Qualitative process evaluation from a complex systems perspective: A systematic review and framework for public...

Area of Science:

• Public Health
• Qualitative Research
• Systems Science

Background:

• Traditional public health evaluation methods are criticized for being reductionist.
• A complex systems approach is advocated to address real-world complexity.
• Qualitative methods are suitable for understanding change in complex social environments, but guidance is limited.

Purpose of the Study:

• To systematically review qualitative process evaluations using a complex systems perspective.
• To propose a framework for qualitative complex system process evaluations.

Main Methods:

• Systematic search of electronic databases (Scopus, MEDLINE, Web of Science) from 2014-2019.
• Inclusion of studies self-identifying with systems/complexity approaches and using qualitative methods.
• Analysis of 21 unique studies evaluating diverse public health interventions across 13 countries.

Main Results:

• No consensus exists on applying a complex systems perspective in qualitative public health evaluations.
• Most studies described static systems at a single time point.
• Only 4 evaluations assessed system changes over time using complexity concepts.

Conclusions:

• A 2-phase framework is proposed for future qualitative process evaluations.
• Phase 1: System description and hypothesis generation.
• Phase 2: Adaptive evaluation following emergent findings to assess change over time.