Attending to design when developing complex health interventions: A qualitative interview study with intervention developers and associated stakeholders

Autoři: Nikki Rousseau aff001;  Katrina M. Turner aff003;  Edward Duncan aff001;  Alicia O’Cathain aff004;  Liz Croot aff004;  Lucy Yardley aff005;  Pat Hoddinott aff001
Působiště autorů: Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP-RU), University of Stirling, Stirling, United Kingdom aff001;  Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom aff002;  Population Health Sciences, University of Bristol, Bristol, United Kingdom aff003;  School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom aff004;  Department of Psychology, University of Southampton, Southampton, United Kingdom aff005;  School of Psychological Science, University of Bristol, Bristol, United Kingdom aff006
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



Guidance and frameworks exist to assist those developing health interventions but may offer limited discussion of ‘design’, the part of development concerned with generating ideas for and making decisions about an intervention’s content, format and delivery. The aim of this paper is to describe and understand the views and experiences of developers and associated stakeholders in relation to how design occurs in health intervention development.


Semi-structured interviews were conducted with 21 people who had developed complex interventions to improve health and/or who were relevant stakeholders (e.g. funders and publishers of intervention development work), regarding their views, experiences and approaches to intervention design. Sampling was purposive in terms of maximising diversity. A thematic inductive analysis was conducted.


Approaches to design varied substantially between intervention developers. This contrasted with consistency in other activities undertaken during development, such as literature review. Design also posed more challenges than other parts of development. We identified six ‘modes’ of design: informed; negotiated; structured; delegated; ‘my baby’; and creative partnership. In understanding the differences between these different modes, and the challenges posed by intervention design, we identified three key themes: enabling creativity during the design process; working with different types of knowledge; and ‘stabilising’ (developing clear shared understandings of) the intervention development to enable design.


Design has received less attention than other activities undertaken when developing interventions to improve health. Developers take a variety of approaches to design and often find it challenging. Guidance for intervention development in health has tended to see design as proceeding in a predictable and controlled manner from acquired knowledge. Our study suggests that design rarely reflects this rational ideal. Future guidance on intervention development in healthcare should support developers to work effectively with different types of knowledge, to help design progress more smoothly and to maximise creativity.

Klíčová slova:

Allied health care professionals – Creativity – Decision making – Language – Prototypes – Qualitative studies – Research design – Research grants


1. Hoddinott P. A new era for intervention development studies. Pilot Feasibility Stud. 2015;1:36. doi: 10.1186/s40814-015-0032-0 27965814

2. O'Cathain A, Sworn K, Duncan E, Rousseau N, Turner K, Yardley L,et al. Taxonomy of approaches to developing interventions to improve health: a systematic methods overview Pilot and Feasibility Studies. 2019;5(41).

3. O'Cathain A, Croot L, Duncan E, Rousseau N, Sworn K, Turner K, et al. Guidance on how to develop complex interventions to improve health and healthcare. BMJ Open. 2019;9.

4. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655. doi: 10.1136/bmj.a1655 18824488

5. Craig P, Matthews L, Moore L, Simpson S, Skivington K. Updated Guidance: Developing and Evaluating Complex Interventions [DRAFT FOR CONSULTATION]. 2019.

6. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and Evaluating Complex Interventions: New Guidance. Medical Research Council; 2008.

7. Mummah S, Robinson T, King A, Gardner C, Sutton S. IDEAS (Integrate, Design, Assess, and Share): A Framework and Toolkit of Strategies for the Development of More Effective Digital Interventions to Change Health Behavior. Journal of Medical Internet Research. 2016;18(12):e317. doi: 10.2196/jmir.5927 27986647

8. Kushniruk A, Nøhr C. Participatory Design, User Involvement and Health IT Evaluation. Studies in health technology and informatics. 2016;222:139–51. 27198099

9. Bessant J, Maher L. Developing radical service innovations in healthcare–the role of design methods. International Journal of Innovation Management. 2009;13(4):555–68.

10. Spencer M, Dineen R, Phillips A. Co-producing services—Co-creating health. 2013.

11. Band R, Bradbury K, Morton K, May C, Michie S, Mair F, et al. Intervention planning for a digital intervention for self-management of hypertension: a theory, evidence and person-based approach. Implement Sci. 2017;12:13. doi: 10.1186/s13012-017-0546-3

12. O'Brien N, Heaven B, Teal G, Evans E, Cleland C, Moffatt S, et al. Integrating Evidence From Systematic Reviews, Qualitative Research, and Expert Knowledge Using Co-Design Techniques to Develop a Web-Based Intervention for People in the Retirement Transition. Journal of Medical Internet Research. 2016;18(8):19.

13. Finch T, Bamford C, Deary V, Sabin N, Parry S. Making sense of a cognitive behavioural therapy intervention for fear of falling: qualitative study of intervention development. Bmc Health Services Research. 2014;14:436. doi: 10.1186/1472-6963-14-436 25252807

14. Koen P, Ajamian G, Burkart R, Clamen A, Davidson J, D'Amore R, et al. Providing clarity and a common language to the "Fuzzy Front End". Res-Technol Manage. 2001;44(2):46–55.

15. Smith P. Developing products in half the time: New rules new tools. New York: John Wiley & Sons; 1998.

16. Nonaka I. A dynamic theory of organisational knowledge creation. Organ Sci. 1994;5(1):14–37.

17. Ocker R. Influences on creativity in asynchronous virtual teams: A qualitative analysis of experimental teams. IEEE Trans Prof Commun. 2005;48(1):22–39.

18. Cross N. Expertise in design: an overview. Design Stud. 2004;25(5):427–41.

19. Roberts J, Fisher T, Trowbridge M, Bent C. A design thinking framework for healthcare management and innovation. HealthCare. 2016;4(1):11–4. doi: 10.1016/j.hjdsi.2015.12.002 27001093

20. Bazzano A, Martin J, Hicks E, Faughnan M, Murphy L. Human-centred design in global health: A scoping review of applications and contexts. PLoS One. 2017;12(11):24.

21. Thies A. On the Value of Design Thinking for Innovation in Complex Contexts: A Case from Healthcare. Interact Des Archit. 2015(27):159–71.

22. Norman D, Draper S. User-Centered System Design: New Perspectives on Human-Computer Interaction. Hillsdale, New Jersey: Lawrence Earlbaum Associates; 1986.

23. IDEO. Human Centred Design Toolkit. San Francisco: IDEO; 2011.

24. Hoddinott P, Pollock A, O'Cathain A, Boyer I, Taylor J, MacDonald C, et al. How do researchers incorporate public, patient, clinician and staff perspectives into the design and conduct of their research. F1000Research [Internet]. 2018;7:752. doi: 10.12688/f1000research.15162.1 30364075

25. Horvath K, Ecklund A, Hunt S, Nelson T, Toomey T. Developing Internet-based health interventions: a guide for public health researchers and practitioners. J Med Internet Res. 2015;17(1):e28. doi: 10.2196/jmir.3770 25650702

26. O'Cathain A, Croot L, Duncan E, Rousseau N, Sworn K, Turner K, et al. INDEX Study (IdentifyiNg and assessing different approaches to DEveloping compleX interventions) 2019 [Available from:

27. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(3):77–101.

28. Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893–907. doi: 10.1007/s11135-017-0574-8 29937585

29. QSR. NVivo qualitative data analysis software. Version 11 ed: QSR International Pty Ltd; 2015.

30. Michie S, Atkins L, West R. The Behaviour Change Wheel: A Guide to Designing Interventions Silverback Publishing; 2014.

31. Murray E, Treweek S, Pope C, MacFarlane A, Ballini L, Dowrick C, et al. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC medicine. 2010;8:63. doi: 10.1186/1741-7015-8-63 20961442

32. Turner K, Rousseau N, Croot L, Duncan E, Yardley L, O’Cathain A, et al. Understanding successful development of complex health and health care interventions and its drivers from the perspective of developers and wider stakeholders: an international qualitative interview study. BMJ Open [Internet]. 2019; 9:e028756. doi: 10.1136/bmjopen-2018-028756 31152042

33. Davidoff F, Dixon-Woods M, Leviton L, Michie S. Demystifying theory and its use in improvement. BMJ Qual Saf. 2015;24(3):228–38. doi: 10.1136/bmjqs-2014-003627 25616279

34. Frishammar J, Floren H, Wincent J. Beyond Managing Uncertainty: Insights From Studying Equivocality in the Fuzzy Front End of Product and Process Innovation Projects. IEEE Trans Eng Manage. 2011;58(3):551–63.

35. De Silva M, Breuer E, Lee L, Asher L, Chowdhary N, Lund C, et al. Theory of Change: a theory-driven approach to enhance the Medical Research Council's framework for complex interventions. Trials. 2014;15:267. doi: 10.1186/1745-6215-15-267 24996765

36. Okhuysen G, Bechky B. Coordination in Organizations: An Integrative Perspective. Acad Manag Ann. 2009;3:463–502.

37. Lowy I. The strength of loose concepts—boundary concepts, federative experimental stratefies and disciplinary growth—the case of immunology. Hist Sci. 1992;30(90):371–96.

38. Visser W. More-or-less following a plan during design—opportunistic deviations in specification. International Journal of Man-Machine Studies. 1990;33(3):247–78.

39. Murad M, Asi N, Alsawas M, Alahdab F. New evidence pyramid. Evidence-based medicine. 2016;21(4):125–7. doi: 10.1136/ebmed-2016-110401 27339128

40. Grimshaw J, Russell I. Achieving health gain through clinical guidelines. I: Developing scientifically valid guidelines. Quality in health care: QHC. 1993;2(4):243–8. doi: 10.1136/qshc.2.4.243 10132459

41. Dixon-Woods M. The problem of context in quality improvement. London; 2014.

42. Scott J. Seeing like a state: How certain schemes to improve the human condition have failed. Yale University Press; 1998.

43. Schulze A, Hoegl M. Organizational knowledge creation and the generation of new product ideas: A behavioral approach. Res Policy. 2008;37(10):1742–50.

44. Lunze K, Higgins-Steele A, Simen-Kapeu A, Vesel L, Kim J, Dickson K. Innovative approaches for improving maternal and newborn health—A landscape analysis. BMC Pregnancy Childbirth. 2015;15:19. doi: 10.1186/s12884-015-0433-3

45. Christensen C, Bohmer R, Kenagy J. Will disruptive innovations cure health care?. Harv Bus Rev. 2000;78(5):102–112. 11143147

46. Berg M. The construction of medical disposals Medical sociology and medical problem-solving in clinical practice. Sociol Health Ill. 1992;14(2):151–80.

47. Ocloo J, Matthews R. From tokenism to empowerment: progressing patient and public involvement in healthcare improvement. BMJ Qual Saf. 2016;25(8):626–32. doi: 10.1136/bmjqs-2015-004839 26993640

48. Casarett D, Karlawish J, Sugarman J. Determining when quality improvement initiatives should be considered research—Proposed criteria and potential implications. JAMA-J Am Med Assoc. 2000;283(17):2275–80.

49. Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. Lancet. 2009;374(9683):86–9. doi: 10.1016/S0140-6736(09)60329-9 19525005

50. Chalmers I, Bracken M, Djulbegovic B, Garattini S, Grant J, Gulmezoglu A, et al. How to increase value and reduce waste when research priorities are set. Lancet. 2014;383(9912):156–65. doi: 10.1016/S0140-6736(13)62229-1 24411644

51. Hawe P. Info sheet. Communicating Public Policy. Sydney: Menzies Centre for Health Policy, University of Sydney; 2017.

52. Duncan E, O’Cathain A, Rousseau N, Croot L, Sworn K, Turner KM, et al. Reporting GUIDance for intervEntion Development in health research (GUIDED) 2017 [Available from:

Článek vyšel v časopise


2019 Číslo 10
Nejčtenější tento týden