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Addressing complexity in population health intervention research: the context/intervention interface
  1. Laetitia Minary1,2,3,
  2. François Alla1,3,4,
  3. Linda Cambon1,5,6,
  4. Joelle Kivits1,4,
  5. Louise Potvin2,7,8
  1. 1 EA4360 Apemac, Université de Lorraine, Université Paris Descartes, Vandoeuvre les Nancy, Nancy, France
  2. 2 Département de Médecine Sociale et Préventive, Ecole de Santé Publique, Universite de Montreal Faculte de medecine, Montréal, Canada
  3. 3 Centre Hospitalier Universitaire de Nancy, INSERM CIC-EC, Nancy, France
  4. 4 Université de Lorraine, Ecole de Santé Publique, Nancy, France
  5. 5 EHESP, Chaire Recherche en Prévention des Cancer, Rennes, France
  6. 6 CNRS, UMR CRAPE Centre de Recherche sur l’Action Politique en Europe-6051, Rennes, France
  7. 7 Institut de Recherche en Santé Publique de l’Université de Montréal, Université de Montréal, Montreal, Quebec, Canada
  8. 8 Centre de Recherche Léa-Roback sur les Inégalités Sociales de Santé de Montréal, Montréal, Quebec, Canada
  1. Correspondence to Dr Laetitia Minary, EA 4360 APEMAC, Faculté de Médecine, Université de Lorraine, Université Paris Descartes, Vandoeuvre-Les-Nancy 54505, France; laetitia.minary{at}univ-lorraine.fr

Abstract

Background Public health interventions are increasingly being recognised as complex and context dependent. Related to this is the need for a systemic and dynamic conception of interventions that raises the question of delineating the scope and contours of interventions in complex systems. This means identifying which elements belong to the intervention (and therefore participate in its effects and can be transferred), which ones belong to the context and interact with the former to influence results (and therefore must be taken into account when transferring the intervention) and which contextual elements are irrelevant to the intervention.

Discussion This paper, from which derives criteria based on a network framework, operationalises how the context and intervention systems interact and identify what needs to be replicated as interventions are implemented in different contexts. Representing interventions as networks (composed of human and non-human entities), we introduce the idea that the density of interconnections among the various entities provides a criterion for distinguishing core intervention from intervention context without disconnecting the two systems. This differentiates endogenous and exogenous intervention contexts and the mediators that connect them, which form the fuzzy and constantly changing intervention/context interface.

Conclusion We propose that a network framework representing intervention/context systems constitutes a promising approach for deriving empirical criteria to delineate the scope and contour of what is replicable in an intervention. This approach should allow better identification and description of the entities that have to be transferred to ensure the potential effectiveness of an intervention in a specific context.

  • methodology
  • public health
  • health promotion

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors LM conceived the idea for the paper, wrote the first draft and led the writing of the paper. FA, LC and JK helped draft the manuscript. LP also conceived the idea for the paper and assisted with the writing of the manuscript. LM acts as guarantor. All authors have approved the final version.

  • Funding This work was supported by the French National Cancer Institute/French Public Health Research Institute /ARC Foundation for Cancer Research, grant ’Primary prevention 2014' and by the French League against Cancer, grant ’Research project in Epidemiology 2014'. LP holds the Canada Research Chair in Community Approaches and Health Inequalities (CIHR 950-228295).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.