Understanding Complexity: Reflections from the Centre for Evaluation Retreat

By: Myra Cheung
LSHTM MSc Public Health Student

For a long time, the main question when it comes to designing and implementing interventions has been “Does it work?”. There has been a continual pursuit for the “game changer” intervention that can be used in across communities, cities and countries: Lawrence Moore, our closing keynote speaker for the Centre for Evaluation Retreat, challenges this notion.

As public health challenges become increasingly complex, we need to find ways to consider the many external factors in designing the interventions that we intend to implement.  This need has given rise to complex interventions that involve multiple, synergistic components that address the major external factors. These external factors are largely social and environmental determinants, the socio-cultural paradigms the norms and attitudes and the historical and political narrative that has shaped the society of the community today. Ultimately, the social acceptability and engagement of programs among beneficiaries is what drives the impact of programmes implemented on a community level. Without strategies that fully engage with the contextual factors, the impact of the intervention would likely be overridden regardless of how efficacious or effective it has proven to be.

So, what does this call for?

The very need to walk across disciplines and expand beyond our familiar scopes calls for a shift away from the traditional mode of evaluation, and towards a more integrated way in evaluating programs. It calls for us to rethink who needs to be involved in the research process not just at the end, but at the earlier stages of the research process.  Rather than the traditional RCT efficacy trials for example, we need to be able to step into the “blackbox” of evaluation. As Lawrence suggests, this calls for scientists to be more daring, to be more comfortable with less certainty because after all, we can know things with great certainty that is of less significance: Are we missing out on how interventions are achieving outcomes and why they work with different contexts by clinging onto what gives us most certainty?

Perhaps rigour needs to be redefined when it comes to pragmatic research: instead of focusing on the rigour of methods and matters of internal validity, we need the most rigour in examining the context.