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Letteratura scientifica selezionata sul tema "Evaluation of complex intervention"

Autore: Grafiati

Pubblicato: 7 settembre 2024

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Articoli di riviste sul tema "Evaluation of complex intervention"

Moore, Graham F., Rhiannon E. Evans, Jemma Hawkins, Hannah Littlecott, G. J. Melendez-Torres, Chris Bonell e Simon Murphy. "From complex social interventions to interventions in complex social systems: Future directions and unresolved questions for intervention development and evaluation". Evaluation 25, n. 1 (31 ottobre 2018): 23–45. http://dx.doi.org/10.1177/1356389018803219.

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Complex systems approaches to social intervention research are increasingly advocated. However, there have been few attempts to consider how models of intervention science, such as the UK’s Medical Research Council complex interventions framework, might be reframed through a complex systems lens. This article identifies some key areas in which this framework might be reconceptualized, and a number of priority areas where further development is needed if alignment with a systems perspective is to be achieved. We argue that a complex systems perspective broadens the parameters of ‘relevant’ evidence and theory for intervention development, before discussing challenges in defining feasibility in dynamic terms. We argue that whole systems evaluations may be neither attainable, nor necessary; acknowledgment of complexity does not mean that evaluations must be complex, or investigate all facets of complexity. However, a systems lens may add value to evaluation design through guiding identification of key uncertainties, and informing decisions such as timings of follow-up assessments.

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Makleff, Shelly, Marissa Billowitz, Jovita Garduño, Mariana Cruz, Vanessa Ivon Silva Márquez e Cicely Marston. "Applying a complex adaptive systems approach to the evaluation of a school-based intervention for intimate partner violence prevention in Mexico". Health Policy and Planning 35, n. 8 (6 agosto 2020): 993–1002. http://dx.doi.org/10.1093/heapol/czaa067.

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Abstract Despite calls for evaluation practice to take a complex systems approach, there are few examples of how to incorporate complexity into real-life evaluations. This article presents the case for using a complex systems approach to evaluate a school-based intimate partner violence-prevention intervention. We conducted a post hoc analysis of qualitative evaluation data to examine the intervention as a potential system disruptor. We analysed data in relation to complexity concepts particularly relevant to schools: ‘diverse and dynamic agents’, ‘interaction’, ‘unpredictability’, ‘emergence’ and ‘context dependency’. The data—two focus groups with facilitators and 33 repeat interviews with 14–17-year-old students—came from an evaluation of a comprehensive sexuality education intervention in Mexico City, which serves as a case study for this analysis. The findings demonstrate an application of complex adaptive systems concepts to qualitative evaluation data. We provide examples of how this approach can shed light on the ways in which interpersonal interactions, group dynamics, the core messages of the course and context influenced the implementation and outcomes of this intervention. This gender-transformative intervention appeared to disrupt pervasive gender norms and reshape beliefs about how to engage in relationships. An intervention comprises multiple dynamic and interacting elements, all of which are unlikely to be consistent across implementation settings. Applying complexity concepts to our analysis added value by helping reframe implementation-related data to focus on how the ‘social’ aspects of complexity influenced the intervention. Without examining both individual and group processes, evaluations may miss key insights about how the intervention generates change, for whom, and how it interacts with its context. A social complex adaptive systems approach is well-suited to the evaluation of gender-transformative interventions and can help identify how such interventions disrupt the complex social systems in which they are implemented to address intractable societal problems.

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Byford, Sarah, e Tom Sefton. "Economic Evaluation of Complex Health and Social Care Interventions". National Institute Economic Review 186 (ottobre 2003): 98–108. http://dx.doi.org/10.1177/002795010300100114.

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The use of economic evaluation in relatively complex areas of health and social care has been limited. The level of complexity is influenced by the nature of the problems and interventions under evaluation, being dependent upon the degree of user involvement and the complexity of the inputs and outcomes. Complexity does not preclude the achievement of a good quality economic evaluation, but it can add significant difficulties. Efforts must be made to ensure scientific validity of evaluations, whilst recognising that the complexity inherent in many health and social care interventions may require deviations from and additions to traditional evaluation models. Fundamentally, the net effect will be the need for more time and money than would perhaps be required for the evaluation of a simpler intervention.

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ȘOMFELEAN, Oana-Maria. "Complex evaluation process in the context of early intervention". Revista Română de Terapia Tulburărilor de Limbaj şi Comunicare IV, n. 2 (15 ottobre 2018): 12–24. http://dx.doi.org/10.26744/rrttlc.2018.4.2.03.

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I., Mühlhauser, e Berger M. "Patient education - evaluation of a complex intervention". Diabetologia 45, n. 12 (1 dicembre 2002): 1723–33. http://dx.doi.org/10.1007/s00125-002-0987-2.

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Jones, Taryn M., Blake F. Dear, Julia M. Hush, Nickolai Titov e Catherine M. Dean. "Application of Intervention Mapping to the Development of a Complex Physical Therapist Intervention". Physical Therapy 96, n. 12 (1 dicembre 2016): 1994–2004. http://dx.doi.org/10.2522/ptj.20150387.

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Abstract Background Physical therapist interventions, such as those designed to change physical activity behavior, are often complex and multifaceted. In order to facilitate rigorous evaluation and implementation of these complex interventions into clinical practice, the development process must be comprehensive, systematic, and transparent, with a sound theoretical basis. Intervention Mapping is designed to guide an iterative and problem-focused approach to the development of complex interventions. Purpose The purpose of this case report is to demonstrate the application of an Intervention Mapping approach to the development of a complex physical therapist intervention, a remote self-management program aimed at increasing physical activity after acquired brain injury. Case Description Intervention Mapping consists of 6 steps to guide the development of complex interventions: (1) needs assessment; (2) identification of outcomes, performance objectives, and change objectives; (3) selection of theory-based intervention methods and practical applications; (4) organization of methods and applications into an intervention program; (5) creation of an implementation plan; and (6) generation of an evaluation plan. The rationale and detailed description of this process are presented using an example of the development of a novel and complex physical therapist intervention, myMoves—a program designed to help individuals with an acquired brain injury to change their physical activity behavior. Conclusion The Intervention Mapping framework may be useful in the development of complex physical therapist interventions, ensuring the development is comprehensive, systematic, and thorough, with a sound theoretical basis. This process facilitates translation into clinical practice and allows for greater confidence and transparency when the program efficacy is investigated.

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Madan, Jason, Meghan Bruce Kumar, Miriam Taegtmeyer, Edwine Barasa e Swaran Preet Singh. "SEEP-CI: A Structured Economic Evaluation Process for Complex Health System Interventions". International Journal of Environmental Research and Public Health 17, n. 18 (17 settembre 2020): 6780. http://dx.doi.org/10.3390/ijerph17186780.

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The economic evaluation of health system interventions is challenging, and methods guidance on how to respond to these challenges is lacking. The REACHOUT consortium developed and evaluated complex interventions for community health program quality improvement in six countries in Africa and Asia. Reflecting on the challenges we faced in conducting an economic evaluation alongside REACHOUT, we developed a Structured Economic Evaluation Process for Complex Health System Interventions (SEEP-CI). The SEEP-CI aims to establish the threshold effect size that would justify investment in a complex intervention, and provide an assessment to a decision-maker of how likely it is that the intervention can achieve this impact. We illustrate how the SEEP-CI could have been applied to REACHOUT to identify outcomes where the intervention might have impact and causal mechanisms, through which that impact might occur, guide data collection by focusing on proximal outcomes most likely to illustrate the effectiveness of the intervention, identify the size of health gain required to justify investment in the intervention, and indicate the assumptions required to accept that such health gains are credible. Further research is required to determine the feasibility and acceptability of the SEEP-CI, and the contexts in which it could be used.

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Steele Gray, Carolyn, e James Shaw. "From summative to developmental". Journal of Integrated Care 27, n. 3 (20 giugno 2019): 241–48. http://dx.doi.org/10.1108/jica-07-2018-0053.

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Purpose Models of integrated care are prime examples of complex interventions, incorporating multiple interacting components that work through varying mechanisms to impact numerous outcomes. The purpose of this paper is to explore summative, process and developmental approaches to evaluating complex interventions to determine how to best test this mess. Design/methodology/approach This viewpoint draws on the evaluation and complex intervention literatures to describe the advantages and disadvantages of different methods. The evaluation of the electronic patient reported outcomes (ePRO) mobile application and portal system is presented as an example of how to evaluate complex interventions with critical lessons learned from this ongoing study. Findings Although favored in the literature, summative and process evaluations rest on two problematic assumptions: it is possible to clearly identify stable mechanisms of action; and intervention fidelity can be maximized in order to control for contextual influences. Complex interventions continually adapt to local contexts, making stability and fidelity unlikely. Developmental evaluation, which is more conceptually aligned with service-design thinking, moves beyond these assumptions, emphasizing supportive adaptation to ensure meaningful adoption. Research limitations/implications Blended approaches that incorporate service-design thinking and rely more heavily on developmental strategies are essential for complex interventions. To maximize the benefit of this approach, three guiding principles are suggested: stress pragmatism over stringency; adopt an implementation lens; and use multi-disciplinary teams to run studies. Originality/value This viewpoint offers novel thinking on the debate around appropriate evaluation methodologies to be applied to complex interventions like models of integrated care.

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Beames, Joanne R., Raghu Lingam, Katherine Boydell, Alison L. Calear, Michelle Torok, Kate Maston, Isabel Zbukvic et al. "Protocol for the process evaluation of a complex intervention delivered in schools to prevent adolescent depression: the Future Proofing Study". BMJ Open 11, n. 1 (gennaio 2021): e042133. http://dx.doi.org/10.1136/bmjopen-2020-042133.

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IntroductionProcess evaluations provide insight into how interventions are delivered across varying contexts and why interventions work in some contexts and not in others. This manuscript outlines the protocol for a process evaluation embedded in a cluster randomised trial of a digital depression prevention intervention delivered to secondary school students (the Future Proofing Study). The purpose is to describe the methods that will be used to capture process evaluation data within this trial.Methods and analysisUsing a hybrid type 1 design, a mixed-methods approach will be used with data collected in the intervention arm of the Future Proofing Study. Data collection methods will include semistructured interviews with school staff and study facilitators, automatically collected intervention usage data and participant questionnaires (completed by school staff, school counsellors, study facilitators and students). Information will be collected about: (1) how the intervention was implemented in schools, including fidelity; (2) school contextual factors and their association with intervention reach, uptake and acceptability; (3) how school staff, study facilitators and students responded to delivering or completing the intervention. How these factors relate to trial effectiveness outcomes will also be assessed. Overall synthesis of the data will provide school cluster-level and individual-level process outcomes.Ethics and disseminationEthics approval was obtained from the University of New South Wales (NSW) Human Research Ethics Committee (HC180836; 21st January 2019) and the NSW Government State Education Research Applications Process (SERAP 2019201; 19th August 2019). Results will be submitted for publication in peer-reviewed journals and discussed at conferences. Our process evaluation will contextualise the trial findings with respect to how the intervention may have worked in some schools but not in others. This evaluation will inform the development of a model for rolling out digital interventions for the prevention of mental illness in schools.Trial registration numberANZCTRN12619000855123; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377664&isReview=true.

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Kainz, Kirsten, Allison Metz e Noreen Yazejian. "Tools for Evaluating the Implementation of Complex Education Interventions". American Journal of Evaluation 42, n. 3 (9 luglio 2021): 399–414. http://dx.doi.org/10.1177/1098214020958490.

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Large-scale education interventions aimed at diminishing disparities and generating equitable learning outcomes are often complex, involving multiple components and intended impacts. Evaluating implementation of complex interventions is challenging because of the interactive and emergent nature of intervention components. Methods that build from systems science have proven useful for addressing evaluation challenges in the complex intervention space. Complexity science shares some terminology with systems science, but the primary aims and methods of complexity science are different from those of systems science. In this paper we describe some of the language and ideas used in complexity science. We offer a set of priorities for evaluation of complex interventions based on language and ideas used in complexity science and methodologies aligned with the priorities.

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Più fonti

Tesi sul tema "Evaluation of complex intervention"

Theodoreli-Riga, C. V. "Evaluation of robotic catheter technology in complex endovascular intervention". Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/11627.

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The past four decades have witnessed tremendous strides in the evolution of endovascular devices and techniques. Catheter-based intervention has revolutionized the management of arterial disease allowing treatment of aortic and peripheral pathologies via a minimally invasive approach. Despite the exponential advances in endovascular equipment, devices and techniques, catheter-based endovascular intervention has certain morphological and technological constraints. Complex patient anatomy, technological impediments and suboptimal fluoroscopic imaging, can make endovascular intervention challenging using traditional endovascular means. Conventional endovascular catheters lack active manoeuvrability of the tip. Manual control can hinder overall stability and control at key target areas, leading to significantly prolonged overall procedure and fluoroscopic times. Repeated instrumentation increases the risk of vessel trauma and distal embolization. More importantly, guidewire-catheter skills are not necessarily intuitive but must be developed and are highly dependent on operator skill with long training pathways as a result. Recognizing the pressing need to address some of the limitations of standard catheter technology this thesis aims to evaluate the role of advanced robotic endovascular catheters in the aortic arch and the visceral segment. Clinical use of this technology is currently limited to transvenous cardiac mapping and ablation procedures. A comprehensive pre-clinical comparison and analysis of robotic versus manual catheter techniques is presented to reveal both their advantages and limitations, with particular emphasis on the potential of robotic catheter technology to reduce the manual skill required for complex tasks, improve stability at key target areas, reduce the risk of vessel trauma, embolization and radiation exposure, whilst improving overall operator performance. The worlds first clinical report of robot-assisted aortic aneurysm repair, a “proof - of - concept” resulting from this research, is also presented, and the potential for future advanced applications in order to increase the applicability of endovascular therapy to a larger cohort of patients discussed.

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Brown, C. T. "Self-management for men with uncomplicated lower urinary tract symptoms : evaluation of a complex intervention". Thesis, University of London, 2007. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.546711.

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Goldthorpe, Joanna. "Developing and evaluating a complex intervention to treat chronic orofacial pain". Thesis, University of Manchester, 2012. https://www.research.manchester.ac.uk/portal/en/theses/developing-and-evaluating-a-complex-intervention-to-treat-chronic-orofacial-pain(29158f44-c916-41c4-a84f-c6481437dc9e).html.

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Introduction: Chronic orofacial pain (COFP) is distressing and disabling to sufferers and can be costly to patients, health services and society. Frequently, no underlying medical pathology can be found to account for the condition. Despite this, patients are treated according to a biomedical model, often by mechanistic and invasive procedures, which tend to be unsuccessful and not evidence based. Evidence suggests that cognitive behavioural therapy (CBT) based management may produce improved outcomes for patients. However, published studies can tell us little about which intervention components are effective, or recommend an optimum way for these components to be applied. Aim: To develop an evidence based intervention for the management of COFP that is feasible and acceptable to patients and practitioners. Method: The Medical Research Council’s guidelines for developing complex interventions were used as a framework for the research. Evidence from multiple sources was synthesised to produce the draft components of an intervention to manage COFP. An exploratory trial investigated preliminary outcomes, acceptability, feasibility and explored parameters for a full scale randomised control trial. Results: The intervention was acceptable to participants and could be feasibly implemented. No conclusions could be drawn relating to the effectiveness of the intervention. Participants were not affected at baseline for a number of outcomes, which implies that cut off points should be introduced into the inclusion and exclusion criteria of any future studies. Conclusion: The study produced an intervention which is acceptable and feasible to participants, however it is not known if it is effective. A number of recommendations are made for progression to a larger, definitive trial.

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Pinnock, Hilary. "Telephone consultations for the routine review of people with asthma in primary care : an evaluation of a complex intervention". Thesis, University of Aberdeen, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.430976.

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Introduction: Set within the Medical Research Council framework for the development and evaluation of complex interventions, this thesis describes the evaluation of telephone consultations for the routine review of people with asthma in primary care. Objectives: 1. To critically review the evidence for regular review of people with asthma. 2. To develop an intervention, underpinned by existing theoretical and empirical evidence on telephone consulting, to improve access to asthma care. 3. To test the hypotheses that telephone consultations improve access and are an acceptable, clinically effective and cost-effective alternative to face-to-face consultations for the provision of routine asthma care. 4. To design a telephone asthma review service for ‘real-world’ implementation. Methods: Literature review and a randomised controlled trial comparing nurse-led telephone with face-to-face asthma reviews in four UK general practices. Results: 1) Despite the evidence for proactive asthma care, attendance at routine clinics remains poor. 2) Convenience for patients and the potential for opportunistic calls, suggest that telephone consultations might increase the proportion of patients reviewed. 3) 101/137 (74%) of people randomised to telephone consultations were reviewed compared with 68/141 (48%) in the surgery group (p<0.001). Asthma-related quality-of-life was comparable in the two groups (risk difference -0.07 (95%Cl -0.40 to 0.27) p=0.69). The shorter duration of telephone consultations resulted in a mean cost saving per consultation achieved of £3.92 (95%Cl £3.01 to £4.84), p<0.001). Patients appreciated the convenience of telephone reviews. 4) Building on these results, a telephone asthma review service is described for testing in an on-going implementation trial.

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McCall, MacBain Marcy C. "Yoga as a complex intervention and its development for health-related quality of life in adult cancer". Thesis, University of Oxford, 2015. http://ora.ox.ac.uk/objects/uuid:c7259cbe-b6c0-42f8-b893-79306cdccdfa.

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The aim of this thesis was to develop yoga as a complex intervention in health care for the improvement of health-related quality of life (HRQoL) in adult cancer. As the Indian tradition of practising yoga increases in popularity worldwide, populations in the West are beginning to see yoga as an opportunity to prevent and treat health conditions. The Medical Research Council’s framework has provided a methodology to address a paucity of coherent evidence for the myriad of unsupported health claims made by yoga enthusiasts. The thesis structure included a step-by-step approach to investigate biomedical theories of how yoga might work to improve health, to synthesise evidence of yoga interventions, to model their process and outcomes, and to test evaluation procedures in the context of a randomised controlled trial (RCT). The results of a bibliometric analysis indicated an overall increase in the publication rate of yoga research in health care, and in 2005 this research began to focus on cancer. A component analysis, semi-structured patient interviews (n=10) and oncologist surveys (n=29) were successively designed, implemented and analysed to advance a model of yoga intervention specific to adult cancer. The cumulative results were applied to design three yoga interventions randomly allocated to men and women receiving treatment for cancer (n=15). Outcomes of the feasibility study demonstrated that yoga intervention is appropriate for adult patients and can be administered safely in a clinical setting. In its conclusion, this thesis produces evidence-based support for the optimisation of yoga intervention in the context of a large-scale RCT for HRQoL in adult cancer, and it provides recommendations to improve research methodology and reporting of complex interventions in health care.

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Kanthabalan, Ana Abhiramy. "The evaluation of a novel imaging-based complex diagnostic and therapeutic pathway intervention for men who fail radiotherapy for prostate cancer". Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10057034/.

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Background: One-third of men may experience biochemical failure by 8 years following radical radiotherapy for prostate cancer. Focal salvage therapy (FST) may offer further curative treatment. Before FST, distant disease must be ruled-out and intra-prostatic disease must be accurately detected and characterised. Aim: The aim of this thesis was to evaluate novel diagnostic and staging techniques and outcomes of focal salvage treatments for radiorecurrent prostate cancer. Methods: Both retrospective and prospective data will be presented. A retrospective analysis was conducted to compare a) Bone scan with Choline PET/CT in the detection of distant metastases b) Accuracy of MRI-Targeted Biopsy (MRI-TB) with whole-gland template mapping biopsy (TPM) c) the outcomes of focal salvage HIFU (FS-HIFU). These retrospective analyses provided important inputs into the design and conduct of the prospective trial FORECAST - Focal RECurrent Assessment and Salvage Treatment. Key trial outcomes were a) detection rate of distant metastatic disease of Whole Body MRI compared to other staging scans b) detection rate of MRI for clinically significant prostate cancer and c) Short-term outcomes of focal salvage therapies. Outcomes: Within the retrospective analyses, there was poor concordance with bone scan and Choline PET/CT in the detection of metastatic disease (kappa value 0.024). MRI-TB had lower detection rates of clinically significant cancer compared with TPM biopsy; 77.9% vs. 85.7% (p=0.146). The b-DFS rate post FS-HIFU was 48% (95% CI 39–59) and composite end free survival was 40% (95% CI 31–50). In the prospective analyses, there was moderate agreement between WB-MRI and Choline PET/CT for bony metastatic disease (Kappa=0.411 (p < 0.0001)). MRI (PIRADS 4) had a high sensitivity, specificity, PPV and NPV for the detection of clinically significant cancer 90%, 81.3%, 85.7% and 86.7%. b-DFS rates post FS-HIFU and FS-cryotherapy was 73% (95% CI 51-100) and 67% (95% CI 30-100) at 12 months (p=0.95).

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Craig, Louise Eisten. "Developing and evaluating a complex intervention in stroke : using very early mobilisation as an example". Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/4294/.

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Background: Complex interventions, those that incorporate multiple interacting components, are difficult to define, measure and implement. The aim of this research was to develop and evaluate the complex intervention, very early mobilisation (VEM) in acute stroke care. The clinical effectiveness and cost-effectiveness of VEM were evaluated whilst simultaneously considering the implications for future implementation. Methods: A mixed methods approach was used: systematic review, predictive modelling, observational study design, individual patient data meta-analysis, qualitative methods and economic evaluation. Statistical models to accurately predict mobility post-stroke were developed. A multicentre observational study was conducted to establish pre-implementation activity levels of acute stroke patients. Data from two completed and comparable feasibility trials were used to estimate the clinical and economic impact of VEM. A qualitative process evaluation was conducted to identify the barriers and facilitators to implementing VEM, if shown to be effective. Results: Two predictive models were developed with age and stroke type common factors to both. Pre-implementation activity levels were low. Patients who underwent VEM were 3-times more likely to be independent at 3 months than were standard care (SC) patients. The incremental cost-effectiveness ratio associated with VEM in comparison to SC indicated VEM to be potentially cost-effective from a societal perspective. Barriers and facilitators identified for each stage of the stroke pathway and a set of HCPs’ beliefs towards VEM were formulated. Conclusions: This research has adhered to current guidance provided by the Medical Research Council to develop and evaluate VEM. The clinical effectiveness and cost-effectiveness of VEM were estimated. The ongoing A Very Early Rehabilitation Trial phase III will provide definitive evidence for the effectiveness of VEM and the wider consequences for stroke care. This research has provided the support and the foundations for the development of a clear implementation strategy for VEM.

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Walker, Jane. "Evaluation of a complex intervention for depression in patients with lung cancer : the design, execution and results of a randomised controlled trial". Thesis, University of Edinburgh, 2014. http://hdl.handle.net/1842/9560.

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The aim of this thesis was to develop and evaluate a complex intervention for major depression in patients with lung cancer. Major depression is a leading cause of disease burden worldwide and is particularly important in patients with lung cancer, not only because it is common in this poor prognosis cancer group but also because it substantially reduces the quality of the often short period of time that patients have left to live. The thesis describes a systematic review of the relevant research literature, the development of a complex intervention and a multi-centre randomised controlled trial. I found no trials, in my systematic review, that had evaluated the effectiveness of treatments for depression in patients with lung cancer. I did, however, find six trials of interventions intended to improve symptoms or quality of life in this patient group, the findings of which suggested that enhanced care approaches were more effective in reducing depressive symptoms than standard medical care. I developed the complex intervention ‘Depression Care for People with Lung Cancer’ (DCPLC) with 12 patients who had major depression and lung cancer. DCPLC was delivered by a team of cancer nurses and psychiatrists in collaboration with the patient’s GP. It included education about depression, antidepressant medication, psychological treatments (behavioural activation and problem solving therapy) and systematic progress monitoring. The trial comparing DCPLC with usual care included 142 patients. Patients who received DCPLC reported significantly lower average depression severity during their time in the trial, and better self-rated depression improvement, anxiety, quality of life, role functioning and perceived quality of depression care. The methodological limitations, relevant literature and implications of these findings for future research and for clinical practice are discussed.

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Scobbie, Lesley. "The development and initial evaluation of a Goal setting and Action Planning (G-AP) framework for use in community based stroke rehabilitation". Thesis, University of Stirling, 2015. http://hdl.handle.net/1893/21909.

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Background: Goal setting is accepted ‘best practice’ in stroke rehabilitation however, there is no consensus about what the key components of goal setting interventions are, how they should be optimally delivered in practice and how best to involve stroke survivors in the process. This PhD by publication describes the development and initial evaluation of a theory-based goal setting and action planning framework (G-AP) to guide goal setting practice in community based stroke rehabilitation settings. Included studies: The Medical Research Council (MRC) framework for developing and evaluating complex interventions guided the development and conduct of a programme of research which included the following studies: (i) a review of the literature to identify theories of behaviour change with most potential to inform goal setting practice (Paper 1) (ii) a causal modelling exercise to map identified theoretical constructs onto a goal setting process and convening of a multi-disciplinary task group to develop the theoretical process into a Goal setting and Action Planning (G-AP) practice framework (Paper 2) (iii) a process evaluation of the G-AP framework in one community rehabilitation team (Paper 3) (iv) a United Kingdom (UK) wide survey to investigate the nature of services providing community based stroke rehabilitation across the UK and what goal setting practice is in these settings in order to understand the context into which an evaluation of the G-AP framework could be introduced (Paper 4) Main Findings: The review of the literature identified three theories of behaviour change that offered most potential to inform goal setting practice: Social Cognitive Theory, Health Action Process Approach and Goal Setting Theory. These theories contained constructs directly relevant to the goal setting practice: self-efficacy, outcome expectancies, goal attributes, action planning, coping planning and appraisal and feedback. The causal modelling and Task group exercise: (i) Informed development of the G-AP framework into a four stage, cyclical process that included (i) goal negotiation and setting (ii) planning and measuring confidence (iii) action and (iv) appraisal, feedback and decision making. (ii) Proposed mechanisms of action: successful completion of action plans resulting in incremental improvements in goal sub-skills and self-efficacy. (iii) Predicted outcomes G-AP was likely to impact on: goal attainment and improved rehabilitation outcomes. The process evaluation suggested that each stage of the G-AP framework had a distinct purpose and made a useful contribution to the overall process. Overall, G-AP was acceptable and feasible to use but implementation of novel aspects of the framework (coping planning and measuring confidence) was inconsistent and health professionals had concerns about the potential impact of unmet goals on patients’ wellbeing. Patient reports suggested that (i) the experience of goal non-attainment could facilitate adjustment to limitations resulting from stroke and (ii) feeling involved in the goal setting process can incorporate both patient-led and professional-led approaches. The survey findings highlighted the variability that exists in community based stroke rehabilitation services in the UK (e.g. the patients they see; the input they provide). Goal setting is reportedly used with all or most stroke survivors in these services; however, practice is variable and may be sub-optimal. Conclusions: G-AP is the first practice framework which has been explicitly developed to guide health professionals through a systematic, theoretically based and patient centred goal setting process in community based stroke rehabilitation. G-AP is a cyclical process that that has four key stages, proposed mechanisms of action and has shown promise as an acceptable, feasible and effective framework to guide goal setting practice. The complexity that exists within community based stroke rehabilitation services, and the variability in usual goal setting practice used within them, should be considered when designing a study to evaluate the effectiveness of G-AP in routine practice.

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Appel, Caroline. "Development, evaluation and measurement of a complex intervention : a preliminary investigation of shoulder strapping used as an adjunct therapy to conventional stroke rehabilitation". Thesis, St George's, University of London, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.604012.

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Development, evaluation and measurement of a complex intervention; a preliminary investigation of shoulder strapping used as an adjunct therapy to conventional stroke rehabilitation Some therapeutic treatments show promise for improving upper limb motor recovery after stroke, especially those with a focus on high-intensity task-specific practice. However, application of such treatments poses a problem in those patients with insufficient joint stability and weakness of the shoulder complex. Intensive exercise might be possible if the shoulder complex were supported during exercise by, for example, shoulder strapping. Whilst studies indicate an interest in shoulder strapping for stroke patients, evidence for its use is not strong. To establish an evidence base for shoulder strapping, clarification is needed on: underlying mechanisms of any action; strapping methods used; which patients benefit; what effect is achieved; what outcome measures should be used; and patient and staff experience. To develop, evaluate and measure shoulder strapping as a complex intervention within the updated MRC framework, four preliminary studies were completed. A systematic review of shoulder movement impairments suggested that in the early aftermath of stroke, shoulder weakness was severe. Another systematic review indicated that few studies have investigated shoulder strapping and focused on treatment of paralysis. The feasibility of a strapping protocol was, therefore, examined in participants with paresis. This indicated that strapping has potential beneficial effects on upper limb function with minimal adverse skin reactions. Strapping was accepted by staff and stroke participants as feasible. Findings of these studies directed the development and preliminary testing of a new tool for measuring shoulder movement in participants with paresis. Results indicated reliable assessment of video footage by neurophysiotherapists and informed further development of the tool. Findings of these four studies will inform development of a future randomised controlled trial to test the efficacy of shoulder strapping on motor recovery after stroke.

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Libri sul tema "Evaluation of complex intervention"

1951-, Schultz Izabela Z., e Gatchel Robert J. 1947-, a cura di. Handbook of complex occupational disability claims: Early risk identification, intervention, and prevention. New York: Springer Science+Business Media, 2005.

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1934-, Brown Allan, e Canadian Coordinating Office for Health Technology Assessment., a cura di. Economic evaluation of glycoprotein IIb/IIIa inhibitors in patients undergoing percutaneous coronary intervention with stenting. Ottawa: Canadian Coordinating Office for Health Technology Assessment, 2005.

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Wai-Tong, Chien, a cura di. Strategies in evaluation of complex health care interventions for people with physical or mental health issues. New York: Nova Science, 2009.

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Borodulina, Elena, Aleksandr Kolsanov e Petr Rogozhkin. Surgical interventions in the complex treatment of pulmonary tuberculosis. Preoperative planning with 3D modeling. ru: INFRA-M Academic Publishing LLC., 2022. http://dx.doi.org/10.12737/1859979.

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The monograph is devoted to an important medical and social problem - improving the effectiveness of treatment of tuberculosis patients with surgical interventions. Evaluation of the effectiveness of surgical treatment in the long-term period made it possible to establish the main controllable risk factors for reactivation of the tuberculosis process in the postoperative period. The influence of the timing of surgical treatment on the long-term results of surgical treatment and the formation of drug resistance of Mycobacterium tuberculosis has been proved. An innovative approach of preoperative planning with the help of 3D computer modeling through the Autopilot program for planning surgical interventions on the lungs is presented. A personalized approach is proposed when choosing surgical treatment and improving the tactics of preoperative preparation. It is intended for doctors — thoracic surgeons, phthisiologists.

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Saw, Jacqueline, J. Emilio Exaire, David S. Lee e Jay S. Yadav, a cura di. Handbook Of Complex Percutaneous Carotid Intervention. Totowa, NJ: Humana Press, 2007. http://dx.doi.org/10.1007/978-1-59745-002-7.

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Koren, Ofir, Raj Makkar, Vivek Patel, Danon Kaewkes, Hasan Jilaihawi e Jubin Joseph, a cura di. Complex Cases in Structural Heart Intervention. Cham: Springer International Publishing, 2023. http://dx.doi.org/10.1007/978-3-031-05965-0.

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Jacqueline, Saw, a cura di. Handbook of complex percutaneous carotid intervention. Totowa, N.J: Humana Press, 2007.

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S, Parry Ruth, a cura di. Custody disputes: Evaluation and intervention. Lexington, Mass: Lexington Books, 1986.

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Andreas, Faludi, e Voogd Henk, a cura di. Evaluation of complex policy problems. Delft, Netherlands: Delftsche Uitgevers Maatschappij, 1985.

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Therapists, College of Occupational, a cura di. Occupational therapy defined as a complex intervention. London: College of Occupational Therapists, 2003.

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Capitoli di libri sul tema "Evaluation of complex intervention"

Barnett, Chris, e Rachel Eager. "Evidencing the Impact of Complex Interventions". In Ethics for Evaluation, 124–40. New York: Routledge, 2021. http://dx.doi.org/10.4324/9781003247234-8.

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Hepgul, Nilay, Wei Gao, Matthew Maddocks e Irene J. Higginson. "Development and Evaluation of Complex Interventions in Palliative Care". In Textbook of Palliative Care, 1669–79. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-319-77740-5_108.

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Hepgul, Nilay, Wei Gao, Matthew Maddocks e Irene J. Higginson. "Development and Evaluation of Complex Interventions in Palliative Care". In Textbook of Palliative Care, 1–11. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-31738-0_108-1.

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Schwartz, Sheree, Nikita Viswasam e Phelister Abdalla. "Integrated Interventions to Address Sex Workers’ Needs and Realities: Academic and Community Insights on Incorporating Structural, Behavioural, and Biomedical Approaches". In Sex Work, Health, and Human Rights, 231–53. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-64171-9_13.

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AbstractSex workers experience multi-factorial threats to their physical and mental health. Stigma, human rights violations and occupational exposures to violence, STIs, HIV, and unintended pregnancy create complex health inequities that may not be effectively addressed through programmes or services that focus on a single disease or issue. Meeting cisgender female, male, and transgender sex workers’ unmet needs and realities effectively requires more nuanced, multi-faceted public health approaches. Using a community-informed perspective, this chapter reviews layered multi-component and multi-level interventions that address a combination of structural, behavioural, and biomedical approaches. This chapter addresses (1) what are integrated interventions and why they are important; (2) what types of integrated interventions have been tested and what evidence is available on how integrated interventions have affected health outcomes; (3) what challenges and considerations are important when evaluating integrated interventions. Key findings include the dominance of biomedical and behavioural research among sex workers, which have produced mixed results at achieving impact. There is a need for further incorporation and evaluation of structural intervention components, particularly those identified as highest priority among sex workers, as well as the need for more opportunities for leadership from the sex work community in setting and implementing the research agenda.

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Ledwaba, Johanna, e Kambidima Wotela. "Evaluating Outcomes of the Antiretroviral Intervention in South Africa: A Systems Thinking Research Framework". In Systems Analysis Approach for Complex Global Challenges, 293–314. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-71486-8_16.

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Letouzé, Emmanuel, Ana Areias e Sally Jackson. "The Evaluation of Complex Development Interventions in the Age of Big Data". In Dealing With Complexity in Development Evaluation: A Practical Approach, 221–50. 2455 Teller Road, Thousand Oaks California 91320: SAGE Publications, Inc, 2016. http://dx.doi.org/10.4135/9781483399935.n12.

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Emsley, Richard, e Graham Dunn. "Evaluation of Potential Mediators in Randomised Trials of Complex Interventions (Psychotherapies)". In Causality, 290–309. Chichester, UK: John Wiley & Sons, Ltd, 2012. http://dx.doi.org/10.1002/9781119945710.ch20.

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Tsiachristas, Apostolos, e Maureen P. M. H. Rutten-van Mölken. "Evaluating Complex Interventions". In Handbook Integrated Care, 297–313. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-56103-5_18.

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Tsiachristas, Apostolos, e Maureen P. M. H. Rutten-van Mölken. "Evaluating Complex Interventions". In Handbook Integrated Care, 611–27. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-69262-9_36.

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Coccia, Giuliana, e Emanuela Scavalli. "Monitoring and evaluation of gender equality policies". In Proceedings e report, 275–80. Florence: Firenze University Press and Genova University Press, 2023. http://dx.doi.org/10.36253/979-12-215-0106-3.48.

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The 2030 Agenda has been adopted to achieve a better and sustainable future for all. The process of approaching its 17 Sustainable Development Goals is monitored through a global system of 240 statistical indicators approved in March 2016 by the United Nations Statistical Commission. Sustainable Development Goal 5 seeks to achieve gender equality and empowerment all women and girls: it is broken down into 9 targets. According to these targets, indicators are being established for monitoring and evaluating progress on SDG in order to ensure high transparency and accountability within the 2030 Agenda. A gender equality plan will typically address several issues at once, leading to a complex set of measures. Nonetheless, effective monitoring and evaluation instruments are often lacking, which undermines the transformative potential of the planned measures. If objectives are not indexed on relevant progress, success or outreach indicators, it is difficult to assess whether the organisation is actually being transformed. Monitoring and evaluation are critical for building a strong, global evidence base around gender equality and for assessing the wide, diverse range of interventions being implemented to address it. Policy makers need support now if they are to use SDG evaluation as an opportunity to improve policies and programmes closer to home, applying tailored approaches. This paper deals with monitoring and evaluation of Goal 5 in Italy. In the context of the SDGs, evaluation relates to determining the merit, worth, significance and sustainability of strategies, policies and programmes that contribute to the achievement of the SDGs at national and territorial level. After analyzing the indicators available for the monitoring of the Goal 5, the benefits and limits that still exist for a full representation of gender equality will be explained.

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Atti di convegni sul tema "Evaluation of complex intervention"

Rassadkin, Georgy, Douglas Ridgway e Jamie Dorey. "Casing Integrity Evaluation in Complex Subsurface Intervention Abandonment Wells Using Magnetic Ranging". In SPE/IATMI Asia Pacific Oil & Gas Conference and Exhibition. SPE, 2021. http://dx.doi.org/10.2118/205699-ms.

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Abstract This paper describes how active and passive magnetic ranging logging used while drilling subsurface intervention wells shows characteristics of the target well casing integrity and damage. Over the course of the development of a novel active magnetic ranging system and through several years of commercial application, data has been collected and analyzed to understand the characteristics of casing damage. This paper explains the methods used in field operations to collect this data. Using the gathered information, various stages of casing damage and poor integrity are shown. Results obtained from active and passive magnetic ranging are presented in the context of identifying casing damage. This is a departure from the standard methods of interpreting the data as it is not focused on locating a wellbore but determining the integrity of the casing. Casing integrity in idle wells is usually understood by conventional logging techniques until there is a restriction or damage on the well. Magnetic ranging logging performed during the intervention to abandon these wells can give an indication to operators of the casing integrity that otherwise would have been unknown without access to the damaged well. This can help optimize subsequent abandonment procedures as well as assist with field planning into the future to mitigate issues stemming from casing integrity and to identify the causes of previously unknown critical casing damage. The paper reports surface experimental data and compares it with two field examples. In the first field example, the passive magnetic interference from a hundred-year-old casing in the offset well caused more than 100000nT deviation from the reference field approximately 1ft away from the offset well, suggesting severe casing damage. The active magnetic signature measured simultaneously approaches zero, pointing to a lack of electrical continuity in the offset casing caused by a complete break. The second field example shows an offset well segment with passive interference of 7000nT in the presence of a stable active magnetic signal at approximately 2ft separation between wells due to possible casing damage without complete separation. The passive interference increases to 14000 nT at deeper depth while the active signal approaches zero due to a complete casing break. Novel application using the data collected by active and passive magnetic ranging techniques is being applied for the understanding of issues related to casing integrity.

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Kothari, Nikita, Mounir Ababou, Srinivas Rao e Jose Gregorio Garcia. "Concentric Coiled Tubing Technology for Well Cleaning and Evaluation in Complex Horizontal Wells: A 3 Wells Case Study from Heavy Oil Field, Kuwait". In SPE/ICoTA Well Intervention Conference and Exhibition. Society of Petroleum Engineers, 2019. http://dx.doi.org/10.2118/194249-ms.

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Ott, Waylin B., Robert T. Fairley, Travis G. Thomas, John C. Pursell, William C. Ables e Manuel L. Guzman. "Utilizing Manually Tracked Variables to Derive Complex Equations in Real-Time Platforms". In SPE/ICoTA Well Intervention Conference and Exhibition. SPE, 2023. http://dx.doi.org/10.2118/212936-ms.

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Abstract Many threshold metrics in the well intervention industry's standard operating procedures (SOP) require monitoring and tracking of difficult-to-sensor operational components. Gathering this important job data is challenging due to the cost and/or availability of technology. This paper will outline how manually tracked parameters can be applied to complex equations inside derived channels and used to make real- time decisions. Traditionally important variables such as return rate, density, and viscosity are tracked and documented manually. These metrics are needed to calculate thresholds such as annular velocity, Reynolds number, and bottoms-up time to surface, all of which are required to ensure debris is effectively transported to the surface during coiled tubing operations. Using the previously mentioned derived metrics in a live platform, users can set up warnings and alarms to make real-time decisions. This methodology enables the user to easily capture manually tracked variables in a singular job data set for post-job evaluation. Because the industry has traditionally relied on handwritten and manually tracked data, the acceptance of digitally calculated results based on manual inputs has become commonplace. What was once minutes of calculation time to obtain a snapshot view of job-specific variables is now instantly available and tracked throughout the job so that time-sensitive decisions can be made using snapshots and tracked deviations from the SOP thresholds. Readily available information enhances overall job performance. Real-time availability of job metrics to the equipment operator and remote engineering support makes completions cleaner, reduces stuck instances and non-productive time (NPT), optimizes chemical usage, and maintains rate of penetration (ROP). True identification of annular velocity in singular and multi-sized casings, measurement of turbulent flow, and fluid balance status determine the ability to remove cuttings from a wellbore, which reduces the overall job time and the production testing costs post-intervention. Job performance metrics can be set and analyzed during operations. Any changes to the project scope can be assessed onsite or remotely to ensure acceptable deviations will not negatively impact the project outcome. In previous years, technical papers have outlined how to optimize coiled tubing drillout efficiencies using SOPs, complex equations, and thresholds regarding fluid metrics, circulation times, differential pressures, and annular velocities. Still, these papers included manually tracked channels to document metrics for specific projects. Using the previously mentioned methods, manually tracked channels will display trends in complex equations, resulting in an improvement of the quality of data in a real-time platform and overall operational enhancement.

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Fitzgerald, S., A. Murphy, A. Kriby, F. Geaney e IJ Perry. "P49 An economic evaluation of a complex workplace dietary intervention: a cluster controlled trial". In Society for Social Medicine, 61st Annual Scientific Meeting, University of Manchester, 5–8 September 2017. BMJ Publishing Group Ltd, 2017. http://dx.doi.org/10.1136/jech-2017-ssmabstracts.150.

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Jackson, William, Dayi Zhang, Ross McMillan, Morteza Tabatabaeipour, Rory Hampson, Adam Gilmour, Charles MacLeod e Gordon Dobie. "Magnetic Inspection Platform for Teleoperated Remote Inspections of Complex Geometry". In 2022 49th Annual Review of Progress in Quantitative Nondestructive Evaluation. American Society of Mechanical Engineers, 2022. http://dx.doi.org/10.1115/qnde2022-98358.

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Abstract The NDE industry is under constant pressure to increase inspection speeds, while simultaneously reducing costs to keep up with the ever-expanding demands of providing robust inspection for new infrastructure as well as ongoing inspections for currently operating facilities, and the increasing rise in the need for extensions in the planned life of existing plants. Currently, setting up an automated phased array ultrasonic inspection requires significant manpower, especially on components with complex geometry, this often exposes operators to hazardous environments. This is a particular problem with conventional ultrasonic NDT where operators must regularly exchange probes (an ‘intervention’). Furthermore, inspections are often carried out during planned outages, and the necessary installation time of rigging can represent a significant part of the inspection cost. To alleviate these challenges, several specialised robotic systems have been developed in industry for performing NDE in areas with well-defined geometries. However, these systems are often limited by a high degree of manual intervention, a lack of general-purpose design, and unsophisticated brute-force data acquisition with little to no data interpretation. The development of next generation, automated NDE solutions present considerable improvements to the current state of design such as reduced inspection time, greater separation of data capture and analysis, data localization – data are intrinsically encoded with the position they were captured. These benefits lead to a reduction in plant downtime & operator dosage. The platform presented will achieve these improvements through a set of universal automated deployment tools, implemented through hardware and software advances. By creating a platform consisting of a motorised magnetic base paired with a miniature robotic arm, a very capable and adaptable system is formed. This allows for different sensing modalities with an initial focus on phased array ultrasonics to be delivered accurately and repeatably to the target inspection site. Furthermore, by introducing additional perceptual sensors such as cameras, laser scanners, & a force-torque sensor the system can understand the environment in which it is operating. Through these sensors the user may guide the robot through the plant remotely in a safe and controlled manner. In addition to this these sensors may be used to generate scan paths of critical areas with unknown geometry on the fly as well as adapt the path in a conformable manner.

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Birdthistle, Isolde. "S01.1 Must the evaluation of complex interventions be complex? Learning from the impact evaluation of DREAMS". In Abstracts for the STI & HIV World Congress (Joint Meeting of the 23rd ISSTDR and 20th IUSTI), July 14–17, 2019, Vancouver, Canada. BMJ Publishing Group Ltd, 2019. http://dx.doi.org/10.1136/sextrans-2019-sti.17.

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Cochrane, Gavin James, Sonja Marjanovic, Enora Robin e Joanna Chataway. "058: EVALUATING A COMPLEX CAPACITY-BUILDING INTERVENTION IN AN INTERNATIONAL DEVELOPMENT CONTEXT: REFLECTING ON THE AFRICAN INSTITUTIONS INITIATIVE EVALUATION". In Global Forum on Research and Innovation for Health 2015. British Medical Journal Publishing Group, 2015. http://dx.doi.org/10.1136/bmjopen-2015-forum2015abstracts.58.

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Hawthorn, A., D. Groves e G. Osunjaye. "Casing Inspection and Cement Evaluation on Drillpipe: Logging in Parallel with Existing Intervention Runs". In SPE/ICoTA Well Intervention Conference and Exhibition. SPE, 2024. http://dx.doi.org/10.2118/218331-ms.

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Abstract The oil and gas industry is in a state of continually challenging the way to improve the efficiency and safety of well construction activities. An interesting path has been followed in the last 30 years in the development and use of logging while drilling tools. The measurement quality and reliability of these tools for open hole formation evaluation and geosteering has propelled an entire sequence of highly complex and highly deviated wells with enormous improvements in productivity from existing fields. You would be hard pressed to find any wells, particularly in the offshore domain, that do not utilize logging while drilling measurements that were once the province of wireline tools only. This development of technologies and tools has, as stated above, largely focused on open hole and while drilling applications only. The same cannot be said for cased hole evaluation tools in general, and for well integrity tools that measure the condition and properties of the casing and cement in particular. This paper will demonstrate the development of a new drillpipe conveyed tool that can both measure the casing condition and what is in the annular space behind the casing. We will show examples from around the world of the tools and how this was qualified versus the existing wireline deployed technology. We will then show a case history from the deepwater West Africa area where the tools were run in parallel with existing intervention operations across a sequence of wells to both increase the efficiency of operations and to de-risk the operation. The basic premise of the tool is that a drill collar is fitted with three circumferential pulse echo ultrasonic transducers. This allows for a full azimuthal image of the casing and annular space behind the casing if the tool is rotated, either from a downhole device such as a mud motor, or by surface rotation through the rig rotary table or top drive. The tool can be run in real-time and also in memory mode, in either case data is both processed downhole and the raw waveforms can be recovered from the tool when back on surface. Analysis of the acquired data allows for interpretation of internal caliper, the thickness of the casing, the location of casing collars and an evaluation of the material in the annular space behind the first casing string. The need to provide oriented images means the tool has magnetometers, accelerometers and a basic gyro measurement device that can be used for orientation of downhole devices such as whipstocks or oriented perforations.

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Hawthorn, Andrew, Roger Steinsiek e Shaela Rahman. "Logging Cement and Casing Integrity in Parallel with Wellbore Intervention to Maximize Efficiency of Operations". In SPE/ICoTA Well Intervention Conference and Exhibition. SPE, 2022. http://dx.doi.org/10.2118/208991-ms.

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Abstract Conventionally casing and cement evaluation logging has played a critical part in the success of well intervention operations. Understanding the condition of the casing, whether it is worn or corroded, and the material in the annulus behind the casing, such as cement quality, whether there is fluid, settled barite or even gas directly play into the success or otherwise and also the safety of these operations. Historically this information has only been available from wireline conveyed tools, as a consequence of this other rig operations then have to stop to allow the wireline logging. As wells become more complex, more deviated and deeper, then the time required to obtain this data can become an economic constraint. This paper will introduce a drillpipe conveyed casing and cement evaluation tool that can be deployed in parallel with other runs in the well to improve the efficiency of well intervention and plug and abandonment operations. This also allows multiple times when this data can be obtained to best fit the rig operations without adding extra time to the rig schedule. Case histories will demonstrate how operators improved efficiency, reduced rigtime and personnel on board, improved the safety of operations and reduced the risk of non-productive time by the application of this new technology.

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Jeffries, Jayne, Angela Wearn, Sameena Hassan, Carolyn Chew-Graham e Sarah Sowden. "OP25 Qualitative evaluation of a complex mental health intervention in general practices serving socioeconomically disadvantaged communities in northern England". In Society for Social Medicine Annual Scientific Meeting Abstracts. BMJ Publishing Group Ltd, 2023. http://dx.doi.org/10.1136/jech-2023-ssmabstracts.25.

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Masset, Edoardo, Som Shrestha e Matt Juden. Evaluating complex interventions in international development. Centre of Excellence for Development Impact and Learning (CEDIL), dicembre 2021. http://dx.doi.org/10.51744/cmwp6.

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Complex interventions are those that are characterized by multiple components, multiple stakeholders, or multiple target populations. They may also be interventions that incorporate multiple processes of behavioral change. While such interventions are very common and receive a large proportion of development aid budgets, they are rarely subject to rigorous evaluations. The CEDIL Methods Working Paper, Evaluating Complex Interventions in International Development reviews promising methods for the evaluation of complex interventions that are new or have been used in a limited way. It offers a taxonomy of complex interventions in international development and draws on literature to discuss several methods that can be used to evaluate these interventions. The paper focuses its attention on methods that address causality and allow us to state conclusively whether an intervention works or not. It shows that several rigorous methods developed in different disciplines can be adapted and used to evaluate complex interventions in international development.

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Howard, Neil, Keetie Roelen, Giel Ton, Mauricio Espinoza, Afrin Aktar e Saklain Al Mamun. CLARISSA Cash Plus Social Protection Intervention: An Evaluation. Institute of Development Studies, luglio 2024. http://dx.doi.org/10.19088/clarissa.2024.008.

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This paper presents the results of the multi-method evaluation of the CLARISSA Cash Plus pilot, which was an innovative social protection scheme for tackling social ills, including the worst forms of child labour. A universal and unconditional ‘cash plus’ programme, it combined community mobilisation, case work, and cash transfers, and was implemented across a high-density, low-income neighbourhood in Dhaka. Findings show that the intervention was impactful in reducing people’s poverty and increasing their wellbeing and resilience. Impacts on work and working conditions were present but limited, quite likely because impact pathways on this ultimate outcome are complex and overlapping. The positive synergies between cash and non-cash components were marked and strongly suggest the need to replicate and scale an intervention of this nature. Recommendations from the evidence are offered for government, donors, and civil society.

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Masset, Edoardo. Evaluating complex interventions: What are appropriate methods? Centre for Excellence and Development Impact and Learning (CEDIL), febbraio 2022. http://dx.doi.org/10.51744/cmb7.

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In this CEDIL Methods Brief, we identify four types of complex development interventions: long causal chain interventions, multicomponent interventions, portfolio interventions, and system-level interventions. These interventions are characterised by multiple activities, multiple outcomes, multiple components, a high level of interconnectedness, and non-linear outcomes. We identify a number of approaches that support the evaluation of different types of complex interventions.

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Lewin, Alex, Karla Diaz-Ordaz, Chris Bonell, James Hargreaves e Edoardo Masset. Machine learning for impact evaluation in CEDIL-funded studies: an ex ante lesson learning paper. Centre for Excellence and Development Impact and Learning (CEDIL), aprile 2023. http://dx.doi.org/10.51744/llp3.

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The Centre of Excellence for Development Impact and Learning (CEDIL) has recently funded several studies that use machine learning methods to enhance the inferences made from impact evaluations. These studies focus on assessing the impact of complex development interventions, which can be expected to have impacts in different domains, possibly over an extended period of time. These studiestherefore involve study participants being followed up at multiple time-points after the intervention, and typically collect large numbers of variables at each follow-up. The hope is that machine learning approaches can uncover new insights into the variation in responses to interventions, and possible causal mechanisms, which in turn can highlight potential areas that policy and planning can focus on. This paper describes these studies using machine learning methods, gives an overview of the common aims and methodological approaches used in impact evaluations, and highlights some lessons and important caveats.

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Baliki, Ghassan, Dorothee Weiffen, Melodie Al Daccache, Aysegül Kayaoglu, Lara Sujud, Hadi Jaafar, Hala Ghattas e Tilman Brück. Seeds for recovery: The long-term impacts of a complex agricultural intervention on welfare, behaviour and stability in Syria (SEEDS). Centre for Excellence and Development Impact and Learning (CEDIL), aprile 2023. http://dx.doi.org/10.51744/crpp7.

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There is scarce evidence on whether and how assistance in humanitarian emergencies and conflict settings impacts household well-being and behaviour. Conducting rigorous impact evaluations in such settings poses multiple challenges in design and data collection. In SEEDS, we evaluate the impact of a complex large-scale multi-arm agricultural intervention on productivity, food security, and resilience in the context of an on-going humanitarian crisis in Syria. Specifically, we identify the causal impacts of agricultural asset transfers over various time horizons (the short-, medium-, and long-run), and across different conditions and subgroups (gender and conflict intensity) at the household-level. We evaluate the effectiveness of irrigation rehabilitation separately at the community-level. We use and combine various data sources, including a unique survey panel dataset collected over a period of four years from multiple governorates in Syria, satellite remote-sensing data, and publicly available violent conflict incidence and weather data. Our findings from using cutting-edge machine and deep learning approaches together with innovative balancing and analytical methods can be summarised as follows: For average treatment effects at the household-level, we find that the provision of agricultural asset support leads to significant improvements in food security in the short- and long-term, three years after the intervention. The positive and significant effect on food security is driven mainly by the increased consumption of healthy food items such as vegetables. In the long-run, livestock support reduces the use of harmful coping strategies households employ to deal with food shortages. Interestingly, we find that households who received vegetable kits are not just less likely to sell their productive assets in the long-term but also are less likely to marry off their young daughters or send their children to work. Overall, we find that both agricultural and livestock asset support is key to improving households’ resilience in the long-term. The irrigation rehabilitation interventions at the community-level positively affected agricultural productivity compared to the pre-intervention and pre-conflict periods. However, these effects were only significantly pronounced in the spring season. As for the heterogeneity analysis, we find that female-headed households benefit remarkably more in terms of food security in the medium-term compared to male-headed families. Moreover, households residing in areas that are moderately affected by violent conflict show stronger food security improvements compared to households from peaceful or conflict-intense settings. Overall, we draw three overarching lessons from our findings in SEEDS: First, agricultural support in protracted conflict settings effectively improves the long-term welfare and resilience of vulnerable households. In fact, the presence of an ongoing humanitarian operation acts as a social safety net if circumstances deteriorate suddenly. Second, not all interventions are equally effective, and not all households equally benefit, underscoring the need to design and implement inclusive context-specific interventions with detailed targeting. Third, methodologically, using multiple remote data sources and machine learning methods help overcome challenges in conducting rigorous impact evaluations in hard-to-reach humanitarian emergency settings.

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Siercke, Maj, Sanne Pagh Moller, Lau Caspar Thygesen, Henrik Sillesen e Dorthe Overgaard. Improving Rehabilitation for Patients with Intermittent Claudication: A Randomized Controlled Trial with a Mixed-Methods Evaluation (The CIPIC Rehab Study). Science Repository, ottobre 2021. http://dx.doi.org/10.31487/j.jicoa.2021.04.01.sup.

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Aim: This study aimed to explore how qualitative data about rehabilitation for patients with intermittent claudication do provide an enhanced understanding of the quantitative experimental results. Background: The study was a randomized clinical trial comparing a rehabilitation intervention with usual care. A statistically significant difference between rehabilitation and usual care was found in walking distance, physical activity, quality of life and diet. The findings from the quantitative and qualitative analyses were analysed separately on their own tradition. In this study, mixed methods address whether the qualitative results could help explain the quantitative results and bring forward additional information. Design: Complex mixed-method intervention design with a convergent questionnaire variant. Methods: From April 2017- May 2019, patients diagnosed with intermittent claudication were included in a randomized clinical trial (N=118). In addition, qualitative interview informants from the intervention group were sampled from the quantitative study population for a survey (N=43) and focus group interviews (N=10). Interviews were conducted from April 2018-August 2019. Results: Integrated analyses identified how improvement in walking distance, physical activity, diet and quality of life was affected by team spirit, pedometer, education and fun exercise in a local setting. Quantitative and qualitative findings primarily confirmed and expanded each other; however, two discordant results were also evident. Conclusion: Our study adds empirical evidence regarding how a mixed-methods study can be used to obtain a more nuanced understanding of complex healthcare problems. The study provides new knowledge concerning how to set up a rehabilitation programme for patients with intermittent claudication.

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Masset, Edoardo, e Howard White. To boldly go where no evaluation has gone before: The CEDIL Evaluation Agenda. Centre for Excellence and Development Impact and Learning (CEDIL), luglio 2019. http://dx.doi.org/10.51744/ceap.

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This paper introduces the rationale behind the establishment of the Centre of Excellence in Development, Impact and Learning (CEDIL) and the challenges it will address. CEDIL was established with funding from the UK Government through the Department for International Development (DFID), with the aim of developing and supporting new methods and approaches in the evaluation of international development interventions in neglected geographic, and thematic areas. CEDIL has concluded its inception phase, which explored new evaluation methods and approaches with a series of papers, workshops, and consultations. This paper sets out CEDIL’s research agenda for the next three years. CEDIL will promote studies in three key areas: 1) unpacking complex interventions with mixed methods approaches, and exploration of mechanisms, 2) generalising evidence through the formulation of mid-level theories of neglected interventions, and 3) promoting evidence use through stakeholder engagement and demonstrating what works within such communication.

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Davey, Calum, Syreen Hassan, Chris Bonell, Nancy Cartwright, Macartan Humphreys, Audrey Prost e James Hargreaves. Gaps in Evaluation Methods for Addressing Challenging Contexts in Development. Centre for Excellence and Development Impact and Learning (CEDIL), settembre 2017. http://dx.doi.org/10.51744/cpip4.

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We start this paper by emphasizing that that we currently do not learn as much as we could from evaluations. While there are well-established methods for determining, and understanding, the effects of simpler interventions in one set of places (i.e. internal validity), it is less clear how to learn the most possible from evaluations of context-specific, complex, interventions, and apply what we learn to other contexts. This is especially important in international development where evaluations are limited by time, cost and opportunity, and where there is significant heterogeneity in the issues and contexts within which work is undertaken. Using examples and case studies throughout, we outline several gaps in evaluation methods that if addressed, could allow us to learn more. First, we argue that an important gap is the failure to combine the analysis and interpretation of process and outcome data, and illustrate the benefits of doing so. We then highlight principles that could be adapted to guide the integration from two methodological frameworks from other research fields, and discuss Bayesian modelling as a potential method that could be employed. Second, we place this gap within an evaluation approach, which relies on developing “midlevel” theories, and using data from evaluations to test and refine these theories to allow for knowledge from one setting to be transported to others. Finally, we identify further gaps and the challenges that confront this evaluation approach.

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Juden, Matthew, Tichaona Mapuwei, Till Tietz, Rachel Sarguta, Lily Medina, Audrey Prost, Macartan Humphreys et al. Process Outcome Integration with Theory (POInT): academic report. Centre for Excellence and Development Impact and Learning (CEDIL), marzo 2023. http://dx.doi.org/10.51744/crpp5.

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This paper describes the development and testing of a novel approach to evaluating development interventions – the POInT approach. The authors used Bayesian causal modelling to integrate process and outcome data to generate insights about all aspects of the theory of change, including outcomes, mechanisms, mediators and moderators. They partnered with two teams who had evaluated or were evaluating complex development interventions: The UPAVAN team had evaluated a nutrition-sensitive agriculture intervention in Odisha, India, and the DIG team was in the process of evaluating a disability-inclusive poverty graduation intervention in Uganda. The partner teams’ theory of change were adapted into a formal causal model, depicted as a directed acyclic graph (DAG). The DAG was specified in the statistical software R, using the CausalQueries package, having extended the package to handle large models. Using a novel prior elicitation strategy to elicit beliefs over many more parameters than has previously been possible, the partner teams’ beliefs about the nature and strength of causal links in the causal model (priors) were elicited and combined into a single set of shared prior beliefs. The model was updated on data alone as well as on data plus priors to generate posterior models under different assumptions. Finally, the prior and posterior models were queried to learn about estimates of interest, and the relative role of prior beliefs and data in the combined analysis.

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Kahabuka, Catherine, Salum Mshamu, Nrupa Jani e Kamden Hoffmann. Midterm evaluation of USAID Tulonge Afya Project. Population Council, agosto 2020. http://dx.doi.org/10.31899/sbsr2020.1010.

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This report examines findings from a mid-term evaluation conducted by Breakthrough RESEARCH, a USAID-funded research and evaluation project. The purpose of this evaluation is to provide recommendations to enhance the effectiveness of USAID Tulonge Afya’s strategies and activities as the program enters year three. The evaluation identified successes, promising strategies, and interventions that can be sustained throughout the life of the project and scaled-up to other regions and districts. The evaluation also helps to identify facilitating and limiting factors for implementing a complex, integrated social and behavior change communication (SBCC) program, with applications for the future of this project as well as future integrated SBCC programming globally.

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