Implementation of Complex (Multi-level) Health Interventions (CHIs)
This site offers information on a definition of CHIs, key concepts, and tools to implement and evaluate them.
Learn to implement complex interventions in your healthcare project
Each area includes applied examples. Information is tailored to practitioners and researchers who are new to or becoming familiar with CHIs in the healthcare and public health areas.
Key Contributors: Monica Perez Jolles, PhD, Penny Hawe, PhD, Brian Mittman, PhD
What are Complex Health Interventions (CHIs)?
One way of defining CHIs is an intervention (e.g., clinical, population-based, and implementation strategy) comprised of all or most of the following elements:
- Have multiple components that interact with each other
- Require coordination between the people delivering and receiving the intervention
- Require adaption at the organizational, workforce, and patient levels
- Require daily flexibility in implementation
- Tackle multi-level gaps or problems from a comprehensive approach
- They are dynamic and adapt over time
- These elements interact with each other and with local contexts
Case Examples
Clinical Example
Adverse Childhood Experiences (ACEs) are potentially traumatic events occurring before age 18, such as maltreatment or exposure to violence. Screening is increasingly recommended to address physical and mental health conditions associated with these events.
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Implementation Intervention
Multi-faceted strategy to implement ACEs screenings in primary care.
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Public Health Example
Content to come
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Resources & Key groups
- DECIPHER brings together experts from a range of disciplines to tackle public health issues
- NCI’s Consortium for Cancer Implementation Science (CCIS) - Action Groups
- Patient Centered Outcomes Research Institute (PCORI) - Standards for Studies of Complex Interventions
- List of Readings and References (Word Document, 38 KB)
- Visit the website on the UK framework on complex interventions
Concepts of Functions and Forms
Functions and forms are two concepts from complex systems thinking that can help you conceptualize an intervention’s change process and its delivery in local contexts.
Core Functions
Structural or procedural goals of the intervention, informed by theory/framework, and fostering a mechanism of change
Forms
Tailored actions (e.g., steps, procedures, implementation strategies) tailored to local contexts and aligned to meet each Core Function
Case Examples of Functions and Forms
Clinical Example
Integrated Actionable Aging Assessment for Cancer Patients (IA3-CP) research projects was established on the basis that aging is the greatest risk factor for cancer incidence and mortality. Strong data and expert recommendations support the use of geriatric screening assessments to guide treatment for older adults (>65 years old).
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Pragmatic Tools
Tools to help you operationalize and apply the concepts of functions and forms in your project.
Functions & Forms PDF
An editable PDF to map your interventions' needs, core functions and forms with team members, partners and patients. Instructions on developing a matrix are included in the PDF document.
Download PDF (632 KB)
Aligned Interview Guide
A word document to guide your adoption of forms and functions. Instructions are included in the pdf interview document.
Download Word Doc ( KB 136)
Adaptations of Forms Tracking Matrix
A fillable PDF to track fidelity to function and adaptations to forms over time (e.g., implementation coaching sessions) for use with partners and study participants.