Entangled complexity: Why complex interventions are just not complicated enough

Abstract

The shift of health care burden from acute to chronic conditions is strongly linked to lifestyle and behaviour. As a consequence, health services are attempting to develop strategies and interventions that can attend to the complex interactions of social and biological factors that shape both. In this paper we trace one of the most influential incarnations of this 'turn to the complex': the Medical Research Council (MRC) guidance on developing and evaluating complex interventions. Through an analysis of the key publications, and drawing on social scientific approaches to what might constitute complexity in this context, we suggest that such initiatives need to adjust their conceptualisation of 'the complex'. We argue that complexity needs to be understood as a dynamic, ecological system rather than a stable, albeit complicated, arrangement of individual elements. Crucially, in contrast to the experimental logic embedded in the MRC guidance, we question whether the Randomised Controlled Trial (RCT) is the most appropriate method through which to engage with complexity and establish reliable evidence of the effectiveness of complex interventions.

Understanding the Context of Health for Persons With Multiple Chronic Conditions: Moving From What Is the Matter to What Matters

“…This heterogeneity of contextual factors is a conceptual and research challenge that requires understanding the health and health care of persons with MCC as a complex system in which contextual factors coevolve with time. [42][43][44][45][46][47][48][49] Although it may seem simpler to ignore multilevel contextual factors, a constricted, disease-specific focus risks making misattributions about cause, effect, and intervention points of leverage in the complex and adaptive system of persons living with MCC. 48 Identifying and then considering the most relevant factors from the domains of context outlined in Table 1 at all stages of the research process, from conceptualization to actualization to implementation and dissemination, and, finally, acting on the The second theme relates to achieving the needed paradigm shift.…”

A mixed-methods evaluation of transformational change in NHS North East

“…152 The research team shares the view that engaging with complexity is not simply a case of developing more carefully contructed efforts to capture additional data. Nor is it a case of developing more sophisticated models to establish causation or those factors which might account for complexity.…”

“…Nor is it a case of developing more sophisticated models to establish causation or those factors which might account for complexity. 152 The research team has wrestled with these issues. It is not enough to acknowledge the existence of complexity in health care, but it is necessary to find ways of engaging with its dynamic variability and constantly changing context.…”

“…Life was simply not the same after the NHS White Paper appeared in July 2010. 1 In short, as Cohn et al 152 put it, 'the challenge is how to go about studying complexity without fully unravelling it'.…”

Chronizität im Alltag der psychiatrischen Versorgung – eine Forschungskollaboration zwischen Sozialpsychiatrie und Europäischer Ethnologie

“…Synergien von experimentellen und beobachtenden Arbeitsweisen sollen genutzt werden, anstatt ihre Effekte als gegensätzlich zu betrachten und damit zu vergeuden (DFG, 2013;Cohn et al, 2013 Nachbereitungszeit und Mühe in der Aufbereitung der gewonnenen Beobachtungen (Emerson, 2001). …”