September 2010

Volume 27, Issue 3

Editorial - The challenges of designing and evaluating complex interventions

Authors: D. Bonetti J.E. Clarkson
doi: 10.1922/CDH_2695Bonetti03


Complex interventions are widely used in the health service and in public health practice, and are increasingly so in the realm of oral health and dentistry (e.g. Bradley et al., 1999; Bonetti et al., 2003; Blair et al., 2004; Renz et al., 2007; Shaw et al., 2009). The Medical Research Council (2008) describes them as interventions that contain several interacting components although the complexity may arise through several dimensions. Designing, implementing and analysing complex interventions can pose many challenges because they are generally multi-centred and always multi-faceted, involving multiple aims, targets, processes, and impacts. Not all of the facets or their interactions can be easily defined, predicted, or assessed, particularly when these interventions take place within the relatively uncontrolled environs of an existing organisation or health care system. Often, the first challenge we meet is deciding on the intervention target(s). Identifying what requires intervening in or what exactly you want to change is not always straightforward. For example, the overall aim might be to improve patient oral health outcomes. However, oral health systematic reviews ( show that oral health outcomes can be influenced by changing many different behaviours, among which are improving oral hygiene, increasing the application of fissure sealants, increasing fluoride use by professionals and patients. To begin designing a complex intervention, decisions have to be made about the specific behaviour you want to target to achieve your overall aim. For example, improving oral hygiene may mean that your intervention targets the behaviour of patients (helping them perform better toothbrushing, or enabling them to request the dentist to fissure seal their children’s teeth or provide advice on the optimum use of fluoride), the behaviour of dentists (encourage them to provide oral hygiene advice, or to focus more on preventive care in their patient management such as applying fluoride varnish or fissure sealants), and/or the behaviour of the system (inform policy change to provide greater financial incentives, or to provide required training/education). Decisions regarding the intervention target behaviour are usually pragmatic and based on what is currently generating personal, public or government interest, available expertise, and research and funding opportunities. However, a study may have many aims that may influence the design of your intervention. For example, in one of our studies (Clarkson et al., 2009) we designed a complex intervention to improve oral health outcomes by changing patient behaviour, targeting how often as well as how thoroughly patients brushed their teeth.


Other articles in this issue

Article Pages Access
Editorial - The challenges of designing and evaluating complex interventions 130-132 Download
Plaque, caries level and oral hygiene habits in young patients receiving orthodontic treatment 133-138 Download
The voice of the elderly in accepting alternative perspectives on oral health 139-144 Download
Social determinants of dental health services utilisation of Greek adults 145-150 Download
Oral health and treatment needs of institutionalized chronic psychiatric patients in Istanbul, Turkey. 151-157 Download
Barriers to oral health care amongst different social classes in India. 158-162 Download
Social differences in tooth decay occurrence in a sample of children aged 3 to 5 in North-East Italy 163-166 Download
Child oral health concerns amongst parents and primary care givers in a Sure Start Local Programme 167-171 Download
A 6-year longitudinal study of caries in teenagers and the effect of “dropouts” on the findings 172-177 Download
The dentist workforce in Kuwait to the year 2020. 178-183 Download
The distribution of individual tooth impaction in general dental patients of Northern India 184-186 Download
Short Communication - Wheelchair-accessible dental offices in Nagasaki, Japan 187-190 Download


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