Title: Complexity in Health Improvement
Funder: Medical Research Council

Abstract: Aims and objectives We aim to lead international efforts in the application of novel methods to: (1) identify the most effective means to improve population health and reduce inequalities; and (2) understand how effectiveness might vary across contexts. We have four objectives: 1. To improve processes and methods to rigorously develop and evaluate theoretically-based complex public health interventions, to routinely incorporate evaluability assessment into the development stages of major new policy programmes, and ensure that evaluations identify what works, for whom, under what circumstances and why. 2. To formulate general principles about the transferability of interventions, by identifying: which aspects of setting, target group or problem have insignificant impact on effectiveness, which can be addressed through intervention adaptation without loss of effectiveness, and which prevent interventions being effective when transferred. 3. To develop and apply network analysis methods and complex systems science to better understand and model the interdependent relationship between multiple determinants of health and behavior and the generation of health inequalities. This will include a focus on social influences on behavior and on alcohol use. 4. To build capacity in the development and evaluation of complex public health interventions and in complex systems science methods, through: staff and student training, developing advanced courses, and leading collaborative networks to develop and share the high quality implementation of these methods. Research plan and methodology There will be three complementary themes. The first will seek to improve methods to support the design and conduct of evaluations of complex interventions, particularly through pragmatic or realist randomised trial designs. In these evaluations, form can vary, external validity is maximised, and there is a focus on understanding and explaining heterogeneity. In particular, interventions are theorised and evaluated in terms of their dependence on context, implementation and differential effectiveness across individuals and populations. This theme will prioritise interventions tackling obesity and alcohol use; using new technology; or targeting health behavior among those with serious mental illness. Our second theme will further investigate issues of transferability across context, with a particular focus on the transferability of parenting interventions to and from resource-poor settings, notably Africa. These first two themes will largely be concerned with interventions that have multiple components and in developing theoretical and empirical evidence of both their effectiveness and their dependence on external factors. The third theme will focus on complex systems theory and related systems science methods, to develop approaches that comprehensively account for complexity and facilitate a broader conception of the multiple, modifiable influences on population health and health inequalities. This theme will also include a focus on the co-evolution of social networks and health.


Research activity codes: 1.2 PSYCHOLOGICAL AND SOCIOECONOMIC PROCESSES
Health categories: GENERIC HEALTH RELEVANCE