Evaluating complex interventions: getting to grips with the tools

Often the last resort of the desperate is to turn to prayer. Many of the issues that we deal with in public health seem so intractable that having a word with those upstairs can, to some, seem like the only viable option. But they haven’t evaluated the evidence, unlike the multi-disciplinary team of academics and researchers at DECIPHer. If they had, they might less readily clasp their hands together and ask for a favour from the divine.

My own research bubble was first punctured by the work of DECIPHer earlier in the year when Co-Director Simon Murphy came to visit us at Fuse in the North-East and gave an insightful and fascinating talk entitled ‘Evidence based policy: The development and implementation of national policy trials in Wales’. I was particularly taken by the level of integrated working that DECIPHer had established with the Welsh Government, a mutually beneficial relationship that most importantly has yielded significant health improvements to the Welsh population.

Simon’s talk had whetted my appetite and I was fortunate enough to be allocated a place on DECIPHer’s courses on developing and evaluating complex health interventions, which ran earlier this month. However, my excitement was slightly tempered by my concern that I didn’t really know what exactly defines a ‘complex’ intervention. It seemed like a rather grand concept, and the prospect of developing and evaluating one felt like something that would require the knowledge and experience gained by decades in academia, not for someone on my pay grade.

All premonitions were soon swept aside with the confident and comfortable manner in which Adam Fletcher managed the course. Although the attendance on both courses was fairly sizeable (approximately 40), Adam cultivated an intimate atmosphere that was genuinely interactive, where all attendees felt at ease to pose questions at any point during a presentation. He was instantly likeable and cracked more than the odd joke and was as confident at talking about behavioural change theory as he was England’s full backs. But his affable manner was more than backed up by his in-depth knowledge of all the subjects presented on the course and you’ll have a job catching him out!

One of the broad concepts hammered home was that of ‘co-production’ and the value of transdisciplinary approaches. This was clearly more than just buzz-words, as was well demonstrated by both the variation of speakers and rapport between them, certainly not a revolving door of one-in-one-out. The course was cleverly punctuated by group work, which enabled us to put the concepts into action, interact and network with our fellow attendees, and also keep our minds active.

Delegates doing group work on the short course.

Getting stuck into some group discussion.

The staff and students teaching on the course were explicit in stating that they do not provide a prescriptive approach to either the development or evaluation of public health interventions (as someone who likes a nice set of rules to follow, I found this a little unnerving) but they do provide all the tools. Just because one intervention worked in one area at a given time, does not necessarily mean that it will be equally effective elsewhere. Therefore, it is essential to follow an evaluation framework ‘to help researchers and research funders to recognise and adopt appropriate methods’, and to think ‘ecologically’. This is not a throwaway hippified term but, as Tim Lang and Geof Rayner state, it is an ‘acceptance of complex and multi-layered connections’. The philosophy identifies the importance of factors operating and interacting at individual, interpersonal, institutional, community and social/policy levels.

I found myself, almost continually, reflecting the teaching back on my own work, making various scribbles on the voluminous course material as to what to use for my own research. There was a dizzying array of information to take in, often leaving me a bit dazed, but all talks were so well referenced that I was able to dig through the literature and discover at my own leisure.

Simon Murphy teaching on the short course

Professor Simon Murphy teaching us about transdisciplinary action research. Note the fruits of our group work decorating the walls.

As a result of the course I now feel better prepared to take on the challenges of my research, equipped with a framework and a way of thinking that allows me to carefully deconstruct a given public health issue and understand the various mechanisms at play at different levels. My enthusiasm was shared by my Fuse colleagues who also attended, who likewise were keen to put into place many of the themes and ideas taught.

It was also great to meet and chat with the other attendees during lunch breaks and the two evening socials and it was a slight shame that our contact details had not been collectively shared, though this was noted for future events. The main room did get a touch stuffy at times, but this was the fault of the glorious Mediterranean style weather we had on the first few days, and there was never a shortage of water and other refreshments at hand to keep us cool and energised.

These were two fantastic courses and I would highly recommend them to anyone working in the area of public health interventions. DECIPHer delivered a course on the cutting-edge, providing a wealth of examples that are bang up-to-date. Most importantly, they know how to stimulate your grey matter and spark your enthusiasm.

About the author: Louis Goffe is a research assistant at Newcastle University, and is part of the UKCRC Public Health Research Centre of Excellence Fuse. He tweets at @Fatty_Bombus.
The DECIPHer short courses, ‘Developing complex public health interventions’ (3 days) and ‘Evaluating complex public health interventions’ (2 days), run annually. For full information on the courses, and to register your interest for 2015 courses, please see the DECIPHer websitePhotos: Britt Hallingberg.

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