Evaluating complex interventions in context: systematic, meta-narrative review of case study approaches
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Background: There is a growing need for methods that acknowledge and successfully capture the dynamic interaction between context and implementation of complex interventions. Case study research has the potential to provide such understanding, enabling in-depth investigation of the particularities of phenomena. However, there is limited guidance on how and when to best use different case study research approaches when evaluating complex interventions. This study aimed to review and synthesise the literature on case study research across relevant disciplines, and determine relevance to the study of contextual influences on complex interventions in health systems and public health research. Methods: Systematic meta-narrative review of the literature comprising (i) a scoping review of seminal texts (n = 60) on case study methodology and on context, complexity and interventions, (ii) detailed review of empirical literature on case study, context and complex interventions (n = 71), and (iii) identifying and reviewing ‘hybrid papers’ (n = 8) focused on the merits and challenges of case study in the evaluation of complex interventions. Results: We identified four broad (and to some extent overlapping) research traditions, all using case study in a slightly different way and with different goals: 1) developing and testing complex interventions in healthcare; 2) analysing change in organisations; 3) undertaking realist evaluations; 4) studying complex change naturalistically. Each tradition conceptualised context differently—respectively as the backdrop to, or factors impacting on, the intervention; sets of interacting conditions and relationships; circumstances triggering intervention mechanisms; and socially structured practices. Overall, these traditions drew on a small number of case study methodologists and disciplines. Few studies problematised the nature and boundaries of ‘the case’ and ‘context’ or considered the implications of such conceptualisations for methods and knowledge production. Conclusions: Case study research on complex interventions in healthcare draws on a number of different research traditions, each with different epistemological and methodological preferences. The approach used and consequences for knowledge produced often remains implicit. This has implications for how researchers, practitioners and decision makers understand, implement and evaluate complex interventions in different settings. Deeper engagement with case study research as a methodology is strongly recommended.
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Mobilising context as complex and dynamic in evaluations of complex health interventions
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- Authors
- Paparini, S., Papoutsi, C., Murdoch, J., Green, J., Petticrew, M., Greenhalgh, T., & Shaw, S. E.
- Affiliations
- University of Oxford (GB)
- King's College London (GB)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Shaw, Sara E.
- Venue
- BMC Medical Research Methodology
- Published
- 2021-10-25
- Volume
- 21
- Issue
- 1
- Pages
- 225-225
- ISSN
- 1471-2288 (ISSN-L)
- PMC
- PMC8543916
- OpenAlex
- W3209048533
- Cited by
- 131
- References
- 22
- Citations by year
- 2026: 29 · 2025: 35 · 2024: 26 · 2023: 31 · 2022: 10
- FWCI
- 3.52
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Medical Research Methodology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Oxford University Research Archive (ORA) (University of Oxford) (submittedVersion, cc-by)
- Funders
- Wellcome Trust (WT104830MA, 221457/Z/20/Z, 203109/Z/16/Z)
- Medical Research Council (MR/S014632/1)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Decision Sciences › Management Science and Operations Research › Evaluation and Performance Assessment
- Social Sciences › Sociology and Political Science › Qualitative Comparative Analysis Research
- Keywords
- complex interventions, case study research, context, implementation, realist evaluation, organizational change, health systems research, public health research, research traditions, epistemology, knowledge production, intervention evaluation
- MeSH terms
- Delivery of Health Care, Humans, Research Personnel, Narration
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