From systems to evidence: a study in applying complexity theory to a health promotion programme. (original) (raw)
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Complexity: a potential paradigm for a health promotion discipline
Health promotion international, 2011
Health promotion underpins a distancing from narrow, simplifying health approaches associated with the biomedical model. However, it has not yet succeeded in formally establishing its theoretical, epistemological and methodological foundations on a single paradigm. The complexity paradigm, which it has yet to broach head-on, might provide it with a disciplinary matrix in line with its implicit stances and basic values. This article seeks to establish complexity's relevance as a paradigm that can contribute to the development of a health promotion discipline. The relevance of complexity is justified primarily by its matching with several implicit epistemological and methodological/theoretical stances found in the cardinal concepts and principles of health promotion. The transcendence of ontological realism and determinism as well as receptiveness in respect of the reflexivity that complexity encompasses are congruent with the values of social justice, participation, empowerment and the concept of positive health that the field promotes. Moreover, from a methodological and theoretical standpoint, complexity assumes a holistic, contextual and transdisciplinary approach, toward which health promotion is tending through its emphasis on ecology and interdisciplinary action. In a quest to illustrate our position, developmental evaluation is presented as an example of practice stemming from a complexity paradigm that can be useful in the evaluation of health promotion initiatives. In short, we argue that it would be advantageous for health promotion to integrate this paradigm, which would provide it with a formal framework appropriate to its purposes and concerns.
Journal of evaluation in clinical practice, 2018
As the Sustainable Development Goals are rolled out worldwide, development leaders will be looking to the experiences of the past to improve implementation in the future. Systems thinking and complexity science (ST/CS) propose that health and the health system are composed of dynamic actors constantly evolving in response to each other and their context. While offering practical guidance for steering the next development agenda, there is no consensus as to how these important ideas are discussed in relation to health. This systematic review sought to identify and describe some of the key terms, concepts, and methods in recent ST/CS literature. Using the search terms "systems thinkin * AND health OR complexity theor* AND health OR complex adaptive system* AND health," we identified 516 relevant full texts out of 3982 titles across the search period (2002-2015). The peak number of articles were published in 2014 (83) with journals specifically focused on medicine/healthcare ...
Dynamic thinking and complexity: considerations for health promotion
Journal of Complexity in Health Sciences, 2020
The aim of this perspective paper is to present a new and unique viewpoint on existing challenges, fundamental concepts, and prevalent notions on health promotion. Paper focuses on possible implications of a newly implemented Healthy Boost project. We further discuss existing health promotion interventions from the standpoint of dynamic complex systems while exploring the need to foster the cooperation component. Disclosure of these relationships and their utilization for structure optimization and evolution of functional possibilities, through the use of the dynamic characteristics of determined chaos at various levels, demonstrate plausible opportunities for the effective implementation of health promotion projects. The topic of health promotion effectiveness is of societal concern to a wider audience and to the scholarly community in general. Consequently, this perspective piece advances the future direction of application of Healthy Boost project within complexity framework.
Journal of advanced nursing, 2015
To examine the application of core concepts from Complexity Theory to explain the findings from a process evaluation undertaken in a trial evaluating implementation strategies for recommendations about reducing surgical fasting times. The proliferation of evidence-based guidance requires a greater focus on its implementation. Theory is required to explain the complex processes across the multiple healthcare organizational levels. This social healthcare context involves the interaction between professionals, patients and the organizational systems in care delivery. Complexity Theory may provide an explanatory framework to explain the complexities inherent in implementation in social healthcare contexts. A secondary thematic analysis of qualitative process evaluation data informed by Complexity Theory. Seminal texts applying Complexity Theory to the social context were annotated, key concepts extracted and core Complexity Theory concepts identified. These core concepts were applied as...
Scoping review of complexity theory in health services research
BMC Health Services Research, 2016
Background: There are calls for better application of theory in health services research. Research exploring knowledge translation and interprofessional collaboration are two examples, and in both areas, complexity theory has been identified as potentially useful. However, how best to conceptualize and operationalize complexity theory in health services research is uncertain. The purpose of this scoping review was to explore how complexity theory has been incorporated in health services research focused on allied health, medicine, and nursing in order to offer guidance for future application. Given the extensiveness of how complexity theory could be conceptualized and ultimately operationalized within health services research, a scoping review of complexity theory in health services research is warranted. Methods: A scoping review of published research in English was conducted using CINAHL, EMBASE, Medline, Cochrane, and Web of Science databases. We searched terms synonymous with complexity theory. Results: We included 44 studies in this review: 27 were qualitative, 14 were quantitative, and 3 were mixed methods. Case study was the most common method. Long-term care was the most studied setting. The majority of research was exploratory and focused on relationships between health care workers. Authors most commonly used complexity theory as a conceptual framework for their study. Authors described complexity theory in their research in a variety of ways. The most common attributes of complexity theory used in health services research included relationships, self-organization, and diversity. A common theme across descriptions of complexity theory is that authors incorporate aspects of the theory related to how diverse relationships and communication between individuals in a system can influence change. Conclusion: Complexity theory is incorporated in many ways across a variety of research designs to explore a multitude of phenomena.. Although complexity theory shows promise in health services research, particularly related to relationships and interactions, conceptual confusion and inconsistent application hinders the operationalization of this potentially important perspective. Generalizability from studies that incorporate complexity theory is, therefore, difficult. Heterogeneous conceptualization and operationalization of complexity theory in health services research suggests there is no universally agreed upon approach of how to use this theory in health services research. Future research should include clear definitions and descriptions of complexity and how it was used in studies. Clear reporting will aid in determining how best to use complexity theory in health services research.
Use of complexity theory in health and social care: a scoping review protocol
BMJ Open
IntroductionDespite the use of a wide variety of improvement tools and approaches, healthcare organisations continue to struggle in several key areas. Complexity-informed approaches have the potential to offer health and social care a new paradigm for understanding, designing, implementing and evaluating solutions, yet so far has failed to gain the traction anticipated some years ago. There is a growing need for high quality syntheses of the existing knowledge base in this area and given the diversity of theory and approaches, a scoping review is the best approach to curate this knowledge.MethodsA scoping review of relevant literature from January 2000 to present, using the refined Arksey and O’Malley six-stage framework will be conducted. This protocol will follow the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols Extension for Scoping Reviews. A three-step search strategy will be used. An initial search of databases will be undertaken to identify key ...
Handbook of Systems and Complexity in Health
2013
I am a graduate from Lübeck Medical School, Germany, where I also completed my PhD. Since 1989 I work in an urban group practice on the NSW Central Coast, with a particular interest in the ongoing patient-centred care of patients with chronic disease and the elderly. In 1994 I started to pursue systems and complexity research with an inquiry into the effects of continuity of care on the care processes and outcomes. Since then my research has expanded and includes the areas of understanding the complex notion of health, health care and healthcare reform, showing that health is an interconnected multi-dimensional construct encompassing somatic, psychological, social and semiotic or sense-making domains, that health care has to embrace the patient's understanding of her health as the basis for effective and ef fi cient care, and that an effective and ef fi cient healthcare system ought to put the patient at the centre. I am joint chief editor of the Forum on Systems and Complexity in Medicine and Healthcare in the Journal of Evaluation in Clinical Practice. Together with Carmel M. Martin and Jim Price I chair the Complexity SIG in WONCA.
Complexity Science and Health IT
Complexity Implementation of health information technology Consolidated framework for implementation research a b s t r a c t Objectives: The intent of this paper is in the examination of health IT implementation processes -the barriers to and facilitators of successful implementation, identification of a beginning set of implementation best practices, the identification of gaps in the health IT implementation body of knowledge, and recommendations for future study and application. Methods: A literature review resulted in the identification of six health IT related implementation best practices which were subsequently debated and clarified by participants attending the NI2012 Research Post Conference held in Montreal in the summer of 2012.