Title |
Entangled complexity: Why complex interventions are just not complicated enough
|
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Published in |
Journal of Health Services Research & Policy, January 2013
|
DOI | 10.1258/jhsrp.2012.012036 |
Pubmed ID | |
Authors |
Simon Cohn, Megan Clinch, Chris Bunn, Paul Stronge |
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. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United Kingdom | 8 | 36% |
Switzerland | 1 | 5% |
Canada | 1 | 5% |
Netherlands | 1 | 5% |
Denmark | 1 | 5% |
Senegal | 1 | 5% |
Australia | 1 | 5% |
South Africa | 1 | 5% |
Unknown | 7 | 32% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 11 | 50% |
Scientists | 7 | 32% |
Practitioners (doctors, other healthcare professionals) | 4 | 18% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
United Kingdom | 4 | 2% |
Netherlands | 1 | <1% |
Belgium | 1 | <1% |
Unknown | 182 | 97% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 37 | 20% |
Student > Ph. D. Student | 36 | 19% |
Student > Master | 25 | 13% |
Student > Doctoral Student | 14 | 7% |
Other | 11 | 6% |
Other | 36 | 19% |
Unknown | 29 | 15% |
Readers by discipline | Count | As % |
---|---|---|
Social Sciences | 38 | 20% |
Medicine and Dentistry | 28 | 15% |
Nursing and Health Professions | 23 | 12% |
Psychology | 21 | 11% |
Business, Management and Accounting | 7 | 4% |
Other | 32 | 17% |
Unknown | 39 | 21% |