From intervention to interventional system: towards greater theorization in population health intervention research

Abstract

BackgroundPopulation health intervention research raises major conceptual and methodological issues. These require us to clarify what an intervention is and how best to address it.This paper aims to clarify the concepts of intervention and context and to propose a way to consider their interactions in evaluation studies, especially by addressing the mechanisms and using the theory-driven evaluation methodology.Main textThis article synthesizes the notions of intervention and context. It suggests that we consider an “interventional system”, defined as a set of interrelated human and non-human contextual agents within spatial and temporal boundaries generating mechanistic configurations – mechanisms – which are prerequisites for change in health. The evaluation focal point is no longer the interventional ingredients taken separately from the context, but rather mechanisms that punctuate the process of change. It encourages a move towards theorization in evaluation designs, in order to analyze the interventional system more effectively. More particularly, it promotes theory-driven evaluation, either alone or combined with experimental designs.ConclusionConsidering the intervention system, hybridizing paradigms in a process of theorization within evaluation designs, including different scientific disciplines, practitioners and intervention beneficiaries, may allow researchers a better understanding of what is being investigated and enable them to design the most appropriate methods and modalities for characterizing the interventional system. Evaluation methodologies should therefore be repositioned in relation to one another with regard to a new definition of “evidence”, repositioning practitioners’ expertise, qualitative paradigms and experimental questions in order to address the intervention system more profoundly.

Dimensions of the Complexity of Health Interventions: What Are We Talking about? A Review

“…Our review of experiences and practices, as reported in the articles, emphasises the perceived importance of such interactions in terms of intervention effects. This is consistent with the view that a complex intervention is an "event in a system" [2,9,14]. Pragmatic operational approaches are being developed to consider context in developing, evaluating and adapting interventions [17,26,27].…”

“…Recognising the system characteristics, Cambon et al suggest, in their approach to complexity, replacing the term "intervention" with "intervention system" [14]. An intervention system was defined as a set of interrelated human and nonhuman contextual agents within certain spatial and temporal boundaries that generate mechanistic configurations (mechanisms) that are prerequisites for changes in health.…”

Housing as a social determinant of health and wellbeing: developing an empirically-informed realist theoretical framework

“…Whilst we can attempt to understand the mechanisms which may generate health and wellbeing outcomes, it is neither possible nor practically useful to attempt to separate 'intervention' elements from the complex open system within which they take place. Rather, we used RE in order to examine the 'interventional systems' [46] within which health and wellbeing change may be generated for and by tenants.…”

WITHDRAWN: Understanding the complexity of population health interventions: assessing intervention system theory (ISyT)

“…However, population health interventions (PHIs) are generally considered complex, as they include several components interacting with one another to produce a number of outcomes (3). Moreover, beyond the interventional components, the intervention should not be isolated from the speci c context in which it is implemented (4,5,3). Indeed, rather than an intervention, it should be considered an "interventional system" (5,6) that includes pre-existing contextual parameters, which could be within or outside the control of intervention developers and implementers.…”