Addressing complexity in population health intervention research: the context/intervention interface

Abstract

Background: Public health interventions are increasingly being recognised as complex and context dependent. Related to this is the need for a systemic and dynamic conception of interventions that raises the question of delineating the scope and contours of interventions in complex systems. This means identifying which elements belong to the intervention (and therefore participate in its effects and can be transferred), which ones belong to the context and interact with the former to influence results (and therefore must be taken into account when transferring the intervention) and which contextual elements are irrelevant to the intervention.

Discussion: This paper, from which derives criteria based on a network framework, operationalises how the context and intervention systems interact and identify what needs to be replicated as interventions are implemented in different contexts. Representing interventions as networks (composed of human and non-human entities), we introduce the idea that the density of interconnections among the various entities provides a criterion for distinguishing core intervention from intervention context without disconnecting the two systems. This differentiates endogenous and exogenous intervention contexts and the mediators that connect them, which form the fuzzy and constantly changing intervention/context interface.

Conclusion: We propose that a network framework representing intervention/context systems constitutes a promising approach for deriving empirical criteria to delineate the scope and contour of what is replicable in an intervention. This approach should allow better identification and description of the entities that have to be transferred to ensure the potential effectiveness of an intervention in a specific context.

Keywords: health promotion; methodology; public health.

Figure 1

Graphic representation of the intervention/context system. The black squares characterise the entities specific to the endogenous context. The grey squares represent entities that connect the intervention’s endogenous and exogenous contexts and allow interactions between the two. The white squares represent entities that the intervention’s endogenous context is not directly connected with (exogenous context). The number of interconnections between entities characterises a network density, whereas the strength of the various connections is characterised by the thickness of the lines that connect entities.

Figure 2

This example illustrates the model through the mapping of the components of the Petits cuistots–parents en réseaux (PC–PR) programme as presented in an implementation evaluation study of this programme.