Linda C Smit1, Marieke J Schuurmans2, Jeanet W Blom3, Isabelle N Fabbricotti4, Aaltje P D Jansen5, Gertrudis I J M Kempen6, Raymond Koopmans7, Willemijn M Looman8, Rene J F Melis9, Silke F Metzelthin6, Eric P Moll van Charante9, Maaike E Muntinga5, Franca G H Ruikes7, Sophie L W Spoorenberg10, Jacqueline J Suijker9, Klaske Wynia10, Jacobijn Gussekloo11, Niek J De Wit12, Nienke Bleijenberg2. 1. Research Group for the Chronically Ill and Elderly, Faculty of Health Care, University of Applied Sciences Utrecht, Utrecht 3584 CS, The Netherlands. Electronic address: Linda.Smit@hu.nl. 2. Research Group for the Chronically Ill and Elderly, Faculty of Health Care, University of Applied Sciences Utrecht, Utrecht 3584 CS, The Netherlands; Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands. 3. Department of Public Health and Primary Care, Leiden University Medical Center, Leiden 2333 ZD, The Netherlands. 4. Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam 3062 PA, The Netherlands. 5. Department of General Practice and Elderly Care, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, 1081 BT, The Netherlands. 6. Department of Health Services Research, and Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht 6229 GT, The Netherlands. 7. Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre Nijmegen, Nijmegen C500 HB, The Netherlands. 8. Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, Nijmegen 6500 HB, The Netherlands. 9. Department of General Practice, Academic Medical Center, Amsterdam 1105 AZ, The Netherlands. 10. Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen 9700 AD, The Netherlands. 11. Department of Public Health and Primary Care, Leiden University Medical Center, Leiden 2333 ZD, The Netherlands; Department of Geriatrics and Gerontology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands. 12. Department of General Practice, Division Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands.
Abstract
OBJECTIVES: Complex interventions are criticized for being a "black box", which makes it difficult to determine why they succeed or fail. Recently, nine proactive primary-care programs aiming to prevent functional decline in older adults showed inconclusive effects. The aim of this study was to systematically unravel, compare, and synthesize the development and evaluation of nine primary-care programs within a controlled trial to further improve the development and evaluation of complex interventions. STUDY DESIGN AND SETTING: A systematic overview of all written data on the nine proactive primary-care programs was conducted using a validated item list. The nine proactive primary-care programs involved 214 general practices throughout the Netherlands. RESULTS: There was little or no focus on the (1) context surrounding the care program, (2) modeling of processes and outcomes, (3) intervention fidelity and adaptation, and (4) content and evaluation of training for interventionists. CONCLUSIONS: An in-depth analysis of the context, modeling of the processes and outcomes, measurement and reporting of intervention fidelity, and implementation of effective training for interventionists is needed to enhance the development and replication of future complex interventions.
OBJECTIVES: Complex interventions are criticized for being a "black box", which makes it difficult to determine why they succeed or fail. Recently, nine proactive primary-care programs aiming to prevent functional decline in older adults showed inconclusive effects. The aim of this study was to systematically unravel, compare, and synthesize the development and evaluation of nine primary-care programs within a controlled trial to further improve the development and evaluation of complex interventions. STUDY DESIGN AND SETTING: A systematic overview of all written data on the nine proactive primary-care programs was conducted using a validated item list. The nine proactive primary-care programs involved 214 general practices throughout the Netherlands. RESULTS: There was little or no focus on the (1) context surrounding the care program, (2) modeling of processes and outcomes, (3) intervention fidelity and adaptation, and (4) content and evaluation of training for interventionists. CONCLUSIONS: An in-depth analysis of the context, modeling of the processes and outcomes, measurement and reporting of intervention fidelity, and implementation of effective training for interventionists is needed to enhance the development and replication of future complex interventions.
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