation of the “Fighting Back” substance abuse initiative supported by the Robert Wood Johnson (RWJ) Foundation. They examined the extent to which coalitions attained selected substance abuse goals in 12 “Fighting Back” communities on which they tracked a variety of indicators through much of the 1990s. They employed a prospective design with multiple comparison communities for each coalition community, quantitative and qualitative methods, and thousands of interviews and observations. Despite all these strengths, lending credibility to the authors’ conclusions, some conceptual and methodologic limitations raise the usual doubts that follow randomized and otherwise controlled community trials, especially when they attempt to isolate one component of complex interventions as a causal explanation for success or failure. Other commentaries and analyses have grappled with the methodologic limitations and pitfalls of such research for purposes of studying community-wide interventions or interventions in communities evaluated at the community level. Some have called specifically into question the limitations of “traditional scientific methodology. . .to capture the outcomes of these complex collaborative organizations” called community coalitions. Others have addressed the problem of unrealistic expectations of community strategies in the short term. Our commentary will address some of the conceptual and procedural issues in understanding community coalitions, best practices, and their evaluation in communities. These are not entirely independent of methodological issues of evaluation, but we believe that we must know what we are attempting to measure and evaluate before we can make strategic and scientific decisions on how best to do so. We will comment, then, on two aspects of the evaluation: (1) the complexity-of-interventions issue in evaluating Fighting Back and the isolation of community coalitions as the common starting point in what became widely varied programs across the communities, and (2) the inflated expectations that follow from isolating community coalitions as the independent variable.