Designing an integrated follow-up programme for people treated for cutaneous malignant melanoma: a practical application of the MRC framework for the design and evaluation of complex interventions to improve health
Abstract
BACKGROUND: Complex health care interventions are difficult to design and evaluate, so the UK Medical Research Council (MRC) has developed a 'framework for the design and evaluation of complex health care intervention'. Researchers differ in applying the framework. OBJECTIVE: To describe and critically evaluate how the two initial phases of the MRC framework facilitate the design of an integrated follow-up programme for cutaneous melanoma to a standard suitable for testing in an exploratory randomized trial. Design of study. Literature review, expert groups, semi-structured interviews and pilot exercise to develop an intervention. SETTING: A department of academic primary care. Two general practices. METHODS: Four techniques were used-iterative literature review, a steering group, semi-structured telephone interviews and an operationalization exercise. These techniques were used simultaneously and iteratively to complete the theoretical preclinical and phase I modelling of the MRC framework when developing an integrated follow-up programme for cutaneous melanoma. RESULTS: Components of an integrated follow-up programme for cutaneous malignant melanoma were identified, developed and refined into a practical intervention comprising GP training; structured protocol-driven appointments; a centralized recall system; a rapid access pathway and a patient information booklet. Several barriers that could have derailed the successful implementation of the intervention, including the different perspectives of stakeholders and resource needs in general practice were identified. The value of the principles of the initial two phases of the MRC framework in guiding the development of complex health care interventions was supported. CONCLUSIONS: We recommend that the first two phases of the MRC framework be used iteratively and simultaneously when developing complex health care interventions.
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Fourteen included studies explored the acceptability and/or feasibility of the intervention to different stakeholders, including providers, recipients or policy makers and service commissioners.
“Fourteen studies explored the acceptability and/or feasibility of the intervention to different stakeholders, including providers, recipients or policy makers and service commissioners [27, 29–32, 34, 36, 37, 39, 40, 42, 43, 47, 48].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [37]
Other studies suggested that the process of identifying stakeholders and the potential lack of representativeness of the stakeholders involved were a limitation for optimisation studies.
“However, other studies suggested that the process of identifying stakeholders and the potential lack of representativeness of the stakeholders involved were a limitation for optimisation studies [27, 37].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [37]
Several included studies used mixed methods, combining qualitative strategies to explore stakeholders' perspectives and quantitative analysis to estimate the intervention effect.
“Several studies used mixed methods, combining qualitative strategies to explore stakeholders’ perspectives and quantitative analysis to estimate the intervention effect [24, 27, 28, 33, 35–37, 40, 42].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [37]
A few included studies reported that the optimisation processes allowed the research team to identify the 'best ingredients' out of several candidate components.
“A few studies reported that the optimisation processes allowed the research team to identify the ‘best ingredients’ out of several candidate components [33, 35–37, 42].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [37]
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- Authors
- Murchie, P., Hannaford, P. C., Wyke, S., Nicolson, M. C., & Campbell, N. C.
- Affiliations
- University of Aberdeen (GB)
- University of Stirling (GB)
- Aberdeen Royal Infirmary (GB)
- Venue
- Family Practice
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-05-16
- Volume
- 24
- Issue
- 3
- Pages
- 283-292
- ISSN
- 0263-2136 (ISSN-L)
- 1460-2229
- OpenAlex
- W2125826528
- Cited by
- 35
- References
- 24
- Citations by year
- 2026: 1 · 2025: 2 · 2020: 1 · 2019: 2 · 2017: 1 · 2016: 2 · 2015: 1 · 2014: 3 · 2013: 6 · 2012: 7
- FWCI
- 4.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Family Practice (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Medical Research Council
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- cutaneous melanoma, follow-up care, MRC framework, intervention design, general practice, general practice training, recall system, patient education booklet, implementation barriers, stakeholder perspectives, primary care
- MeSH terms
- Adult, Aged, Continuity of Patient Care, Family Practice, Female, United Kingdom, Humans, Interviews as Topic, Male, Melanoma, Middle Aged, Review Literature as Topic, Program Development
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