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Designing complex health system interventions: an integrated theory-informed approach
Shobhana Nagraj1,2, Francesca Maraschin1
1Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
Frontiers in Health Services
|July 24, 2026
Summary
Effective health system interventions require integrating behavioral science, implementation science, and systems thinking. A layered design approach aligning micro, meso, and macro levels enhances intervention impact and sustainability.
Area of Science:
- Health Systems Research
- Intervention Science
- Translational Research
Background:
- Health system interventions often fail due to misaligned mechanisms, context, and system dynamics.
- Theoretical frameworks from behavioral science, implementation science, and systems thinking are typically used in isolation.
- A design-first perspective, using theory prospectively, is crucial for developing effective interventions.
Purpose of the Study:
- To synthesize and compare theoretical approaches for complex health system intervention development.
- To examine how behavioral science, implementation science, and systems thinking offer complementary insights.
- To propose an integrated approach for designing effective, scalable, and sustainable health interventions.
Main Methods:
- Focused narrative review of 46 articles (2010-2026).
- Synthesis of theories across micro (individual), meso (organizational), and macro (system) levels.
- Analysis of how different theoretical traditions contribute to intervention design.
Main Results:
- Effective intervention design needs a layered architecture aligning behavioral mechanisms, organizational processes, and system dynamics.
- The boundaries between behavioral science, implementation science, and systems thinking are blurring.
- Hybrid frameworks and integration of design thinking show promise for advancing intervention design.
Conclusions:
- An integrated, pluralistic approach strengthens causal clarity while allowing for adaptation.
- Aligning micro, meso, and macro levels is essential for intervention effectiveness.
- Advancing integrated practice is key to improving health system intervention scalability and sustainability.
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