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Paparini S, Papoutsi C, Murdoch J, Green J, Petticrew M, Greenhalgh T, Shaw SE. Evaluating complex interventions in context: systematic, meta-narrative review of case study approaches. BMC Med Res Methodol 2021; 21:225. [PMID: 34689742 PMCID: PMC8543916 DOI: 10.1186/s12874-021-01418-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/29/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND There is a growing need for methods that acknowledge and successfully capture the dynamic interaction between context and implementation of complex interventions. Case study research has the potential to provide such understanding, enabling in-depth investigation of the particularities of phenomena. However, there is limited guidance on how and when to best use different case study research approaches when evaluating complex interventions. This study aimed to review and synthesise the literature on case study research across relevant disciplines, and determine relevance to the study of contextual influences on complex interventions in health systems and public health research. METHODS Systematic meta-narrative review of the literature comprising (i) a scoping review of seminal texts (n = 60) on case study methodology and on context, complexity and interventions, (ii) detailed review of empirical literature on case study, context and complex interventions (n = 71), and (iii) identifying and reviewing 'hybrid papers' (n = 8) focused on the merits and challenges of case study in the evaluation of complex interventions. RESULTS We identified four broad (and to some extent overlapping) research traditions, all using case study in a slightly different way and with different goals: 1) developing and testing complex interventions in healthcare; 2) analysing change in organisations; 3) undertaking realist evaluations; 4) studying complex change naturalistically. Each tradition conceptualised context differently-respectively as the backdrop to, or factors impacting on, the intervention; sets of interacting conditions and relationships; circumstances triggering intervention mechanisms; and socially structured practices. Overall, these traditions drew on a small number of case study methodologists and disciplines. Few studies problematised the nature and boundaries of 'the case' and 'context' or considered the implications of such conceptualisations for methods and knowledge production. CONCLUSIONS Case study research on complex interventions in healthcare draws on a number of different research traditions, each with different epistemological and methodological preferences. The approach used and consequences for knowledge produced often remains implicit. This has implications for how researchers, practitioners and decision makers understand, implement and evaluate complex interventions in different settings. Deeper engagement with case study research as a methodology is strongly recommended.
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Affiliation(s)
- Sara Paparini
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
| | - Jamie Murdoch
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Judith Green
- Wellcome Centre for Cultures & Environments of Health, University of Exeter, Exeter, UK
| | - Mark Petticrew
- Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK.
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Mathevet I, Ost K, Traverson L, Zinszer K, Ridde V. Accounting for health inequities in the design of contact tracing interventions: A rapid review. Int J Infect Dis 2021; 106:65-70. [PMID: 33716194 PMCID: PMC8026168 DOI: 10.1016/j.ijid.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022] Open
Abstract
Background Contact tracing has been a central control measure for coronavirus disease 2019 (COVID-19) transmission. However, without consideration of the needs of specific populations, public health interventions can exacerbate health inequities. Aim The purpose of this rapid review was to determine if and how health inequities were included in the design of contact tracing interventions in epidemic settings. Methods A search of the electronic databases MEDLINE and Web of Science was conducted. The following inclusion criteria were applied for article selection: (1) described the design of contact tracing interventions, (2) published between 2013 and 2020 in English, French, Spanish, Chinese, or Portuguese, (3) and included at least 50% of empiricism, according to the Automated Classifier of Texts on Scientific Studies (ATCER) tool. Various tools were used to extract data. Results Following screening of the titles and abstracts of 230 articles, 39 met the inclusion criteria. Only seven references were retained after full text review. None of the selected studies considered health inequities in the design of contact tracing interventions. Conclusions The use of tools/concepts for incorporating health inequities, such as the REFLEX-ISS tool, and ‘proportionate universalism’ when designing contact tracing interventions, would enable practitioners, decision-makers, and researchers to better consider health inequities.
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Affiliation(s)
- Isadora Mathevet
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France.
| | | | - Lola Traverson
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France
| | - Kate Zinszer
- University of Montreal, Montreal, Canada; Centre de Recherche en Santé Publique, Montreal, Canada
| | - Valéry Ridde
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France
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Shallcross L, Lorencatto F, Fuller C, Tarrant C, West J, Traina R, Smith C, Forbes G, Crayton E, Rockenschaub P, Dutey-Magni P, Richardson E, Fragaszy E, Michie S, Hayward A. An interdisciplinary mixed-methods approach to developing antimicrobial stewardship interventions: Protocol for the Preserving Antibiotics through Safe Stewardship (PASS) Research Programme. Wellcome Open Res 2020; 5:8. [PMID: 32090173 PMCID: PMC7014923 DOI: 10.12688/wellcomeopenres.15554.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 01/13/2023] Open
Abstract
Behaviour change is key to combating antimicrobial resistance. Antimicrobial stewardship (AMS) programmes promote and monitor judicious antibiotic use, but there is little consideration of behavioural and social influences when designing interventions. We outline a programme of research which aims to co-design AMS interventions across healthcare settings, by integrating data-science, evidence- synthesis, behavioural-science and user-centred design. The project includes three work-packages (WP): WP1 (Identifying patterns of prescribing): analysis of electronic health-records to identify prescribing patterns in care-homes, primary-care, and secondary-care. An online survey will investigate consulting/antibiotic-seeking behaviours in members of the public. WP2 (Barriers and enablers to prescribing in practice): Semi-structured interviews and observations of practice to identify barriers/enablers to prescribing, influences on antibiotic-seeking behaviour and the social/contextual factors underpinning prescribing. Systematic reviews of AMS interventions to identify the components of existing interventions associated with effectiveness. Design workshops to identify constraints influencing the form of the intervention. Interviews conducted with healthcare-professionals in community pharmacies, care-homes, primary-, and secondary-care and with members of the public. Topic guides and analysis based on the Theoretical Domains Framework. Observations conducted in care-homes, primary and secondary-care with analysis drawing on grounded theory. Systematic reviews of interventions in each setting will be conducted, and interventions described using the Behaviour Change Technique taxonomy v1. Design workshops in care-homes, primary-, and secondary care. WP3 (Co-production of interventions and dissemination). Findings will be integrated to identify opportunities for interventions, and assess whether existing interventions target influences on antibiotic use. Stakeholder panels will be assembled to co-design and refine interventions in each setting, applying the Affordability, Practicability, Effectiveness, Acceptability, Side-effects and Equity (APEASE) criteria to prioritise candidate interventions. Outputs will inform development of new AMS interventions and/or optimisation of existing interventions. We will also develop web-resources for stakeholders providing analyses of antibiotic prescribing patterns, prescribing behaviours, and evidence reviews.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - PASS Research Group
- University College London, London, UK
- University of Leicester, Leicester, UK
- Royal College of Art, London, UK
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Terris-Prestholt F, Neke N, Grund JM, Plotkin M, Kuringe E, Osaki H, Ong JJ, Tucker JD, Mshana G, Mahler H, Weiss HA, Wambura M. Using discrete choice experiments to inform the design of complex interventions. Trials 2019; 20:157. [PMID: 30832718 PMCID: PMC6399844 DOI: 10.1186/s13063-019-3186-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/08/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Complex health interventions must incorporate user preferences to maximize their potential effectiveness. Discrete choice experiments (DCEs) quantify the strength of user preferences and identify preference heterogeneity across users. We present the process of using a DCE to supplement conventional qualitative formative research in the design of a demand creation intervention for voluntary medical male circumcision (VMMC) to prevent HIV in Tanzania. METHODS The VMMC intervention was designed within a 3-month formative phase. In-depth interviews (n = 30) and participatory group discussions (n = 20) sought to identify broad setting-specific barriers to and facilitators of VMMC among adult men. Qualitative results informed the DCE development, identifying the role of female partners, service providers' attitudes and social stigma. A DCE among 325 men in Njombe and Tabora, Tanzania, subsequently measured preferences for modifiable VMMC service characteristics. The final VMMC demand creation intervention design drew jointly on the qualitative and DCE findings. RESULTS While the qualitative research informed the community mobilization intervention, the DCE guided the specific VMMC service configuration. The significant positive utilities (u) for availability of partner counselling (u = 0.43, p < 0.01) and age-separated waiting areas (u = 0.21, p < 0.05) led to the provision of community information booths for partners and provision of age-separated waiting areas. The strong disutility of female healthcare providers (u = - 0.24, p < 0.01) led to re-training all providers on client-friendliness. CONCLUSION This is, to our knowledge, the first study documenting how user preferences from DCEs can directly inform the design of a complex intervention. The use of DCEs as formative research may help increase user uptake and adherence to complex interventions.
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Affiliation(s)
- Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, London, WC1H 9SH UK
| | - Nyasule Neke
- National Institute for Medical Research, PO Box 1462, Mwanza, Tanzania
| | - Jonathan M. Grund
- Centers for Disease Control and Prevention (CDC), Center for Global Health, Division of Global HIV & TB, Atlanta, GA 30333 USA
| | - Marya Plotkin
- Jhpiego, 1615 Thames Street, Baltimore, MD 21231 USA
| | - Evodius Kuringe
- National Institute for Medical Research, PO Box 1462, Mwanza, Tanzania
| | - Haika Osaki
- National Institute for Medical Research, PO Box 1462, Mwanza, Tanzania
| | - Jason J. Ong
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, London, WC1H 9SH UK
| | - Joseph D. Tucker
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT UK
- University of North Carolina Chapel Hill Project—China, No. 2, Lujing Road, Guangzhou, 510095 China
| | - Gerry Mshana
- National Institute for Medical Research, PO Box 1462, Mwanza, Tanzania
| | - Hally Mahler
- FHI 360, 1825 Connecticut Avenue NW, Washington, DC 20009 USA
| | - Helen A. Weiss
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT UK
| | - Mwita Wambura
- National Institute for Medical Research, PO Box 1462, Mwanza, Tanzania
| | - The VMMC study team
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, London, WC1H 9SH UK
- National Institute for Medical Research, PO Box 1462, Mwanza, Tanzania
- Centers for Disease Control and Prevention (CDC), Center for Global Health, Division of Global HIV & TB, Atlanta, GA 30333 USA
- Jhpiego, 1615 Thames Street, Baltimore, MD 21231 USA
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT UK
- University of North Carolina Chapel Hill Project—China, No. 2, Lujing Road, Guangzhou, 510095 China
- FHI 360, 1825 Connecticut Avenue NW, Washington, DC 20009 USA
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT UK
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