Evaluating complex interventions in context: systematic, meta-narrative review of case study approaches

Sara Paparini; Chrysanthi Papoutsi; Jamie Murdoch; Judith Green; Mark Petticrew; Trisha  Greenhalgh; Sara Shaw

doi:10.1186/s12874-021-01418-3

Evaluating complex interventions in context: systematic, meta-narrative review of case study approaches

Sara Paparini, Chrysanthi Papoutsi, Jamie Murdoch, Judith Green, Mark Petticrew, Trisha Greenhalgh, Sara Shaw^*

^*Corresponding author for this work

Population Health Sciences

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: There is a growing need for methods that acknowledge and successfully capture the dynamic interaction between context and implementation of complex interventions. Case study research has the potential to provide such understanding, enabling in-depth investigation of the particularities of phenomena. However, there is limited guidance on how and when to best use different case study research approaches when evaluating complex interventions. This study aimed to review and synthesise the literature on case study research across relevant disciplines, and determine relevance to the study of contextual influences on complex interventions in health systems and public health research. Methods: Systematic meta-narrative review of the literature comprising (i) a scoping review of seminal texts (n = 60) on case study methodology and on context, complexity and interventions, (ii) detailed review of empirical literature on case study, context and complex interventions (n = 71), and (iii) identifying and reviewing ‘hybrid papers’ (n = 8) focused on the merits and challenges of case study in the evaluation of complex interventions. Results: We identified four broad (and to some extent overlapping) research traditions, all using case study in a slightly different way and with different goals: 1) developing and testing complex interventions in healthcare; 2) analysing change in organisations; 3) undertaking realist evaluations; 4) studying complex change naturalistically. Each tradition conceptualised context differently—respectively as the backdrop to, or factors impacting on, the intervention; sets of interacting conditions and relationships; circumstances triggering intervention mechanisms; and socially structured practices. Overall, these traditions drew on a small number of case study methodologists and disciplines. Few studies problematised the nature and boundaries of ‘the case’ and ‘context’ or considered the implications of such conceptualisations for methods and knowledge production. Conclusions: Case study research on complex interventions in healthcare draws on a number of different research traditions, each with different epistemological and methodological preferences. The approach used and consequences for knowledge produced often remains implicit. This has implications for how researchers, practitioners and decision makers understand, implement and evaluate complex interventions in different settings. Deeper engagement with case study research as a methodology is strongly recommended.

Original language	English
Article number	225
Journal	BMC Medical Research Methodology
Volume	21
Issue number	1
DOIs	https://doi.org/10.1186/s12874-021-01418-3
Publication status	Published - 25 Oct 2021

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title = "Evaluating complex interventions in context: systematic, meta-narrative review of case study approaches",

abstract = "Background: There is a growing need for methods that acknowledge and successfully capture the dynamic interaction between context and implementation of complex interventions. Case study research has the potential to provide such understanding, enabling in-depth investigation of the particularities of phenomena. However, there is limited guidance on how and when to best use different case study research approaches when evaluating complex interventions. This study aimed to review and synthesise the literature on case study research across relevant disciplines, and determine relevance to the study of contextual influences on complex interventions in health systems and public health research. Methods: Systematic meta-narrative review of the literature comprising (i) a scoping review of seminal texts (n = 60) on case study methodology and on context, complexity and interventions, (ii) detailed review of empirical literature on case study, context and complex interventions (n = 71), and (iii) identifying and reviewing {\textquoteleft}hybrid papers{\textquoteright} (n = 8) focused on the merits and challenges of case study in the evaluation of complex interventions. Results: We identified four broad (and to some extent overlapping) research traditions, all using case study in a slightly different way and with different goals: 1) developing and testing complex interventions in healthcare; 2) analysing change in organisations; 3) undertaking realist evaluations; 4) studying complex change naturalistically. Each tradition conceptualised context differently—respectively as the backdrop to, or factors impacting on, the intervention; sets of interacting conditions and relationships; circumstances triggering intervention mechanisms; and socially structured practices. Overall, these traditions drew on a small number of case study methodologists and disciplines. Few studies problematised the nature and boundaries of {\textquoteleft}the case{\textquoteright} and {\textquoteleft}context{\textquoteright} or considered the implications of such conceptualisations for methods and knowledge production. Conclusions: Case study research on complex interventions in healthcare draws on a number of different research traditions, each with different epistemological and methodological preferences. The approach used and consequences for knowledge produced often remains implicit. This has implications for how researchers, practitioners and decision makers understand, implement and evaluate complex interventions in different settings. Deeper engagement with case study research as a methodology is strongly recommended.",

author = "Sara Paparini and Chrysanthi Papoutsi and Jamie Murdoch and Judith Green and Mark Petticrew and Trisha Greenhalgh and Sara Shaw",

note = "Funding Information: The research was funded by the Medical Research Council (MR/S014632/1). Funding Information: Additional funding for SP, TG, CP and SS salaries over the course of the study was provided by the UK National Institute for Health Research Oxford Biomedical Research Centre (BRC-1215-20008), Wellcome Trust (WT104830MA; 221457/Z/20/Z) and the University of Oxford{\textquoteright}s Higher Education Innovation Fund. JG was additionally supported by a Wellcome Trust Centre Grant (203109/Z/16/Z). Publisher Copyright: {\textcopyright} 2021, The Author(s).",

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doi = "10.1186/s12874-021-01418-3",

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AU - Paparini, Sara

AU - Papoutsi, Chrysanthi

AU - Murdoch, Jamie

AU - Green, Judith

AU - Petticrew, Mark

AU - Greenhalgh, Trisha

AU - Shaw, Sara

N1 - Funding Information: The research was funded by the Medical Research Council (MR/S014632/1). Funding Information: Additional funding for SP, TG, CP and SS salaries over the course of the study was provided by the UK National Institute for Health Research Oxford Biomedical Research Centre (BRC-1215-20008), Wellcome Trust (WT104830MA; 221457/Z/20/Z) and the University of Oxford’s Higher Education Innovation Fund. JG was additionally supported by a Wellcome Trust Centre Grant (203109/Z/16/Z). Publisher Copyright: © 2021, The Author(s).

PY - 2021/10/25

Y1 - 2021/10/25

N2 - Background: There is a growing need for methods that acknowledge and successfully capture the dynamic interaction between context and implementation of complex interventions. Case study research has the potential to provide such understanding, enabling in-depth investigation of the particularities of phenomena. However, there is limited guidance on how and when to best use different case study research approaches when evaluating complex interventions. This study aimed to review and synthesise the literature on case study research across relevant disciplines, and determine relevance to the study of contextual influences on complex interventions in health systems and public health research. Methods: Systematic meta-narrative review of the literature comprising (i) a scoping review of seminal texts (n = 60) on case study methodology and on context, complexity and interventions, (ii) detailed review of empirical literature on case study, context and complex interventions (n = 71), and (iii) identifying and reviewing ‘hybrid papers’ (n = 8) focused on the merits and challenges of case study in the evaluation of complex interventions. Results: We identified four broad (and to some extent overlapping) research traditions, all using case study in a slightly different way and with different goals: 1) developing and testing complex interventions in healthcare; 2) analysing change in organisations; 3) undertaking realist evaluations; 4) studying complex change naturalistically. Each tradition conceptualised context differently—respectively as the backdrop to, or factors impacting on, the intervention; sets of interacting conditions and relationships; circumstances triggering intervention mechanisms; and socially structured practices. Overall, these traditions drew on a small number of case study methodologists and disciplines. Few studies problematised the nature and boundaries of ‘the case’ and ‘context’ or considered the implications of such conceptualisations for methods and knowledge production. Conclusions: Case study research on complex interventions in healthcare draws on a number of different research traditions, each with different epistemological and methodological preferences. The approach used and consequences for knowledge produced often remains implicit. This has implications for how researchers, practitioners and decision makers understand, implement and evaluate complex interventions in different settings. Deeper engagement with case study research as a methodology is strongly recommended.

AB - Background: There is a growing need for methods that acknowledge and successfully capture the dynamic interaction between context and implementation of complex interventions. Case study research has the potential to provide such understanding, enabling in-depth investigation of the particularities of phenomena. However, there is limited guidance on how and when to best use different case study research approaches when evaluating complex interventions. This study aimed to review and synthesise the literature on case study research across relevant disciplines, and determine relevance to the study of contextual influences on complex interventions in health systems and public health research. Methods: Systematic meta-narrative review of the literature comprising (i) a scoping review of seminal texts (n = 60) on case study methodology and on context, complexity and interventions, (ii) detailed review of empirical literature on case study, context and complex interventions (n = 71), and (iii) identifying and reviewing ‘hybrid papers’ (n = 8) focused on the merits and challenges of case study in the evaluation of complex interventions. Results: We identified four broad (and to some extent overlapping) research traditions, all using case study in a slightly different way and with different goals: 1) developing and testing complex interventions in healthcare; 2) analysing change in organisations; 3) undertaking realist evaluations; 4) studying complex change naturalistically. Each tradition conceptualised context differently—respectively as the backdrop to, or factors impacting on, the intervention; sets of interacting conditions and relationships; circumstances triggering intervention mechanisms; and socially structured practices. Overall, these traditions drew on a small number of case study methodologists and disciplines. Few studies problematised the nature and boundaries of ‘the case’ and ‘context’ or considered the implications of such conceptualisations for methods and knowledge production. Conclusions: Case study research on complex interventions in healthcare draws on a number of different research traditions, each with different epistemological and methodological preferences. The approach used and consequences for knowledge produced often remains implicit. This has implications for how researchers, practitioners and decision makers understand, implement and evaluate complex interventions in different settings. Deeper engagement with case study research as a methodology is strongly recommended.

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Evaluating complex interventions in context: systematic, meta-narrative review of case study approaches

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