Electronic versions

  • Mark Petticrew
    London School of Hygiene & Tropical Medicine
  • Eva Rehfuess
    University of Munich
  • Jane Noyes
  • Julian P T Higgins
    University of Bristol
  • Alain Mayhew
    Ottawa Hospital Research Institute
  • Tomas Pantoja
    Pontificia Universidad Católica de Chile
  • Ian Shemilt
    University of Munich
  • Amanda Sowden
    University of York

OBJECTIVES: Although there is increasing interest in the evaluation of complex interventions, there is little guidance on how evidence from complex interventions may be reviewed and synthesized, and the relevance of the plethora of evidence synthesis methods to complexity is unclear. This article aims to explore how different meta-analytical approaches can be used to examine aspects of complexity; describe the contribution of various narrative, tabular, and graphical approaches to synthesis; and give an overview of the potential choice of selected qualitative and mixed-method evidence synthesis approaches.

STUDY DESIGN AND SETTING: The methodological discussions presented here build on a 2-day workshop held in Montebello, Canada, in January 2012, involving methodological experts from the Campbell and Cochrane Collaborations and from other international review centers (Anderson L, Petticrew M, Chandler J, et al.

INTRODUCTION: systematic reviews of complex interventions. In press). These systematic review methodologists discussed the broad range of existing methods and considered the relevance of these methods to reviews of complex interventions.

RESULTS: The evidence from primary studies of complex interventions may be qualitative or quantitative. There is a wide range of methodological options for reviewing and presenting this evidence. Specific contributions of statistical approaches include the use of meta-analysis, meta-regression, and Bayesian methods, whereas narrative summary approaches provide valuable precursors or alternatives to these. Qualitative and mixed-method approaches include thematic synthesis, framework synthesis, and realist synthesis. A suitable combination of these approaches allows synthesis of evidence for understanding complex interventions.

CONCLUSION: Reviewers need to consider which aspects of complex interventions should be a focus of their review and what types of quantitative and/or qualitative studies they will be including, and this will inform their choice of review methods. These may range from standard meta-analysis through to more complex mixed-method synthesis and synthesis approaches that incorporate theory and/or user's perspectives.

Keywords

  • Data Interpretation, Statistical, Humans, Research Design, Review Literature as Topic, Comment, Journal Article, Research Support, Non-U.S. Gov't
Original languageEnglish
Pages (from-to)1230-43
Number of pages14
JournalJournal of Clinical Epidemiology
Volume66
Issue number11
DOIs
Publication statusPublished - Nov 2013
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