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Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: Exploring Synergistic Interactions And Catalysts In Complex Interventions: Longitudinal, Mixed Methods Case Studies Of An Optimised Multi-Level Suicide Prevention Intervention In Four European Countries (Ospi-Europe)
Authors: Harris, Fiona Margaret
Maxwell, Margaret
O'Connor, Rory C
Coyne, James
Arensman, Ella
Coffey, Claire
Koburger, Nicole
Gusmao, Ricardo
Costa, Susana
Szekely, Andras
Cserháti, Zoltan
McDaid, David
Audenhove, Chantal van
Hegerl, Ulrich
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Keywords: complex interventions
longitudinal study
process evaluation
suicide prevention
synergistic interactions
programme as catalyst
Issue Date: 15-Mar-2016
Publisher: BioMed Central
Citation: Harris FM, Maxwell M, O'Connor RC, Coyne J, Arensman E, Coffey C, Koburger N, Gusmao R, Costa S, Szekely A, Cserháti Z, McDaid D, Audenhove Cv & Hegerl U (2016) Exploring Synergistic Interactions And Catalysts In Complex Interventions: Longitudinal, Mixed Methods Case Studies Of An Optimised Multi-Level Suicide Prevention Intervention In Four European Countries (Ospi-Europe), BMC Public Health, 16, Art. No.: 268.
Abstract: Background  The Medical Research Council (MRC) Framework for complex interventions highlights the need to explore interactions between components of complex interventions, but this has not yet been fully explored within complex, non-pharmacological interventions. This paper draws on the process evaluation data of a suicide prevention programme implemented in four European countries to illustrate the synergistic interactions between intervention levels in a complex programme, and to present our method for exploring these.  Methods  A realist evaluation approach informed the process evaluation, which drew on mixed methods, longitudinal case studies. Data collection consisted of 47 semi-structured interviews, 12 focus groups, one workshop, fieldnoted observations of six programme meetings and 20 questionnaires (delivered at six month intervals to each of the four intervention sites). Analysis drew on the framework approach, facilitated by the use of QSR NVivo (v10). Our qualitative approach to exploring synergistic interactions (QuaSIC) also developed a matrix of hypothesised synergies that were explored within one workshop and two waves of data collection.  Results  All four implementation countries provided examples of synergistic interactions that added value beyond the sum of individual intervention levels or components in isolation. For instance, the launch ceremony of the public health campaign (a level 3 intervention) in Ireland had an impact on the community-based professional training, increasing uptake and visibility of training for journalists in particular. In turn, this led to increased media reporting of OSPI activities (monitored as part of the public health campaign) and also led to wider dissemination of editorial guidelines for responsible reporting of suicidal acts. Analysis of the total process evaluation dataset also revealed the new phenomenon of the OSPI programme acting as a catalyst for externally generated (and funded) activity that shared the goals of suicide prevention.  Conclusions  The QuaSIC approach enabled us to develop and refine our definition of synergistic interactions and add the innovative concept of catalytic effects. This represents a novel approach to the evaluation of complex interventions. By exploring synergies and catalytic interactions related to a complex intervention or programme, we reveal the added value to planned activities and how they might be maximised.
Type: Journal Article
DOI Link:
Rights: © Harris et al. 2016 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated.
Affiliation: NMAHP Research
NMAHP Research
University of Glasgow
University of Pennsylvania
University College Cork
University College Cork
Universitätsklinikum Leipzig AöR
New University of Lisbon
New University of Lisbon
Semmelweis University Budapest
Semmelweis University Budapest
London School of Economics
KU Leuven
University Leipzig

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