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

Abstract

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.

Study Protocol for the Evaluation of “SuperFIT”, a Multicomponent Nutrition and Physical Activity Intervention Approach for Preschools and Families

“…It also contains elements (e.g., on-the-job coaching) that directly assist childcare workers in its application in the context of their daily practice, and therefore stimulates implementation [76]. The extensive process evaluation will study these factors and try to understand the changes that occur within the system that may or may not lead to effects from the SuperFIT approach [77,78].…”

Evaluating health promotion in complex adaptive school systems

“…Before going into more detail on schools as complex adaptive systems and how we dealt with this in the reported studies, first more insight is provided regarding the concept of complexity. What is meant by complexity has been explained by other researchers by comparing a complicated and a complex problem [43,46]. Sending a rocket to the moon can be considered a complicated problem.…”

“…Resulting from the perspective that is embraced, several key assumptions are part of this programme theory. First, it is assumed that during the process of change, the school system tries to find a new balance: it tends to self-organize to a state of stability, either by pushing the change out of the school or by integrating the change into the school [43]. A second key assumption concerns non-linearity in the cause-effect relation: it is assumed that small changes in a school can produce large effects at a so-called 'tipping' point.…”

“…A second key assumption concerns non-linearity in the cause-effect relation: it is assumed that small changes in a school can produce large effects at a so-called 'tipping' point. A third assumption is that realized changes may shift the school's norms toward a focus on health and well-being, thereby creating momentum for additional HP changes [43]. This third assumption is visualized in the loop in the bottom of the programme theory.…”

“…To fully understand the content of the programme theory, one can best start on the left side of the model, which shows the input. This input can be seen as an 'event' that attempts to positively disrupt the pre-existing dynamics in the school context in order to integrate health promotion [43,54]. This school context should be understood as thoroughly as possible, because it determines the starting point of HPSF.…”