Assessing the complexity of interventions within systematic reviews: development, content and use of a new tool (iCAT_SR)

doi:10.1186/s12874-017-0349-x

. 2017 Apr 26;17(1):76.

doi: 10.1186/s12874-017-0349-x.

Assessing the complexity of interventions within systematic reviews: development, content and use of a new tool (iCAT_SR)

Simon Lewin^{1

2}, Maggie Hendry³, Jackie Chandler⁴, Andrew D Oxman⁵, Susan Michie⁶, Sasha Shepperd⁷, Barnaby C Reeves⁸, Peter Tugwell⁹, Karin Hannes¹⁰, Eva A Rehfuess¹¹, Vivien Welch^{12

13

14}, Joanne E Mckenzie¹⁵, Belinda Burford¹⁶, Jennifer Petkovic¹⁷, Laurie M Anderson¹⁸, Janet Harris¹⁹, Jane Noyes²⁰

Affiliations

¹ Norwegian Institute of Public Health, Oslo, Norway. simon.lewin@fhi.no.
² Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa. simon.lewin@fhi.no.
³ North Wales Centre for Primary Care Research, Bangor University, Bangor, UK.
⁴ Cochrane, Cochrane Central Executive, London, UK.
⁵ Norwegian Institute of Public Health, Oslo, Norway.
⁶ Centre for Behaviour Change, University College London, London, UK.
⁷ Nuffield Department of Population Health, University of Oxford, Oxford, UK.
⁸ Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
⁹ Institute of Population Health, University of Ottawa, Ottawa, Canada.
¹⁰ Social Research Methodology Group, Centre for Sociological Research, Faculty of Social Sciences, KU Leuven, Leuven, Belgium.
¹¹ Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany.
¹² Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada.
¹³ School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.
¹⁴ Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
¹⁵ School of Public Health and Preventive Medicine, The Alfred Centre, Monash University, Melbourne, Victoria, Australia.
¹⁶ Cochrane Public Health Group and Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
¹⁷ Campbell and Cochrane Equity Methods Group, Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Canada.
¹⁸ Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA.
¹⁹ School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
²⁰ School of Social Sciences, Bangor University, Bangor, UK.

PMID: 28446138
PMCID: PMC5406941
DOI: 10.1186/s12874-017-0349-x

Assessing the complexity of interventions within systematic reviews: development, content and use of a new tool (iCAT_SR)

Simon Lewin et al. BMC Med Res Methodol. 2017.

. 2017 Apr 26;17(1):76.

doi: 10.1186/s12874-017-0349-x.

Authors

Affiliations

¹ Norwegian Institute of Public Health, Oslo, Norway. simon.lewin@fhi.no.
² Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa. simon.lewin@fhi.no.
³ North Wales Centre for Primary Care Research, Bangor University, Bangor, UK.
⁴ Cochrane, Cochrane Central Executive, London, UK.
⁵ Norwegian Institute of Public Health, Oslo, Norway.
⁶ Centre for Behaviour Change, University College London, London, UK.
⁷ Nuffield Department of Population Health, University of Oxford, Oxford, UK.
⁸ Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
⁹ Institute of Population Health, University of Ottawa, Ottawa, Canada.
¹⁰ Social Research Methodology Group, Centre for Sociological Research, Faculty of Social Sciences, KU Leuven, Leuven, Belgium.
¹¹ Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany.
¹² Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada.
¹³ School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.
¹⁴ Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
¹⁵ School of Public Health and Preventive Medicine, The Alfred Centre, Monash University, Melbourne, Victoria, Australia.
¹⁶ Cochrane Public Health Group and Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
¹⁷ Campbell and Cochrane Equity Methods Group, Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Canada.
¹⁸ Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA.
¹⁹ School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
²⁰ School of Social Sciences, Bangor University, Bangor, UK.

PMID: 28446138
PMCID: PMC5406941
DOI: 10.1186/s12874-017-0349-x

Abstract

Background: Health interventions fall along a spectrum from simple to more complex. There is wide interest in methods for reviewing 'complex interventions', but few transparent approaches for assessing intervention complexity in systematic reviews. Such assessments may assist review authors in, for example, systematically describing interventions and developing logic models. This paper describes the development and application of the intervention Complexity Assessment Tool for Systematic Reviews (iCAT_SR), a new tool to assess and categorise levels of intervention complexity in systematic reviews.

Methods: We developed the iCAT_SR by adapting and extending an existing complexity assessment tool for randomized trials. We undertook this adaptation using a consensus approach in which possible complexity dimensions were circulated for feedback to a panel of methodologists with expertise in complex interventions and systematic reviews. Based on these inputs, we developed a draft version of the tool. We then invited a second round of feedback from the panel and a wider group of systematic reviewers. This informed further refinement of the tool.

Results: The tool comprises ten dimensions: (1) the number of active components in the intervention; (2) the number of behaviours of recipients to which the intervention is directed; (3) the range and number of organizational levels targeted by the intervention; (4) the degree of tailoring intended or flexibility permitted across sites or individuals in applying or implementing the intervention; (5) the level of skill required by those delivering the intervention; (6) the level of skill required by those receiving the intervention; (7) the degree of interaction between intervention components; (8) the degree to which the effects of the intervention are context dependent; (9) the degree to which the effects of the interventions are changed by recipient or provider factors; (10) and the nature of the causal pathway between intervention and outcome. Dimensions 1-6 are considered 'core' dimensions. Dimensions 7-10 are optional and may not be useful for all interventions.

Conclusions: The iCAT_SR tool facilitates more in-depth, systematic assessment of the complexity of interventions in systematic reviews and can assist in undertaking reviews and interpreting review findings. Further testing of the tool is now needed.

Keywords: Complex; Complex interventions; Complexity; Evidence synthesis; Intervention; Intervention development; Systematic review; Tool.

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References

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[1] Clark AM, Briffa TG, Thirsk L, Neubeck L, Redfern J. What football teaches us about researching complex health interventions. BMJ. 2012;345:e8316. doi: 10.1136/bmj.e8316. - DOI - PubMed

[2] Clark AM, Briffa TG, Thirsk L, Neubeck L, Redfern J. What football teaches us about researching complex health interventions. BMJ. 2012;345:e8316. doi: 10.1136/bmj.e8316. - DOI - PubMed

[3] Petticrew M. When are complex interventions ‘complex’? When are simple interventions ‘simple’? Eur J Public Health. 2011;21(4):397–398. doi: 10.1093/eurpub/ckr084. - DOI - PubMed

[4] Petticrew M. When are complex interventions ‘complex’? When are simple interventions ‘simple’? Eur J Public Health. 2011;21(4):397–398. doi: 10.1093/eurpub/ckr084. - DOI - PubMed

[5] Shepperd S, Lewin S, Straus S, Clarke M, Eccles MP, Fitzpatrick R, Wong G, Sheikh A. Can we systematically review studies that evaluate complex interventions? PLoS Med. 2009;6(8):e1000086. doi: 10.1371/journal.pmed.1000086. - DOI - PMC - PubMed

[6] Shepperd S, Lewin S, Straus S, Clarke M, Eccles MP, Fitzpatrick R, Wong G, Sheikh A. Can we systematically review studies that evaluate complex interventions? PLoS Med. 2009;6(8):e1000086. doi: 10.1371/journal.pmed.1000086. - DOI - PMC - PubMed

[7] Moore G, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, Moore L, O’Cathain A, Tinati T, Wight D, et al. Process evaluation of complex interventions: medical research council guidance. London: MRC Population Health Science Research Network; 2014. - PMC - PubMed

[8] Moore G, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, Moore L, O’Cathain A, Tinati T, Wight D, et al. Process evaluation of complex interventions: medical research council guidance. London: MRC Population Health Science Research Network; 2014. - PMC - PubMed

[9] Richards D, Hallberg I, editors. Complex interventions in health: an overview of research methods. Oxford and New York: Routledge; 2015.

[10] Richards D, Hallberg I, editors. Complex interventions in health: an overview of research methods. Oxford and New York: Routledge; 2015.

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Assessing the complexity of interventions within systematic reviews: development, content and use of a new tool (iCAT_SR)

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Assessing the complexity of interventions within systematic reviews: development, content and use of a new tool (iCAT_SR)

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