Designing and evaluating complex interventions to improve health care

doi:10.1136/bmj.39108.379965.BE

BMJ 2007;334:455-459 (3 March), doi:10.1136/bmj.39108.379965.BE

Analysis

Designing and evaluating complex interventions to improve health care

Neil C Campbell, reader¹, Elizabeth Murray, director, e-health unit², Janet Darbyshire, director³, Jon Emery, professor of general practice⁴, Andrew Farmer, university lecturer⁵, Frances Griffiths, associate professor⁶, Bruce Guthrie, professor of primary care⁷, Helen Lester, professor of primary care⁸, Phil Wilson, senior clinical research fellow⁹, Ann Louise Kinmonth, professor of general practice¹⁰

¹ Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen AB25 2AY, ² Department of Primary Care and Population Sciences, University College London, London N19 5LW, ³ MRC Clinical Trials Unit, London NW1 2DA, ⁴ School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Claremont, Australia , ⁵ Department of Primary Health Care, University of Oxford, Oxford OX3 7LF, ⁶ Health Sciences Research Institute, University of Warwick, Coventry CV4 7AL, ⁷ Tayside Centre for General Practice, University of Dundee, Dundee DD2 4BF, ⁸ National Primary Care Research and Development Centre, Manchester M13 9PL, ⁹ Section of General Practice and Primary Care, University of Glasgow, Glasgow G12 9LX, ¹⁰ General Practice and Primary Care Research Unit, University of Cambridge, Cambridge CB2 2SR

Correspondence to: N Campbell n.campbell@abdn.ac.uk

Determining the effectiveness of complex interventions can bedifficult and time consuming. Neil C Campbell and colleaguesexplain the importance of ground work in getting usable results

The first 150 words of the full text of this article appear below.

Complex interventions are "built up from a number of components,which may act both independently and interdependently."¹ ² Manyhealth service activities should be considered as complex. Evaluatingcomplex interventions can pose a considerable challenge andrequires a substantial investment of time. Unless the trialsilluminate processes and mechanisms they often fail to provideuseful information. If the result is negative, we are left wonderingwhether the intervention is inherently ineffective (either becausethe intervention was inadequately developed or because all similarinterventions are ineffective), whether it was inadequatelyapplied or applied in an inappropriate context, or whether thetrial used an inappropriate design, comparison groups or outcomes.If there is a positive effect, it can be hard to judge how theresults of the trial might be applied to a different context(box 1).

The NHS Plan in 2000 suggested that by 2004, primarycare trusts in England should employ . . . [Full text of this article]

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Patient preference and trials of complex interventions: Hasnain M Dalal, et al.
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