Complex<br />interventions<br />Anders Ringnér<br />R.N., PhD Student<br />
Background and history<br />First MRC paper<br />from 2000<br />Updated in 2008<br />(937 citations)<br />(200 citations)<...
Examples<br />Rehabilitation units for stroke patients<br />Self-study to decrease disturbing behaviour among people with ...
Where is the complexityin a complex intervention?<br />Takes place in a naturalistic setting<br />Several...<br />componen...
Differences<br />
The MRC model<br />
Development<br />Identifying the evidence base<br />Identifying/developing theory<br />Modelling process and outcomes<br />
Modelling– an example<br />Intervention points and behaviour change techniques<br />Casual model<br />Measures for evaluat...
Identifying salient beliefs towards behaviour change
Reinforcing positive beliefs
Problem solving in relation to negative beliefs</li></ul>Attitude towards behaviour<br />Subjective norm<br />Perceived be...
Self-monitoring
Self-reinforcement
Goal review
Building new habits
Preparing for and dealing with setbacks</li></ul>Physical ActivityQuestionnaire<br />Specific behaviours to increase  phys...
The interventionprotocol<br />Strict fidelity is probably inappropriate. Strive for tailoring!<br />Should be possible to ...
Feasibility/piloting<br />Testing procedures<br />Estimating recruitment/retention<br />Determining sample size<br />
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Complex Interventions May 16th 2011

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Presentation at a joint seminar day for occupational therapy, physiotherapy and nursing at Umeå University, Sweden.

(Credits to professor David Richards, University of Exeter, for his enthusiasm and inspiration at the Summer Schools of the European Academy of Nursing.)

Published in: Education, Health & Medicine
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Complex Interventions May 16th 2011

  1. 1.
  2. 2. Complex<br />interventions<br />Anders Ringnér<br />R.N., PhD Student<br />
  3. 3. Background and history<br />First MRC paper<br />from 2000<br />Updated in 2008<br />(937 citations)<br />(200 citations)<br />
  4. 4. Examples<br />Rehabilitation units for stroke patients<br />Self-study to decrease disturbing behaviour among people with learning disabilities<br />Community prevention of heart disease<br />Group psychotherapy<br />Patient education<br />A clinical drug trial<br />
  5. 5. Where is the complexityin a complex intervention?<br />Takes place in a naturalistic setting<br />Several...<br />components<br />behaviours<br />possible outcomes<br />levels of the health care system<br />Heterogeneous population<br />Almost always needs tailoring<br />
  6. 6. Differences<br />
  7. 7. The MRC model<br />
  8. 8. Development<br />Identifying the evidence base<br />Identifying/developing theory<br />Modelling process and outcomes<br />
  9. 9. Modelling– an example<br />Intervention points and behaviour change techniques<br />Casual model<br />Measures for evaluation<br />Past behaviour<br />Physical ActivityQuestionnaire<br /><ul><li>Information about disease risk and preventive behaviour
  10. 10. Identifying salient beliefs towards behaviour change
  11. 11. Reinforcing positive beliefs
  12. 12. Problem solving in relation to negative beliefs</li></ul>Attitude towards behaviour<br />Subjective norm<br />Perceived behaviour control<br />Theory of Planned BehaviourQuestionnaire<br />Theory of Planned BehaviourQuestionnaire<br /><ul><li>Setting achievable goals</li></ul>Behaviour intention<br /><ul><li>Action planning (prompts)
  13. 13. Self-monitoring
  14. 14. Self-reinforcement
  15. 15. Goal review
  16. 16. Building new habits
  17. 17. Preparing for and dealing with setbacks</li></ul>Physical ActivityQuestionnaire<br />Specific behaviours to increase physical activity<br />
  18. 18. The interventionprotocol<br />Strict fidelity is probably inappropriate. Strive for tailoring!<br />Should be possible to replicate<br />Should be published<br />
  19. 19. Feasibility/piloting<br />Testing procedures<br />Estimating recruitment/retention<br />Determining sample size<br />
  20. 20. Evaluation<br />Assessing effectiveness<br />Understanding change process<br />Assessing cost-effectiveness<br />
  21. 21. Choosing theoptimal design<br />Don’t just go for the most common design in your field!<br />Always consider randomisation!<br />Always consider experimental designs!<br />Usual treatment rather than placebo<br />
  22. 22. Measuring outcomes<br />A step away from “primary outcome”<br />What variation is there in outcomes...<br />Between individuals<br />Between sites<br />Over time<br />And what causes the variation?<br />
  23. 23. Whatever happenswithin the black box?<br />
  24. 24. ”<br />Evaluation of complex interventions requires use of qualitative and quantitativeevidence”<br />MRC guidelines, 2000<br />
  25. 25. Implementation<br />Dissemination<br />Surveillance and follow-up<br />Long term follow-up<br />
  26. 26. Conclusion:why would we need this?<br />Evidence-based practice<br />Complexity is no reason for not evaluating<br />Focus on practical effectiveness<br />Implementation in practice is emphasized<br />
  27. 27. The MRC guidance<br />Short executive summary<br />All steps described<br />Lots of questions to ask yourself<br />14 case studies<br />161 references<br />
  28. 28. References<br />http://bit.ly/kva9vp<br />

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