Understanding functions and forms of complex/multilevel interventions*
Advancing implementation science (IS) requires explicit attention to interactions between and among multiple levels of influence and the development and implementation of multilevel/complex health interventions designed to target them. Multilevel interventions (MLIs) are defined as interventions at two or more levels of individuals, providers, clinical teams, health care systems, and/or community settings that measure outcomes at three levels. Complex interventions are generally defined as multicomponent adaptable interventions. All MLIs are complex interventions, but not all complex interventions are MLIs. Due to the inherent complexity of complex/MLI research, few examples along the cancer care continuum exist and even fewer have been implemented into practice.
Moreover, most intervention studies lack sufficient detail around the multilevel context, making it difficult to understand how and why an intervention succeeds or fails across different settings and populations. Initiated in 2020, the goal of the Consortium for Cancer Implementation Sciences (CCIS) Implementation of Complex/Multilevel Intervention action group is to advance the science and understanding of MLIs through three objectives: (1) understanding the interface of MLIs and IS, (2) exploring the interface of complex interventions and IS, and (3) producing goods and tutorials to help others seeking to work at the interface of these disciplines. A common need identified by members of the action group includes specific tools, resources, and examples to help navigate the inherent complexity of MLI research. The following resource, funded by the CCIS in 2021, applied an existing pragmatic tool to well-defined case examples of MLIs across the cancer care continuum to advance our understanding of developing and implementing complex interventions/MLIs.
Contributors
Jessica D. Austin, PhD
Kristin E. Morrill, PhD; Erin Kenzie, PhD, MSc; Katelyn Fox, PhD; Raul U. Hernandez-Ramirez, PhD; Jennifer Leeman, DrPH, MPH, MDiv; Matthew F. Hudson, PhD, MPH; Erica Lau, PhD; Lorella Palazzo, PhD; Erica Breslau, PhD, MPH; Melinda Davis, PhD, MCR; Brian S. Mittman, PhD; Maria E. Fernández, PhD
Note
* This public good was developed with funding from a CCIS public goods cycle.