HCS: Case study, Context and Complex interventions (TRIPLE C) - development of guidance and publication standards to support case study-based research

在卫生服务和公共卫生实践中广泛使用复杂的干预措施(例如，重新设计中风服务、城市重建方案)。人们如何开发、实施和评估复杂的干预措施仍然是研究人员的一个关键问题。为了迎接这一挑战，传统的研究方法已经到了极限。人们对开发研究方法越来越感兴趣，这些方法支持改善卫生保健的发展和实施，并以考虑复杂干预措施的背景(社区、组织等)的方式。案例研究被广泛认为提供了这样的方法，并被认为是理解背景对复杂干预的影响的重要资源。在卫生服务研究和社会科学中，已经存在大量关于案例研究的重要文献。这些文献从不同的学科(如心理学、社会学、管理学)和研究传统(如定性或定量)演变而来。尚未对其进行审问，以支持改进保健和公共卫生领域复杂干预措施的发展和实施。系统文献审查的传统方法试图整理符合预先规定的资格标准的所有证据，以便回答特定的研究问题。这种方法适用于某些工作领域(往往相当狭窄)，但在审查不同的跨学科主题时，如案例研究在评估复杂干预措施中的作用，往往没有那么大的帮助。因此，我们提出了元叙事回顾：换句话说，使用一种系统的、理论驱动的技术来指导对案例研究方法的广泛文献的回顾，并帮助我们理解这些方法是如何被不同的研究小组概念化和使用的。元叙事回顾是一个持续的过程，让评价者了解什么对目标受众最有用，从多个角度阐明主题，捕捉研究传统如何随着时间的推移而展开，检查来自不同研究传统的“相互矛盾的数据”，不断反思新的发现，并从外部受众那里获得反馈，以指导进一步的反思和分析。我们将结合来自关键来源的数据来描述案例研究传统是如何以及为什么演变的，然后比较这些不同传统的结果，从多个角度构建关于复杂干预的案例研究的丰富图景。在总结了相关文献之后，我们将与最多30名案例研究专家一起进行在线调查(确保一系列视角、组织和地点)。我们的想法将是与工作组分享我们的文献摘要，激发反思，并(通过三轮在线讨论)努力尽可能接近就在研究复杂干预措施时使用案例研究的指导意见草案达成共识。然后，我们计划与最多5个进行并发表了备受推崇的复杂干预案例研究的研究团队以及最多10个案例研究专家小组一起测试这一指南草案。通过这一迭代过程，我们将就如何设计和开展复杂保健干预措施的案例研究制定方法论指导，并发布基于案例研究的复杂干预措施研究标准。我们将免费提供这些服务。我们还计划围绕这一领域的案例研究建立一个实践社区，将来自不同学科和传统的专家聚集在一起，为复杂系统一级干预措施的未来发展、实施和评估提供信息。

Complex interventions (e.g. redesign of stroke services, urban regeneration programmes) are widely used in the health service and in public health practice. The issue of how one develops, implements and evaluates complex interventions remains a key one for researchers. Traditional research methods have been stretched to the limit in meeting this challenge. There has been growing interest in developing research methods that support improved development and implementation in health care, and in ways that account for the contexts (communities, organisations and so on) in which complex interventions are intended. Case study research is widely recognised as offering such methods, and as a vital resource for understanding the influence of context on complex interventions. A significant literature on case study research already exists in health services research and the social sciences. This literature has evolved out of different disciplines (e.g. psychology, sociology, management), and research traditions (e.g. qualitative or quantitative). It has yet to be interrogated in a way that can support improved development and implementation of complex interventions in health care and public health. Traditional approaches to systematic literature review attempt to collate all evidence that fits pre-specified eligibility criteria in order to answer a specific research question. Such approaches lend themselves to certain (often quite narrow) areas of work but tend to be far less helpful when reviewing diverse, cross-disciplinary topics like the role of case study research in evaluating complex interventions. We therefore propose a meta-narrative review: in other words, using a systematic, theory-driven technique to guide reviewing the wide-ranging literature on case study methods and help us to understand how such methods have been differently conceptualised and used by different groups of researchers. Meta-narrative review is an on-going process, involving the reviewer in understanding what will be most useful to the intended audience, illuminating the topic from multiple angles, capturing how research traditions have unfolded over time, examining 'conflicting data' from different research traditions, continually reflecting on emerging findings and gaining feedback from an external audience to guide further reflection and analysis. We will combine data from key sources to produce an account of how and why case study traditions have evolved, and then compare findings from these different traditions to build a rich picture of case study research on complex interventions from multiple perspectives.Having summarised the relevant literature, we will conduct an online survey with a group of up to 30 experts in case study research (ensuring a range of perspectives, organisations and locations). The idea will be to share our summary of the literature with the group, stimulate reflection and (over three rounds of online discussion) work towards getting as close as possible to consensus on draft guidance on the use of case study when researching complex interventions. We plan to then test this draft guidance with up to five teams of researchers who have conducted and published highly regarded case studies of complex interventions, as well as a group of up to 10 case study experts. Through this iterative process, we will develop methodological guidance on how to design and carry out case studies of complex interventions in health care, and publish standards for case study-based research on complex interventions. We will make these freely available. We also plan to build a community of practice around case study research in this field, bringing together experts from different disciplines and traditions to inform future development, implementation and evaluation of complex system-level interventions.