Research Article: Can We Systematically Review Studies That Evaluate Complex Interventions?

Date Published: August 11, 2009

Publisher: Public Library of Science

Author(s): Sasha Shepperd, Simon Lewin, Sharon Straus, Mike Clarke, Martin P. Eccles, Ray Fitzpatrick, Geoff Wong, Aziz Sheikh

Abstract: In three Viewpoints, Sasha Shepperd and colleagues, Geoff Wong, and Aziz Sheikh explore various approaches to help systematic reviewers who wish to review complex health interventions.

Partial Text: I believe that complex health interventions (CHIs) can be systematically reviewed, but only if a paradigm shift occurs in the way that these interventions are conceptualised. In this Viewpoint, I discuss an alternative way of viewing CHIs that focuses on the interactions between components of a CHI and the impact of human behaviour on the outcome of the intervention. I then discuss how this different way of viewing CHIs has given rise to a different method, called “realist review”, to systematically review CHIs.

The evaluation of complex interventions is increasingly commonplace within health services research. It is therefore important and timely that attention is given to reflecting critically on how these studies can best be identified and appraised, and their findings then synthesised and interpreted. The answer to the somewhat rhetorical question of whether it is feasible to systematically review studies of complex interventions is, at one level at least, obvious. Many of the general principles of systematic review methods can and indeed should be used when undertaking systematic reviews of complex intervention studies in health care. Sasha Shepperd and colleagues offer a number of useful suggestions in this respect, including: (1) the need to use broad search techniques in an attempt to identify and include studies that may have been poorly indexed; (2) carefully defining and describing the interventions being studied; and (3) a willingness to consider narrative synthesis if studies are found to be too heterogeneous to be synthesised quantitatively.



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