“Walking the talk on multi-level interventions: The power of parsimony“
There is strong consensus regarding the need for multi-level interventions (MLIs) to address today’s complex health problems.
The greatest public health burdens globally (e.g., chronic and infectious diseases) derive from a mix of causal and contributing factors and are inherently complex, operating interdependently and reflexively over time.
Several longstanding social ecological frameworks are commonly referred to in guiding MLI development. The specificity and comprehensiveness of these frameworks unwittingly suggest that the totality of included influences are important in all health contexts. Not surprisingly, when viewed as requirining intervention at all levels of influence, MLIs are often considered to be infeasible due to sizeable cost and logistical barriers. Thus, efforts to develop and evaluate MLIs have been extremely limited, and comparatively few examples are found in the health literature.
We argue that operational frameworks to identify which levels matter in which contexts – henceforth, referred to as parsimony – could accelerate the field towards broader use of MLIs.
We suggest a hypothetical operational framework informed by complexity theory and pragmatic approaches that could enable us to conceptualize, design and evaluate MLIs to consider where reflexive and recursive process mechanisms that cross levels should be targeted by MLI. The approach also emphasizes sustainability of MLIs. Without developing parsimony-based operational frameworks to move us forward, we fear that little will change, and we will simply continue to talk, without proceeding to the walk.
We consider it a good principle to explain the phenomena by the simplest hypotheses possible.
Ptolemy
It has been suggested complexity theory as one example of a conceptual model to guide visioning for how MLIs might lead to bi-directional and synergistic influences on targeted health outcomes that could be capitalized on for maximal benefit. We borrow from complexity domains enumerated in the “realist” framework.
Parsimony
“Everything should be made as simple
Albert Einstein.
as possible, but no simpler.”
Implementation science thinking also will be essential in the MLI planning process. Implementation efforts are often large-scale, can involve interventions at multiple levels, and are conducted across multiple sites simultaneously.
Parsimony is supported when we can conceptualize, design and evaluate MLIs that can exploit linkages across levels of influence, recognizing where the impact of reflexive and recursive process chains of mechanisms that cross levels are most influential in differing contexts.
Without doing so, we fear that little will change, and we will simply continue to talk, without proceeding to the walk.
Surtil : 