Entangled complexity: why complex interventions are just not complicated enough
Entangled complexity: why complex interventions are just not complicated enough
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DOI：
10.1258/jhsrp.2012.012036
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发表时间：
2013-01-01
影响因子：
2.4
通讯作者：
Stronge, Paul
中科院分区：
文献类型：
--
作者：
Cohn, Simon;Clinch, Megan;Stronge, Paul
卫生保健负担从急性向慢性病的转变与生活方式和行为密切相关。因此，卫生服务机构正试图制定战略和干预措施，以处理塑造两者的社会和生物因素的复杂相互作用。在这篇文章中，我们追踪了这种“转向复杂”的最有影响力的化身之一：医学研究理事会(MRC)关于开发和评估复杂干预措施的指导。通过对主要出版物的分析，并借鉴社会科学方法来分析在这种情况下什么可能构成复杂性，我们建议这些倡议需要调整其对“综合体”的概念。我们认为，复杂性需要被理解为一个动态的生态系统，而不是单个元素的稳定安排，尽管复杂。至关重要的是，与MRC指南中嵌入的实验逻辑不同，我们质疑随机对照试验(RCT)是否是处理复杂性并建立复杂干预有效性的可靠证据的最合适方法。(C)智者出版有限公司2013年
The shift of health care burden from acute to chronic conditions is strongly linked to lifestyle and behaviour. As a consequence, health services are attempting to develop strategies and interventions that can attend to the complex interactions of social and biological factors that shape both. In this paper we trace one of the most influential incarnations of this 'turn to the complex': the Medical Research Council (MRC) guidance on developing and evaluating complex interventions. Through an analysis of the key publications, and drawing on social scientific approaches to what might constitute complexity in this context, we suggest that such initiatives need to adjust their conceptualisation of 'the complex'. We argue that complexity needs to be understood as a dynamic, ecological system rather than a stable, albeit complicated, arrangement of individual elements. Crucially, in contrast to the experimental logic embedded in the MRC guidance, we question whether the Randomised Controlled Trial (RCT) is the most appropriate method through which to engage with complexity and establish reliable evidence of the effectiveness of complex interventions. (C) SAGE Publications Ltd 2013