All interventions are complex, but some are more complex than others: using iCAT_SR to assess complexity

Moore, Graham; Evans, Rhiannon; Hawkins, Jemma; Littlecott, Hannah; Turley, Ruth

doi:10.1002/14651858.ed000122

Cited by 15 publications

(13 citation statements)

References 15 publications

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“…Recent years have seen much debate about where complexity resides in social intervention research (Moore et al, 2017). Original MRC guidance (Campbell et al, 2000) located complexity within the components of an intervention, contrasting ‘complex’ multi-component programmes with ‘simple’ mono-component drug therapies.…”

Section: What Is a Complex Social Intervention?mentioning

confidence: 99%

“…Complex interventions in complex social systems pose almost infinite uncertainties (Moore et al, 2017), and there will always be much going on outside of the field of vision of an individual study. However, a focus on discrete impacts of system change does not necessarily betray a naïve view of how systems work, but may simply reflect a pragmatic focusing of research on core uncertainties.…”

Section: What Does a Systems Lens Mean For Intervention Development Amentioning

confidence: 99%

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From complex social interventions to interventions in complex social systems: Future directions and unresolved questions for intervention development and evaluation

et al. 2018

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Complex systems approaches to social intervention research are increasingly advocated. However, there have been few attempts to consider how models of intervention science, such as the UK’s Medical Research Council complex interventions framework, might be reframed through a complex systems lens. This article identifies some key areas in which this framework might be reconceptualized, and a number of priority areas where further development is needed if alignment with a systems perspective is to be achieved. We argue that a complex systems perspective broadens the parameters of ‘relevant’ evidence and theory for intervention development, before discussing challenges in defining feasibility in dynamic terms. We argue that whole systems evaluations may be neither attainable, nor necessary; acknowledgment of complexity does not mean that evaluations must be complex, or investigate all facets of complexity. However, a systems lens may add value to evaluation design through guiding identification of key uncertainties, and informing decisions such as timings of follow-up assessments.

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Section: What Is a Complex Social Intervention?mentioning

confidence: 99%

Section: What Does a Systems Lens Mean For Intervention Development Amentioning

confidence: 99%

From complex social interventions to interventions in complex social systems: Future directions and unresolved questions for intervention development and evaluation

et al. 2018

Self Cite

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“…Complex interventions are hard to reproduce [3] and identifying the 'active ingredients' is challenging [17]. Essential elements of complex health interventions have been identified [18] and appear in our adapted TiIDier checklist from the multiple clinical trials that established the intervention efficacy. The same two physical therapists identified the active ingredients (Table 1) and came to consensus of the items informed by a series of randomized controlled trials by our research team which led to the development of FAME.…”

Section: Discussionmentioning

confidence: 99%

Evaluation and facilitation of intervention fidelity in community exercise programs through an adaptation of the TIDier framework

Bird

Eng

2020

BMC Health Serv Res

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Background: Despite high quality evidence supporting multiple physical and cognitive benefits of communitybased exercise for people after stroke, there is little understanding on how to facilitate uptake of these research findings to real-world programs. A common barrier is a lack of standardised training for community fitness instructors, which hampers the ability to train more instructors to deliver the program as it was designed. Scaling up program delivery, while maintaining program fidelity, is complex. The objective of this research is to explore novel use of the Template for Intervention Description and Replication (TIDier) framework to evaluate and support implementation fidelity of a community exercise program. Methods: We embedded intervention fidelity evaluation into an inaugural training program for fitness instructors who were to deliver the Fitness and Mobility Exercise Program for stroke, which has established efficacy. The training program consisted of a face-to-face workshop followed by 3 worksite 'audit and feedback coaching cycles' provided over 3 iterations of the 12-week program offered over 1 year. A modified TIDIER checklist (with 2 additional criteria) was used within the training workshop to clarify the key 'active ingredients' that were required for program fidelity, and secondly as a basis for the audit and feedback process enabling the quantitative measurement of fidelity. Data were collected from audits of observed classes and from a survey provided by fitness instructors who implemented the program. Results: We demonstrated the feasibility of the TIDier checklist to capture 14 essential items for implementation evaluation of a complex exercise intervention for people with chronic health conditions over 3 iterations of the program. Based on the audit tool, program fidelity was high and improved over time. Three content areas for workplace coaching (intensity monitoring, space, and educational tips) were identified from the audit tool and were addressed. Conclusion: Training of staff to deliver exercises to high need populations utilising workshops and workplace coaching that used the TIDier framework for training, onsite audit and feedback resulted in a high level of fidelity to the program principles. A novel checklist based on the TIDier framework was useful for embedding implementation fidelity in complex community-based interventions.

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“…A multicomponent intervention is not merely a discrete package of separate components, but a process of changing what complex systems do [18]. Intervening within a complex system involves disrupting prior ways of working while introducing new ones [19].…”

Section: Rationale For the Present Trialmentioning

confidence: 99%

“…Implementation seminars will be held at months 0, 6 and 12, and midway evaluation at months 3, 9 and 15. Data will be collected at baseline (month 0), after the first intervention period (month 6-7), after the second intervention period (month 12-13), after the third intervention period (month [18][19] and at the end of the study at 24 months. b Schedule of enrollment, interventions and assessments over the study period while caregiver psychiatric symptoms will be selfreported using the Geriatric Depression Scale (GDS) [78] in addition to the RSS [67].…”

Section: Outcome Measuresmentioning

confidence: 99%

LIVE@Home.Path—innovating the clinical pathway for home-dwelling people with dementia and their caregivers: study protocol for a mixed-method, stepped-wedge, randomized controlled trial

Husebø

Allore

Achterberg

et al. 2020

Trials

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Background: The global health challenge of dementia is exceptional in size, cost and impact. It is the only top ten cause of death that cannot be prevented, cured or substantially slowed, leaving disease management, caregiver support and service innovation as the main targets for reduction of disease burden. Institutionalization of persons with dementia is common in western countries, despite patients preferring to live longer at home, supported by caregivers. Such complex health challenges warrant multicomponent interventions thoroughly implemented in daily clinical practice. This article describes the rationale, development, feasibility testing and implementation process of the LIVE@Home.Path trial. Methods: The LIVE@Home.Path trial is a 2-year, multicenter, mixed-method, stepped-wedge randomized controlled trial, aiming to include 315 dyads of home-dwelling people with dementia and their caregivers, recruited from 3 municipalities in Norway. The stepped-wedge randomization implies that all dyads receive the intervention, but the timing is determined by randomization. The control group constitutes the dyads waiting for the intervention. The multicomponent intervention was developed in collaboration with user-representatives, researchers and stakeholders to meet the requirements from the national Dementia Plan 2020. During the 6-month intervention period, the participants will be allocated to a municipal coordinator, the core feature of the intervention, responsible for regular contact with the dyads to facilitate L:

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All interventions are complex, but some are more complex than others: using iCAT_SR to assess complexity

Cited by 15 publications

References 15 publications

From complex social interventions to interventions in complex social systems: Future directions and unresolved questions for intervention development and evaluation

From complex social interventions to interventions in complex social systems: Future directions and unresolved questions for intervention development and evaluation

Evaluation and facilitation of intervention fidelity in community exercise programs through an adaptation of the TIDier framework

LIVE@Home.Path—innovating the clinical pathway for home-dwelling people with dementia and their caregivers: study protocol for a mixed-method, stepped-wedge, randomized controlled trial

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