Mobilising context as complex and dynamic in evaluations of complex health interventions.
Mobilising context as complex and dynamic in evaluations of complex health interventions.
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DOI：
10.1186/s12913-023-10354-5
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发表时间：
2023-12-18
影响因子：
2.8
通讯作者：
Shaw, Sara E.
中科院分区：
文献类型：
--
作者：
Murdoch, Jamie;Paparini, Sara;Papoutsi, Chrysanthi;James, Hannah;Greenhalgh, Trisha;Shaw, Sara E.
关键词：
医疗保健干预和背景之间的关系被广泛认为是随着时间的推移涉及复杂和动态的相互作用。然而，复杂的卫生干预措施的评价往往未能调动这种复杂性，报告背景和干预措施的具体化和划分类别。这就提出了有关实践塑造背景知识的问题，并对我们在研究中使谁和什么可见产生了影响。通过案例研究的透镜，我们利用收集的数据为三C研究（侧重于案例研究，背景和复杂的干预措施），批判这些做法，并呼吁在如何操作的背景下，在复杂的健康干预措施的评估概念系统范围内的变化。三C研究由医学研究理事会资助，以制定病例研究指南和报告原则，并考虑到背景和复杂性。作为这项研究的一部分，为期一天的研讨会与58名参与者和9个采访进行了研究，评估，出版，资助和制定政策和实践的案例研究。讨论的重点是如何在复杂健康干预措施的案例研究评估中概念化和操作化背景。分析的重点是不同的结构和连接的背景下，复杂的干预措施和更广泛的社会力量结构参与者的帐户。我们发现，知识的实践背景下形成的认识和政治力量，表现为：阐明复杂性和清晰的描述之间的紧张关系;本体论（中）的上下文和所使用的方法的概念化之间的一致性;和具体化版本的上下文被特权时，与资助者，期刊，政策制定者和公众沟通。我们认为，复杂的卫生干预措施的评估迫切需要广泛的批判性反思背景是如何动员-由资助者，卫生服务研究人员，期刊编辑和政策制定者。与学者如何处理跨学科的复杂性和背景相联系，为创造性地扩大健康评价领域提供了机会，使人们能够对长期建立的传统持批判性立场，并为创新复杂健康干预措施的评价设计开辟了可能性。
The relationship between healthcare interventions and context is widely conceived as involving complex and dynamic interactions over time. However, evaluations of complex health interventions frequently fail to mobilise such complexity, reporting context and interventions as reified and demarcated categories. This raises questions about practices shaping knowledge about context, with implications for who and what we make visible in our research. Viewed through the lens of case study research, we draw on data collected for the Triple C study (focused on Case study, Context and Complex interventions), to critique these practices, and call for system-wide changes in how notions of context are operationalised in evaluations of complex health interventions. The Triple C study was funded by the Medical Research Council to develop case study guidance and reporting principles taking account of context and complexity. As part of this study, a one-day workshop with 58 participants and nine interviews were conducted with those involved in researching, evaluating, publishing, funding and developing policy and practice from case study research. Discussions focused on how to conceptualise and operationalise context within case study evaluations of complex health interventions. Analysis focused on different constructions and connections of context in relation to complex interventions and the wider social forces structuring participant’s accounts. We found knowledge-making practices about context shaped by epistemic and political forces, manifesting as: tensions between articulating complexity and clarity of description; ontological (in)coherence between conceptualisations of context and methods used; and reified versions of context being privileged when communicating with funders, journals, policymakers and publics. We argue that evaluations of complex health interventions urgently requires wide-scale critical reflection on how context is mobilised - by funders, health services researchers, journal editors and policymakers. Connecting with how scholars approach complexity and context across disciplines provides opportunities for creatively expanding the field in which health evaluations are conducted, enabling a critical standpoint to long-established traditions and opening up possibilities for innovating the design of evaluations of complex health interventions.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
3.1
作者：
Campbell, Catherine;Nair, Yugi;Maimane, Sbongile
通讯作者：
Maimane, Sbongile
影响因子：
3.1
作者：
Asdal, Kristin;Moser, Ingunn
通讯作者：
Moser, Ingunn
影响因子：
2.7
作者：
Bilodeau, Angele;Potvin, Louise
通讯作者：
Potvin, Louise
影响因子：
3.1
作者：
Hawe, Penelope;Shiell, Alan;Riley, Therese
通讯作者：
Riley, Therese