Development of a Framework for Complex Interventions

In the first step, we undertook purposive literature searches for models, theories and frameworks concerned with context and/or implementation. We critically examined the publications identified in this way and, using our understanding of complex interventions within complex systems, we built an initial framework. In parallel, methods for logic models [33 ] as well as methods to undertake an assessment of effectiveness, economic, socio-cultural, ethical and legal aspects were developed within INTEGRATE-HTA. Starting in step 1 and continuing, we aimed to come to agreement across the project regarding the domains of the CICI framework as well as the aspects covered by each domain, so that all methods could be used in a coherent and complementary fashion (Fig. 1). As a research team, we applied the initial framework within three rapid assessments of complex interventions (i.e., improved household stoves and fuels for developing countries, specialist palliative care and e-learning interventions to increase evidence-based healthcare competencies in healthcare professionals). These rapid assessments explored whether the broad principles of the framework might apply across very different types of health interventions. The rapid assessments unveiled inconsistencies in the interpretation of the terms context and implementation and the characteristics assigned to each of these among members of the research team.