Background: The reporting of intervention implementation in studies included in systematic reviews of organisational-level workplace interventions was appraised. Implementation is taken to include such factors as intervention setting, resources, planning, collaborations, delivery and macro-level socioeconomic contexts. Understanding how implementation affects intervention outcomes may help prevent erroneous conclusions and misleading assumptions about generalisability, but implementation must be adequately reported if it is to be taken into account. Methods: Data on implementation were obtained from four systematic reviews of complex interventions in workplace settings. Implementation was appraised using a specially developed checklist and by means of an unstructured reading of the text. Results: 103 studies were identified and appraised, evaluating four types of organisational-level workplace intervention (employee participation, changing job tasks, shift changes and compressed working weeks). Many studies referred to implementation, but reporting was generally poor and anecdotal in form. This poor quality of reporting did not vary greatly by type or date of publication. A minority of studies described how implementation may have influenced outcomes. These descriptions were more usefully explored through an unstructured reading of the text, rather than by means of the checklist. Conclusions: Evaluations of complex interventions should include more detailed reporting of implementation and consider how to measure quality of implementation. The checklist helped us explore the poor reporting of implementation in a more systematic fashion. In terms of interpreting study findings and their transferability, however, the more qualitative appraisals appeared to offer greater potential for exploring how implementation may influence the findings of specific evaluations. Implementation appraisal techniques for systematic reviews of complex interventions require further development and testing.The case has been made for providing policymakers with synthesised, detailed and robust accounts of the implementation of effective interventions in order to make better progress in tackling population morbidities and inequalities. Advocates of a staged approach to the development and evaluation of complex interventions have also stressed the importance of accurately defining interventions and promoting effective implementation.2 Implementation refers to the design and delivery of interventions. [3][4][5][6] The way an intervention is implemented may influence its outcomes, and evaluations that do not take this into account risk (for example) misinterpreting negative outcomes that result from poor implementation as evidence that interventions are inherently ineffective.7 8 We developed a tool to appraise the quality of reporting of implementation and applied this tool to four systematic reviews of complex intervention evaluations affecting the workplace.
Implementation and complex interventionsResearchers and policy-makers ha...
Objective: To systematically review the health and psychosocial effects (with reference to the demandcontrol-support model) of changes to the work environment brought about by task structure work reorganisation, and to determine whether those effects differ for different socioeconomic groups. Design: Systematic review (QUORUM) of experimental and quasi-experimental studies (any language) reporting health and psychosocial effects of such interventions. Data sources: Seventeen electronic databases (medical, social science and economic), bibliographies and expert contacts. Results: Nineteen studies were reviewed. Some task-restructuring interventions failed to alter the psychosocial work environment significantly, and so could not be expected to have a measurable effect on health. Those that increased demand and decreased control tended to have an adverse effect on health, while those that decreased demand and increased control resulted in improved health, although some effects were minimal. Increases in workplace support did not appear to mediate this relationship. Conclusion: This systematic review suggests that task-restructuring interventions that increase demand or decrease control adversely affect the health of employees, in line with observational research. It lends support to policy initiatives such as the recently enforced EU directive on participation at work, which aims to increase job control and autonomy.
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