Week 36
O'Cathain, A., Croot, L., Duncan, E., Rousseau, N., Sworn, K., Turner, K. M., ...
& Hoddinott, P. (2019). Guidance on how to develop complex interventions to
improve health and healthcare.
Purpose and context: The article addresses the growing need for structured guidance in developing
complex health interventions. As healthcare systems face multifaceted challenges – like
multimorbidity, digital health integration, and behavioural risks – reseachers must design interventions
that are not only effective but also feasibly and context-sensitive.
Methodology:
The guidance was developed through:
A consensus exercise involving experts
Systematic reviews of existing literature
Qualitative interviews with researchers experienced in intervention development
This triangulated approach ensured that the guidance was both evidence-informed and grounded in
real-world practice.
Key principles for intervention development:
There are nine core actions that researchers should consider:
1) Dynamic and iterative process: intervention development is not linear. It requires cycles of
refinement based on feedback and emerging insights
2) Stakeholder involvement: Engage patients, practitioners, and policymakers early and
throughout the process to ensure relevance and acceptability
3) Review of existing evidence: systematically examine prior research to avoid duplication and
build on proven strategies
4) Use of theory: Draw on behavioural, social, and implementation theories to inform design
and predict outcomes
5) Articulation of programme theory: Clearly define how the intervention is expected to work,
including mechanisms of change and contextual factors
6) Primary data collection: conduct qualitative or quantitative research to fill gaps in
knowledge and tailor the intervention to the target population
7) Understanding context: consider the social, cultural, organizational, and policy environments
where the intervention will be implemented
8) Implementation considerations: Design with scalability and sustainability in mind,
anticipating barriers and facilitators to real-world adaptation
9) Iterative design and refinement: prototype, pilot, and revise the intervention using
stakeholders feedback and empirical data
Conclusion:
The authors emphasize that these actions are not prescriptive steps but considerations to be weighed
based on the specific intervention and context. Researchers should revisit the principles throughout the
development process to ensure the intervention remains grounded, adaptable, and impactful.
Implications:
This guidance bridges the gap between theory and practice, offering a flexible yet rigorous framework
for developing interventions that are:
, Evidence-based
Contextually appropriate
Stakeholder-informed
Implementation-ready
It’s a foundational resource for health researchers, especially those working in multidisciplinary teams
or tackling complex public health challenges.
Kok, G., Peters, L. W. H. & Ruiter, R. A. C. (2017). Planning theory- and
evidence-based behavior change interventions: A conceptual review of the
intervention mapping protocol.
Purpose and scoping: this article provides a conceptual review of the intervention mapping (IM)
protocol, a systematic framework for developing theory- and evidence-based behaviour change
interventions. Originally designed for health promotion, IM has since been applied across diverse
domains including safety, education, environmental conservation, and workplace reintegration.
Core perspectives of intervention mapping:
1) Social ecological approach: behaviour is influenced not only by individual factors but also
by social, physical, and organizational environments.
2) Stakeholder participation: involving all relevant parties – target populations, implementers,
policymakers – ensures contextual relevance and cultural appropriateness.
3) Use of theory and evidence: grounding interventions in behavioural science theories and
empirical data enhances their effectiveness and credibility.
The six steps of intervention mapping:
1) Needs assessment: identify the health problem, its behavioural and environmental causes, and
their determinants. Develop a logic model of the problem.
2) Matrices of change objectives: define who and what needs to change. Specify performance
objectives and link them to behavioural determinants
3) Theory-based methods and practical applications: select behaviour change techniques
grounded in theory and translate them into practical strategies
4) Program production: design and organize the intervention components, materials, and
delivery methods
5) Adaptation and implementation plan: Develop strategies to ensure the intervention is
adopted, implemented, and maintained in real-world settings
6) Evaluation plan: create a plan to assess both process and outcomes, including effectiveness
and fidelity.
Key contributions:
Flexibility across domains: IM is not limited to health promotion – it’s applicable to any
behaviour determinants
Theory integration: encourages the use of multiple theories to address complex behavioural
determinants
Stakeholder-centered design: promotes co-creation and contextual tailoring of interventions.
Implications for practice:
IM empowers planners to:
Develop interventions that are systematic, transparent, and replicable
Avoid common pitfalls like vague objectives or untested strategies
, Enhance the likelihood of success by aligning interventions with real-world constraints and
stakeholder needs.
Moore, G., Michie, S., Anderson, J., Belesova, K., Crane, M., Deloly, C., ... &
Osrin, D.(2021). Developing a programme theory for a transdisciplinary research
collaboration: Complex urban systems for sustainability and health.
Purpose and context: this article presents the development of programme theory for the complex
urban systems for sustainability and health (CUSSH) project – a transdisciplinary, multi-agency
research collaboration aimed at guiding transformative urban change for better health and
environmental outcomes. The authors seek to understand how such a complex initiative works and
how it can be evaluated and improved.
Methodology and approach:
The programme theory was developed over two years through a participatory process
involving researchers, policymakers, and stakeholders across multiple cities
It draws on concepts from complex systems thinking, programme evaluation, and
transdisciplinary learning
The team used iterative workshops, stakeholder consultations, and document reviews to co-
create the theory
Structure of the program theory:
1) Action model (describes the chain of activities and outputs improved urban
sustainability and health):
a. Collaborative research and evidence generation
b. Stakeholder engagement
c. Policy influence
d. Capacity building
2) Change model (outlines the anticipated outcomes):
a. People (knowledge, attitudes, skills)
b. Processes (Decision-making, governance)
c. Policies (urban planning, environmental regulation)
d. Practices (implementation of sustainable solutions)
e. Research (new methods and interdisciplinary approaches)
Key insights:
Transdisciplinary collaboration: essential for addressing urban complexity, but requires
deliberate effort to build shared understanding and trust
Programme theory as a tool: helps clarify assumptions, guide evaluation, and foster
reflexivity within the team
Challenges faced:
o Fluid team membership and evolving roles
o Difficulty in agreeing on the scope and focus on the theory
o Navigating unpredictability inherent in complex systems
Conclusions and contributions:
The article contributes to the literature on program theory development in complex, multi-
context initiatives
It demonstrates how theory-building can support team cohesion, strategic planning, and
evaluation
O'Cathain, A., Croot, L., Duncan, E., Rousseau, N., Sworn, K., Turner, K. M., ...
& Hoddinott, P. (2019). Guidance on how to develop complex interventions to
improve health and healthcare.
Purpose and context: The article addresses the growing need for structured guidance in developing
complex health interventions. As healthcare systems face multifaceted challenges – like
multimorbidity, digital health integration, and behavioural risks – reseachers must design interventions
that are not only effective but also feasibly and context-sensitive.
Methodology:
The guidance was developed through:
A consensus exercise involving experts
Systematic reviews of existing literature
Qualitative interviews with researchers experienced in intervention development
This triangulated approach ensured that the guidance was both evidence-informed and grounded in
real-world practice.
Key principles for intervention development:
There are nine core actions that researchers should consider:
1) Dynamic and iterative process: intervention development is not linear. It requires cycles of
refinement based on feedback and emerging insights
2) Stakeholder involvement: Engage patients, practitioners, and policymakers early and
throughout the process to ensure relevance and acceptability
3) Review of existing evidence: systematically examine prior research to avoid duplication and
build on proven strategies
4) Use of theory: Draw on behavioural, social, and implementation theories to inform design
and predict outcomes
5) Articulation of programme theory: Clearly define how the intervention is expected to work,
including mechanisms of change and contextual factors
6) Primary data collection: conduct qualitative or quantitative research to fill gaps in
knowledge and tailor the intervention to the target population
7) Understanding context: consider the social, cultural, organizational, and policy environments
where the intervention will be implemented
8) Implementation considerations: Design with scalability and sustainability in mind,
anticipating barriers and facilitators to real-world adaptation
9) Iterative design and refinement: prototype, pilot, and revise the intervention using
stakeholders feedback and empirical data
Conclusion:
The authors emphasize that these actions are not prescriptive steps but considerations to be weighed
based on the specific intervention and context. Researchers should revisit the principles throughout the
development process to ensure the intervention remains grounded, adaptable, and impactful.
Implications:
This guidance bridges the gap between theory and practice, offering a flexible yet rigorous framework
for developing interventions that are:
, Evidence-based
Contextually appropriate
Stakeholder-informed
Implementation-ready
It’s a foundational resource for health researchers, especially those working in multidisciplinary teams
or tackling complex public health challenges.
Kok, G., Peters, L. W. H. & Ruiter, R. A. C. (2017). Planning theory- and
evidence-based behavior change interventions: A conceptual review of the
intervention mapping protocol.
Purpose and scoping: this article provides a conceptual review of the intervention mapping (IM)
protocol, a systematic framework for developing theory- and evidence-based behaviour change
interventions. Originally designed for health promotion, IM has since been applied across diverse
domains including safety, education, environmental conservation, and workplace reintegration.
Core perspectives of intervention mapping:
1) Social ecological approach: behaviour is influenced not only by individual factors but also
by social, physical, and organizational environments.
2) Stakeholder participation: involving all relevant parties – target populations, implementers,
policymakers – ensures contextual relevance and cultural appropriateness.
3) Use of theory and evidence: grounding interventions in behavioural science theories and
empirical data enhances their effectiveness and credibility.
The six steps of intervention mapping:
1) Needs assessment: identify the health problem, its behavioural and environmental causes, and
their determinants. Develop a logic model of the problem.
2) Matrices of change objectives: define who and what needs to change. Specify performance
objectives and link them to behavioural determinants
3) Theory-based methods and practical applications: select behaviour change techniques
grounded in theory and translate them into practical strategies
4) Program production: design and organize the intervention components, materials, and
delivery methods
5) Adaptation and implementation plan: Develop strategies to ensure the intervention is
adopted, implemented, and maintained in real-world settings
6) Evaluation plan: create a plan to assess both process and outcomes, including effectiveness
and fidelity.
Key contributions:
Flexibility across domains: IM is not limited to health promotion – it’s applicable to any
behaviour determinants
Theory integration: encourages the use of multiple theories to address complex behavioural
determinants
Stakeholder-centered design: promotes co-creation and contextual tailoring of interventions.
Implications for practice:
IM empowers planners to:
Develop interventions that are systematic, transparent, and replicable
Avoid common pitfalls like vague objectives or untested strategies
, Enhance the likelihood of success by aligning interventions with real-world constraints and
stakeholder needs.
Moore, G., Michie, S., Anderson, J., Belesova, K., Crane, M., Deloly, C., ... &
Osrin, D.(2021). Developing a programme theory for a transdisciplinary research
collaboration: Complex urban systems for sustainability and health.
Purpose and context: this article presents the development of programme theory for the complex
urban systems for sustainability and health (CUSSH) project – a transdisciplinary, multi-agency
research collaboration aimed at guiding transformative urban change for better health and
environmental outcomes. The authors seek to understand how such a complex initiative works and
how it can be evaluated and improved.
Methodology and approach:
The programme theory was developed over two years through a participatory process
involving researchers, policymakers, and stakeholders across multiple cities
It draws on concepts from complex systems thinking, programme evaluation, and
transdisciplinary learning
The team used iterative workshops, stakeholder consultations, and document reviews to co-
create the theory
Structure of the program theory:
1) Action model (describes the chain of activities and outputs improved urban
sustainability and health):
a. Collaborative research and evidence generation
b. Stakeholder engagement
c. Policy influence
d. Capacity building
2) Change model (outlines the anticipated outcomes):
a. People (knowledge, attitudes, skills)
b. Processes (Decision-making, governance)
c. Policies (urban planning, environmental regulation)
d. Practices (implementation of sustainable solutions)
e. Research (new methods and interdisciplinary approaches)
Key insights:
Transdisciplinary collaboration: essential for addressing urban complexity, but requires
deliberate effort to build shared understanding and trust
Programme theory as a tool: helps clarify assumptions, guide evaluation, and foster
reflexivity within the team
Challenges faced:
o Fluid team membership and evolving roles
o Difficulty in agreeing on the scope and focus on the theory
o Navigating unpredictability inherent in complex systems
Conclusions and contributions:
The article contributes to the literature on program theory development in complex, multi-
context initiatives
It demonstrates how theory-building can support team cohesion, strategic planning, and
evaluation
