Problematisations of Complexity: On the Notion and Production of Diverse Complexities in Healthcare Interventions and Evaluations
Problematisations of Complexity: On the Notion and Production of Diverse Complexities in Healthcare Interventions and Evaluations
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DOI：
10.1080/09505431.2016.1212003
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发表时间：
2017-01-01
影响因子：
2.6
通讯作者：
Pickersgill, Martyn
中科院分区：
文献类型：
--
作者：
Broer, Tineke;Bal, Roland;Pickersgill, Martyn
在关于评价卫生（政策）干预措施的文献中，复杂性是一个备受争议的问题。特别是，许多人声称，所谓的复杂干预措施“对评价研究提出的挑战与显然简单的干预措施不同”。不同的评价方式需要特定的复杂性本体论和认识论。他们的不同之处在于，他们是否将复杂性定义为干预措施的量化特征，他们是否将评估视为干预措施的一部分或外部，以及复杂性是否可以被视为干预措施及其评估的一种新兴属性。在实践中，大型医疗保健改善项目的评估人员和专员依赖于不同的，有时是相互矛盾的，关于进行良好评估意味着什么的指令集。这是委员、研究人员、有时还有方案管理人员之间不断谈判的一个问题。特别是，可评价性、有用性和距离/独立性的概念以不同的方式受到质疑，产生了不同的后果，这反过来又产生了其他概念和复杂性层次，如时间、体制和情感的复杂性。当（社会科学）研究人员声称一种或另一种方法能够更好地把握复杂性时，他们忽略了这样一个问题，即任何方法论的选择都会强调某些复杂性，而让其他复杂性消失在背景中。分析评估研究中涉及的实用性和情感，为分析审查打开了复杂性的概念，并为生物医学，公共卫生和社会科学家（包括科学和技术研究学者）之间的共同理论化提供了基础。
Within the literature on the evaluation of health (policy) interventions, complexity is a much-debated issue. In particular, many claim that so-called complex interventions' pose different challenges to evaluation studies than apparently simple interventions' do. Distinct ways of doing evaluation entail particular ontologies and epistemologies of complexity. They differ in terms of whether they define complexity as a quantitative trait of interventions, whether they see evaluation as part of or outside the intervention, and whether complexity can be regarded as an emergent property of the intervention and its evaluation. In practice, evaluators and commissioners of large health care improvement programmes rely on different, sometimes contradictory, repertoires about what it means to conduct a good' evaluation. This is an ongoing matter negotiated between and among commissioners, researchers, andsometimesprogramme managers. In particular, notions of evaluability, usefulness and distance/independence are problematised in different ways and with diverse consequences, which, in turn, produce other notions and layers of complexity such as temporal, institutional and affective complexities. When (social science) researchers claim that one method or another is better able to grasp complexity, they elide the issue that any methodological choice emphasises some complexities and lets others fade into the background. Analysing the practicalities and emotions involved in evaluation studies opens up the notion of complexity to analytical scrutiny, and suggests a basis for co-theorising between biomedical, public health and social scientists (including Science and Technology Studies scholars).