Complexity in Health Improvement
The Complexity in Health Improvement programme seeks to develop and apply research methods that are specifically designed for understanding and measuring the multiplicity of interdependent factors that shape the impact of interventions and policies designed to improve public health and/or reduce health inequalities. Work within the programme will revolve around three overlapping themes, focusing on (1) the development and evaluation of complex interventions; (2) the transferability of interventions across contexts; and (3) complex systems science.
Public health interventions whose mechanisms rely solely on human agency often fail to bring about sustained improvement in public health, and may increase social inequalities in health. Strategies are more likely to be effective if complex and underpinned by explicit theoretical frameworks and perspectives. These include the socio-ecological model, complex systems theory; realist evaluation which highlights the need to not just identify ‘what works?’ but ‘what works, for whom, under what circumstances and why?’; and an implementation science/knowledge exchange perspective that identifies the need to include, at all stages of the development and evaluation process, 1) engagement with policy, practice and public partners; and 2) a focus on whether interventions will Reach those most in need, are Efficacious, and can be Adopted, Implemented and Maintained in the real world effectively and at reasonable cost (REAIM).
The programme aims to lead international efforts in the application of novel methods (1) to identify the most effective means to improve population health and reduce inequalities, and (2) understand how effectiveness might vary across contexts. Our objectives are to:
- Develop and apply novel methods to support the rigorous development and evaluation of complex public health improvement interventions.
- Formulate general principles about the transferability of interventions.
- Develop and apply complex systems science methods to the modelling of health inequalities and social network influences on health.
- Build capacity in the development and evaluation of complex public health improvement interventions and in complex systems science methods.
This new programme will take a concerted and coherent approach to the challenge of improving the volume and quality of evidence on the effectiveness of public health improvement interventions. Notably by developing methodology and supporting the conduct of evaluations of complex, multilevel interventions and policies.
The programme scientists will work with the Unit’s Population Health Research Facility and Knowledge team to create a world class, collaborative environment to support the successful implementation of translational research in public health improvement, to be taken forward in collaborative projects with the Unit’s other programmes and external collaborators. Furthermore, we aim to create capacity through our critical mass and researcher development, and to both lead and support studies that: identify promising intervention mechanisms; apply them; and evaluate their effectiveness and generalizability between contexts.
Rutter H, Savona N, Glonti K, Bibby J, Cummins S, Finegood D, Greaves F, Harper L, Hawe P, Moore L, Petticrew M, Rehfuess E, Shiell A, Thomas J, White M. Why we need a complex systems model of evidence for public health [editorial]. The Lancet [in press]
Dobbie F, Purves R, McKell J, Dougall N, White J, Campbell R, Amos A, Moore L, Bauld L. A process evaluation of the implementation of ASSIST in Scotland: final report. Stirling, 2017open access
Segrott J, Holliday J, Murphy S, MacDonald S, Roberts J, Moore LM. Implementation of a Cooking Bus intervention to support cooking in schools in Wales. Health Education 2017;117:234-251open access
Segrott J, Murphy S, Rothwell H, Scourfield J, Foxcroft D, Gillespie D, Holliday J, Hood K, Hurlow C, Morgan-Trimmer S, Phillips C, Reed H, Roberts Z, Moore L. An application of Extended Normalisation Process Theory in a randomised controlled trial of a complex social intervention: process evaluation of the Strengthening Families Programme (10-14) in Wales, UK. SSM - Population Health 2017;3:255–265open access
Barratt H, Campbell M, Moore L, Zwarenstein M, Bower P. Randomised controlled trials of complex interventions and large-scale transformation of services. In: Raine R Fitzpatrick R Barratt H Bevan G Black N Boaden R et al., editor Challenges, solutions and future directions in the evaluation of service innovations in health care and public health. . 2016:19–36.open access
Chambers S, Ford A, Boydell N, Moore L, Stead M, Eadie D. Universal free school meals in Scotland: a process evaluation of implementation and uptake. European Journal of Public Health 2016;26:ckw169.025open access
Holliday J, Audrey S, Campbell R, Moore L. Identifying well-connected opinion leaders for informal health promotion: the example of the ASSIST smoking prevention program. Health Communication 2016;31:946-53open access
Kipping R, Jago R, Metcalfe C, White J, Papadaki A, Campbell R, Hollingworth D, Ward D, Wells S, Brockman R, Nicholson A, Moore L. NAP SACC UK: protocol for a feasibility cluster randomised controlled trial in nurseries and at home to increase physical activity and healthy eating in 2-4 year olds. BMJ Open 2016;6open access
Littlecott HJ, Moore GF, Moore L, Lyons RA, Murphy S. ‘Breakfast: how important is it really?’ A response [letter]. Public Health Nutrition 2016;19:1720–1721open access
Moore SC, Wood AM, Moore LAR, Shepherd JP, Murphy S, Brown GDA. A rank based social norms model of how people judge their levels of drunkenness whilst intoxicated. BMC Public Health 2016;16:798open access
Pugmire J, Sweeting H, Moore L. Environmental tobacco smoke exposure among infants, children and young people: now is no time to relax. Archives of Disease in Childhood 2016;102:117-118
Segrott J, Rothwell H, Pignatelli I, Playle R, Hewitt G, Huang C, Murphy S, Hickman M, Reed H, Moore L. Exploratory trial of a school-based alcohol prevention intervention with a family component. Health Education 2016;116:410-431
Smith KE, Collin J, Hawkins B, Hilton S, Moore L. The pursuit of ignorance [editorial]. BMJ 2016;352 :i1446open access
Vargas-Prada S, Demou E, Lalloo D, Avila-Palencia I, Sanati K, Sampere M, Freer K, Serra C, Macdonald EB. Effectiveness of very early workplace interventions to reduce sickness absence: a systematic review of the literature and meta-analysis. Scandinavian Journal of Work, Environment & Health 2016;42:261-72open access
Williams A, Moore SC, Shovelton C, Moore L, Murphy S. Process evaluation of an environmental health risk audit and action plan intervention to reduce alcohol related violence in licensed premises. BMC Public Health 2016;16:455open access
Francis D, Turley R, Thomson H, Weightman A, Waters E, Moore L. Supporting the needs of public health decision-makers and review authors in the UK. Journal of Public Health 2015;37:172-174open access
Jenkins KT, Benton D, Tapper K, Murphy S, Moore L. A cross-sectional observational study of the nutritional intake of UK primary school children from deprived and non-deprived backgrounds: implications for school breakfast schemes. International Journal of Behavioral Nutrition and Physical Activity 2015;12:86open access
Moore G, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, Moore L, O’Cathain A, Tinati T, Wight D, Baird J. Process evaluation of complex interventions: a summary of Medical Research Council guidance. In: Richards D, Hallberg IR, editors Complex interventions in health: an overview of research methods. Abingdon: Routledge, 2015.
Moore G, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, Moore L, O’Cathain A, Tinati T, Wight D, Baird J. Process evaluation of complex interventions: Medical Research Council guidance. BMJ 2015;350:h1258open access
Moore G, Hewitt G, Evans J, Littlecott HJ, Holliday J, Ahmed N, Moore L, Murphy S, Fletcher A. Electronic-cigarette use among young people in Wales: evidence from two cross-sectional surveys. BMJ Open 2015;5:e007072open access
Moore GF, Moore L, Littlecott HJ, Ahmed N, Lewis S, Sulley G, Jones E, Holliday J. Prevalence of smoking restrictions and child exposure to secondhand smoke in cars and homes: a repeated cross-sectional survey of children aged 10–11 years in Wales. BMJ Open 2015;5open access
Segrott J, Rothwell H, Hewitt G, Playle R, Huang C, Murphy S, Moore LM, Hickman M, Reed H. Preventing alcohol misuse in young people: an exploratory cluster randomised controlled trial of the Kids, Adults Together (KAT) programme. Public Health Research 2015;3:1-218open access
Wold B, Littlecott H, Tynjala J, Samdal O, Moore LM, Roberts C, Kannas L, Villberg J, Aaro LE. Changes from 1986 to 2006 in reasons for liking leisure-time physical activity among adolescents. Scandinavian Journal of Medicine & Science in Sports 2015;26:951-9
Armstrong R, Waters E, Moore L, Dobbins M, Pettman T, Burns C, Swinburn B, Anderson L, Petticrew M. Understanding evidence: a statewide survey to explore evidence-informed public health decision-making in a local government setting. Implementation Science 2014;9:188open access
Bonell C, Humphrey N, Fletcher A, Moore L, Anderson R. Why schools should promote students’ health and wellbeing [editorial]. The BMJ 2014;348:g3078open access
Centre for Reviews & Dissemination . Housing improvement and home safety. Effectiveness matters 2014;Novemberopen access
Gibbs L, Waters E, de Silva A, Riggs E, Moore L, Armit C, Johnson B. An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from refugee and migrant backgrounds: a protocol paper for Teeth Tales. BMJ Open 2014;4:e004260open access
Littlecott HJ, Moore GF, Moore L, Murphy S. Psychosocial mediators of change in physical activity in the Welsh National Exercise Referral Scheme: secondary analysis of a randomised controlled trial. International Journal of Behavioral Nutrition and Physical Activity 2014;11:109open access
Moore G, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, Moore L, O’Cathain A, Tinati T, Wight D, Baird J. Process evaluation of complex interventions: Medical Research Council guidance. MRC Population Health Science Research Network, London, 2014open access
Moore G, Littlecott HJ, Moore L, Ahmed N, Holliday J. E-cigarette use and intentions to smoke among 10-11 year old never smokers in Wales. Tobacco Control 2014;25:147-152open access
Moore G, Moore L, Ahmed N, Littlecott H, Holliday J. Exposure to secondhand smoke in cars and e-cigarette use among 10-11 year old children in Wales: CHETS Wales 2 - key findings report. Welsh Government Social Research 71/2014, Cardiff, 2014open access
Segrott J, Holliday J, Rothwell H, Foxcroft D, Murphy S, Scourfield J, Hood K, Moore L. Cultural adaptation and intervention integrity: a response to Skärstrand, Sundell and Andréasson. European Journal of Public Health 2014;24 :354-355open access
Bonell C, Parry W, Wells H, Jamal F, Fletcher A, Harden A, Thomas J, Campbell R, Petticrew M, Murphy S, Whitehead M, Moore L. The effects of the school environment on student health: A systematic review of multi-level studies. Health & Place 2013;21:180-91pubmed open access
Bonell C, Harden A, Wells H, Jamal F, Fletcher A, Petticrew M, Thomas J, Whitehead M, Campbell R, Murphy S. Protocol for a systematic review of the effects of schools and school-environment interventions on health: evidence mapping and syntheses. BMC Public Health 2011;11:453