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Models of integrated care are prime examples of complex interventions, incorporating multiple interacting components that work through varying mechanisms to impact…
Models of integrated care are prime examples of complex interventions, incorporating multiple interacting components that work through varying mechanisms to impact numerous outcomes. The purpose of this paper is to explore summative, process and developmental approaches to evaluating complex interventions to determine how to best test this mess.
This viewpoint draws on the evaluation and complex intervention literatures to describe the advantages and disadvantages of different methods. The evaluation of the electronic patient reported outcomes (ePRO) mobile application and portal system is presented as an example of how to evaluate complex interventions with critical lessons learned from this ongoing study.
Although favored in the literature, summative and process evaluations rest on two problematic assumptions: it is possible to clearly identify stable mechanisms of action; and intervention fidelity can be maximized in order to control for contextual influences. Complex interventions continually adapt to local contexts, making stability and fidelity unlikely. Developmental evaluation, which is more conceptually aligned with service-design thinking, moves beyond these assumptions, emphasizing supportive adaptation to ensure meaningful adoption.
Blended approaches that incorporate service-design thinking and rely more heavily on developmental strategies are essential for complex interventions. To maximize the benefit of this approach, three guiding principles are suggested: stress pragmatism over stringency; adopt an implementation lens; and use multi-disciplinary teams to run studies.
This viewpoint offers novel thinking on the debate around appropriate evaluation methodologies to be applied to complex interventions like models of integrated care.
Communications regarding this column should be addressed to Mrs. Cheney, Peabody Library School, Nashville, Term. 37203. Mrs. Cheney does not sell the books listed here. They are available through normal trade sources. Mrs. Cheney, being a member of the editorial board of Pierian Press, will not review Pierian Press reference books in this column. Descriptions of Pierian Press reference books will be included elsewhere in this publication.
Communications regarding this column should be addressed to Mrs. Cheney, Peabody Library School, Nashville, Tenn. 37203. Mrs. Cheney does not sell the books listed here. They are available through normal trade sources. Mrs. Cheney, being a member of the editorial board of Pierian Press, will not review Pierian Press reference books in this column. Descriptions of Pierian Press reference books will be included elsewhere in this publication.
SEPTEMBER is the month when, Summer being irrevocably over, our minds turn to library activities for the winter. At the time of writing the international situation is however so uncertain that few have the power to concentrate on schemes or on any work other than that of the moment. There is an immediate placidity which may be deceptive, and this is superficial even so far as libraries are concerned. In almost every town members of library staffs are pledged to the hilt to various forms of national service—A.R.P. being the main occupation of senior men and Territorial and other military services occupying the younger. We know of librarians who have been ear‐marked as food‐controllers, fuel controllers, zone controllers of communication centres and one, grimly enough, is to be registrar of civilian deaths. Then every town is doing something to preserve its library treasures, we hope. In this connexion the valuable little ninepenny pamphlet issued by the British Museum on libraries and museums in war should be studied. In most libraries the destruction of the stock would not be disastrous in any extreme way. We do not deny that it would be rather costly in labour and time to build it up again. There would, however, be great loss if all the Local Collections were to disappear and if the accession books and catalogues were destroyed.
The old snobbery in regard to public libraries expressed itself in the phrase “the provision of the illiterate for the illiterate by the illiterate” —a phrase which is too literate to have had any but an easily recognizable origin. It was always hypocritical or ignorant, or both, of course, but the snobbery it reflected has faded into its true values today. Recent careful analyses of the registers of a few public libraries go to show that the greater number of readers are actual ratepayers, and many of them substantial ones. The old fear of the “free” library with its charity associations has gone, except perhaps in such quarters as originated the phrase quoted above. A fair reflection of this was a remark in a very recent public case where the counsel asked a witness who complained that she had “to get pocket money to buy books” if she did not know of free libraries, and the presiding Chancellor of the Diocese of Norwich remarked that he had obtained books from the County Library. On all sides, too, we hear that the issues from public libraries at this Easier have surpassed all records.
THERE was a rather remarkable statement made at the Royal Institute of British Architects by Mr. Berwick Sayers last month. He affirmed that so far as the recorded issues of the reference libraries in the municipal libraries of London were concerned, only 8,880 books were consulted daily. This, as the statistical account of twenty‐nine public libraries, shows an average of a fraction over 302 books daily. To some this may seem not an inadequate issue, if all the books recorded are books which the student and the searcher for information have used. The point of the meeting at which the remark was made was that the reference libraries of London should do more in co‐operation with industry, and it was argued by the representatives of ASLIB who took part in the conference that our London reference libraries should be strengthened in the science and technology departments, even at the expense of the lending libraries. The experience of the public librarian seemed to be that few people lived in London near their work; and that they had command of the special libraries in London in a way that provincial industrialists had not, and therefore they did not make any use that mattered of London reference libraries. The Chambers of Commerce in the various boroughs of London consist of small traders as a rule whose main purpose is “to keep down the rates,” and who have very little connection with industry on the scale in the minds of the ASLIB representatives. In short, the chief function of the London public libraries is mainly that of home reading. Ultimately the solution of the reference problem may be the establishment of one or two great regional reference libraries supported by the co‐operation of the boroughs. Co‐operation, however, is in its initial stages yet, and it will probably be some time before such an ideal, if it be an ideal, is achieved.
BOURNEMOUTH fulfilled some of the high expectations of those who attended it. The welcome was cordial, the local arrangements good, as we were entitled to expect from so proved an organizer as Mr. Charles Riddle and from his committee and staff, and, when fine, the town was most attractive. The weather, however, was bad, and too warm at the same time for most of us. One thing that certainly emerged from this experience was the real need to change the time of the conference. Only librarians among similar bodies appear to meet in the summer season. The accountants, engineers and other professional people confer in late May or in June, when they do not compete with holiday‐makers for accommodation and attention. The Council might well consider the re‐arrangement of its year with such a change in view.