Complexity in Health
Our Complexity in health programme develops and applies research methods that are designed for understanding the variety of interdependent factors that shape the impact of interventions and policies that aim to improve health and to reduce health inequalities.
Public health interventions, whose mechanisms rely solely on human agency, often fail to bring about sustained improvement in health, and may increase social inequalities in health.
Strategies are more likely to be effective if underpinned by explicit theoretical frameworks and perspectives that take account of context and complexity. These include the socio-ecological model, complex systems theory and realist evaluation which highlights the need to not just identify ‘what works’ but ‘what works, for whom, under what circumstances and why’.
Our programme has four overlapping workstreams: Modelling Complex Systems, Schools and Educational Settings, Methods Development and Translation, and Development and Evaluation of Complex Interventions.
Our programme aims to lead international efforts in the application and dissemination of novel methods to identify the most effective means to improve population health and to reduce inequalities. We work to create a world-class, collaborative environment to support the successful implementation of translational research in public health improvement.
Our objectives are to:
- Develop and translate methods and processes that support the involvement of stakeholders in all stages of development, evaluation and implementation.
- Develop and normalise a wider range of approaches to evaluation, including complex systems approaches and other methods more suited to the evaluation of meso-, macro- and multi-level interventions.
- Develop and apply agent based models to a range of public health issues including social care, welfare reform and place-based health.
- Develop and evaluate complex interventions, particularly focusing on healthy ageing, adolescent health and educational settings.
Publications
Bonell, C. et al. (2013) The effects of the school environment on student health: A systematic review of multi-level studies. Health and Place, 21, pp. 180-191. (doi: 10.1016/j.healthplace.2012.12.001) (PMID:23501377)
Simpson, S. A. et al. (2020) An app, web and social support based weight loss intervention for adults with obesity: the ‘HelpMeDoIt!’ feasibility randomised controlled trial. Pilot and Feasibility Studies, 6, 133. (doi: 10.1186/s40814-020-00656-4) (PMID:32968544) (PMCID:PMC7501712)
Hawkins, J. et al. (2017) Protocol for a feasibility randomised controlled trial of the use of Physical ACtivity monitors in an Exercise Referral Setting: The PACERS study. Pilot and Feasibility Studies, 3, 51. (doi: 10.1186/s40814-017-0194-z) (PMID:29238607) (PMCID:PMC5725949)
Lachman, J. M. , Wamoyi, J., Spreckelsen, T. F. , Wight, D. , Maganga, J. and Gardner, F. (2020) Combining parenting and economic strengthening programmes to reduce violence against children: a cluster randomised controlled trial with predominantly male caregivers in rural Tanzania caregivers. BMJ Global Health, 5, e002349. (doi: 10.1136/bmjgh-2020-002349) (PMID:32641291) (PMCID:PMC7348478)
Katikireddi, S. V. , Niedzwiedz, C. L. and Popham, F. (2016) Employment status and income as potential mediators of educational inequalities in population mental health. European Journal of Public Health, 26(5), pp. 814-816. (doi: 10.1093/eurpub/ckw126) (PMID:27593454) (PMCID:PMC5054277)
Johnstone, A. , Hughes, A., Martin, A. and Reilly, J. (2018) Utilising active play interventions to promote physical activity and improve fundamental movement skills in children. BMC Public Health, 18, 789. (doi: 10.1186/s12889-018-5687-z) (PMID:29940923) (PMCID:PMC6019649)
Marquez, J., Inchley, J. and Long, E. (2022) Cross-country and gender differences in factors associated with population-level declines in adolescent life satisfaction. Child Indicators Research, 15(4), pp. 1405-1428. (doi: 10.1007/s12187-022-09930-8)
Mccann, M. , Broccatelli, C., Moore, L. and Mitchell, K. (2018) Distribution of Sexual Health Knowledge and Attitudes in Adolescent Social Networks: Social Network Analysis of Data from the STIs and Sexual Health Feasibility Study. Lancet Public Health Science 2018, Belfast, UK, 23 Nov 2018. S60. (doi: 10.1016/S0140-6736(18)32047-6)
Afshin, A. et al. (2017) Health effects of overweight and obesity in 195 countries over 25 years. New England Journal of Medicine, 377(1), pp. 13-27. (doi: 10.1056/NEJMoa1614362) (PMID:28604169) (PMCID:PMC5477817)
Breeze, P. R. et al. (2023) Guidance on the use of complex systems models for economic evaluations of public health interventions. Health Economics, 32(7), pp. 1603-1625. (doi: 10.1002/hec.4681) (PMID:37081811)
Katikireddi, S. V. et al. (2022) Two-dose ChAdOx1 nCoV-19 vaccine protection against COVID-19 hospital admissions and deaths over time: a retrospective, population-based cohort study in Scotland and Brazil. Lancet, 399(10319), pp. 25-35. (doi: 10.1016/S0140-6736(21)02754-9) (PMID:34942103) (PMCID:PMC8687670)
Farooq, A., Martin, A. , Janssen, X., Wilson, M., Gibson, A.-M., Hughes, A. and Reilly, J. J. (2019) Longitudinal changes in moderate-to-vigorous-intensity physical activity in children and adolescents: a systematic review and meta-analysis. Obesity Reviews, (doi: 10.1111/obr.12953) (PMID:31646739) (PMCID:PMC6916562)
Hilton Boon, M. , Craig, P. , Thomson, H. , Campbell, M. and Moore, L. (2021) Regression discontinuity designs in health: a systematic review. Epidemiology, 32(1), pp. 87-93. (doi: 10.1097/EDE.0000000000001274) (PMID:33196561) (PMCID:PMC7707156)
Shenderovich, Y., Sacolo-Gwebu, H., Fang, Z., Lachman, J. , Cluver, L. and Ward, C. (2023) Adaptations and staff experiences in delivering parenting programmes and other family support services in three community-based organisations in Cape Town, South Africa during the COVID pandemic. Global Public Health, (doi: 10.1080/17441692.2022.2129725) (PMID:36342401) (Early Online Publication)
McCartney, G. et al. (2016) Explaining trends in alcohol-related harms in Scotland, 1991–2011 (I): the role of incomes, effects of socio-economic and political adversity and demographic change. Public Health, 132, pp. 13-23. (doi: 10.1016/j.puhe.2015.12.013) (PMID:26917268)
Hawkins, J. et al. (2019) Acceptability and feasibility of implementing accelorometry-based activity monitors and a linked web portal in an exercise referral scheme: feasibility randomized controlled trial. Journal of Medical Internet Research, 21(3), e12374. (doi: 10.2196/12374) (PMID:30924791) (PMCID:PMC6460312)
Boydell, N. , Fergie, G. , Hilton, S. and McDaid, L. (2015) “… Giving Something back to the Gay Community by Taking Part”: Gay and Bisexual Men’s Understandings of Participation in Behavioural Research. BASHH Spring Conference 2015, Glasgow, UK, 1-3 June 2015. A79. (doi: 10.1136/sextrans-2015-052126.233)
White, J., Moore, L. , Cannings-John, R., Hawkins, J., Bonell, C., Hickman, M., Zammit, S. and Adara, L. (2023) Association between gender minority status and mental health in high school students. Journal of Adolescent Health, 72(5), pp. 811-814. (doi: 10.1016/j.jadohealth.2022.12.028) (PMID:36809864)
Wight, D. , Sekiwunga, R., Namutebi, C., Zalwango, F. and Siu, G. E. (2022) A Ugandan parenting programme to prevent gender-based violence: description and formative evaluation. Research on Social Work Practice, 32(4), pp. 448-464. (doi: 10.1177/10497315211056246) (PMID:35431527) (PMCID:PMC7612614)
Thomson, M. , Martin, A. , Logue, J. , Wells, V. and Simpson, S. A. (2020) Barriers and facilitators of successful weight loss during participation in behavioural weight management programmes: A protocol for a systematic review. Systematic Reviews, 9, 168. (doi: 10.1186/s13643-020-01427-1) (PMID:32731884) (PMCID:PMC7393897)
Reitsma, M. B. et al. (2021) Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet, 397(10292), pp. 2337-2360. (doi: 10.1016/S0140-6736(21)01169-7) (PMID:34051883) (PMCID:PMC8223261)
Holliday, J., Audrey, S., Campbell, R. and Moore, L. (2016) Identifying well-connected opinion leaders for informal health promotion: the example of the ASSIST smoking prevention program. Health Communication, 31(8), pp. 946-953. (doi: 10.1080/10410236.2015.1020264) (PMID:26699125) (PMCID:PMC4898141)
Matthews, L. et al. (2017) Study protocol for the ‘HelpMeDoIt!’ randomised controlled feasibility trial: an app, web and social support based weight loss intervention for adults with obesity. BMJ Open, 7(10), e017159. (doi: 10.1136/bmjopen-2017-017159) (PMID:29074513) (PMCID:PMC5665248)
Silverman, E. , Gostoli, U. , Picascia, S. , Almagor, J. , McCann, M. , Shaw, R. and Angione, C. (2021) Situating agent-based modelling in population health research. Emerging Themes in Epidemiology, 18, 10. (doi: 10.1186/s12982-021-00102-7) (PMID:34330302) (PMCID:PMC8325181)
Thomson, H. and Centre for Reviews and Dissemination, (2014) Housing improvement and home safety. Effectiveness Matters,
Shenderovich, Y. et al. (2021) The science of scale for violence prevention: a new agenda for family strengthening in low- and middle-income countries. Frontiers in Public Health, 9, 581440. (doi: 10.3389/fpubh.2021.581440) (PMID:33869123) (PMCID:PMC8044965)
Martin, M., Steele, B., Lachman, J. M. and Gardner, F. (2021) Measures of facilitator competent adherence used in parenting programs and their psychometric properties: a systematic review. Clinical Child and Family Psychology Review, 24(4), pp. 834-853. (doi: 10.1007/s10567-021-00350-8) (PMID:34021442) (PMCID:PMC8541983)
Segrott, J., Rothwell, H., Pignatelli, I., Playle, R., Hewitt, G., Huang, C., Murphy, S., Hickman, M., Reed, H. and Moore, L. (2016) Exploratory trial of a school-based alcohol prevention intervention with a family component. Health Education, 116(4), pp. 410-431. (doi: 10.1108/HE-01-2015-0005)
Baxter, A. J. et al. (2023) Contraceptive use and pregnancy planning in Britain during the first year of the COVID-19 pandemic: findings from a large, quasi-representative survey (Natsal-COVID). BMJ Sexual and Reproductive Health, (doi: 10.1136/bmjsrh-2022-201763) (PMID:36958823) (Early Online Publication)
Huggins, C. F. et al. (2022) TeenCovidLife: a resource to understand the impact of the COVID-19 pandemic on adolescents in Scotland. Wellcome Open Research, 6, 277. (doi: 10.12688/wellcomeopenres.17252.2) (PMID:35999909) (PMCID:PMC9360910)
Inchley, J. C. , Willis, M. , Mabelis, J. , Brown, J. and Currie, D. B. (2023) Inequalities in health complaints: 20-year trends among adolescents in Scotland, 1998–2018. Frontiers in Psychology, 14, 1095117. (doi: 10.3389/fpsyg.2023.1095117) (PMID:37020907) (PMCID:PMC10067662)
Gold, N., Yau, A., Rigby, B. , Dyke, C., Remfry, E. A. and Chadborn, T. (2021) Effectiveness of digital interventions for reducing behavioral risks of cardiovascular disease in nonclinical adult populations: systematic review of reviews. Journal of Medical Internet Research, 23(5), e19688. (doi: 10.2196/19688) (PMID:33988126) (PMCID:PMC8164125)
Kromydas, T., Campbell, M. , Chambers, S. , Hilton Boon, M. , Pearce, A. , Wells, V. and Craig, P. (2022) The effects of school summer holidays on inequalities in children and young people's mental health and cognitive ability in the UK. A secondary analysis from the Millennium cohort study. BMC Public Health, 22, 154. (doi: 10.1186/s12889-022-12540-2) (PMID:35065629) (PMCID:PMC8782677)
Bonell, C., Humphrey, N., Fletcher, A., Moore, L. , Anderson, R. and Campbell, R. (2014) Why schools should promote students' health and wellbeing. British Medical Journal, 348(g3078), (doi: 10.1136/bmj.g3078)
Eldridge, S. M. et al. (2016) CONSORT 2010 Statement: extension to randomised pilot and feasibility trials. British Medical Journal, 355, i5239. (doi: 10.1136/bmj.i5239) (PMID:27777223) (PMCID:PMC5076380)
Broccatelli, C. , Wang, P., McDaid, L. , McCann, M. , Simpson, S. A. , Elliott, L., Moore, L. and Mitchell, K. (2021) Social Network Research contribution to evaluating process in a feasibility study of a peer-led and school-based sexual health intervention. Scientific Reports, 11, 12244. (doi: 10.1038/s41598-021-90852-w) (PMID:34112848) (PMCID:PMC8192897)
Zheng, Y., Panayiotou, M., Currie, D., Yang, K., Bagnall, C., Qualter, P. and Inchley, J. (2022) The role of school connectedness and friend contact in adolescent loneliness, and implications for physical health. Child Psychiatry and Human Development, (doi: 10.1007/s10578-022-01449-x) (PMID:36260256) (Early Online Publication)
Marquez, J., Goodfellow, C. , Hardoon, D., Inchley, J. , Leyland, A.H. , Qualter, P., Simpson, S.A. and Long, E. (2023) Loneliness in young people: a multilevel exploration of social ecological influences and geographic variation. Journal of Public Health, 45(1), pp. 109-117. (doi: 10.1093/pubmed/fdab402) (PMID:34999845) (PMCID:PMC10017088)
Smith, M. J. and Hilton, S. (2023) Youth’s exposure to and engagement with e-cigarette marketing on social media: a UK focus group study. BMJ Open, 13(8), e071270. (doi: 10.1136/bmjopen-2022-071270) (PMID:37612101)
Taylor, R. and Dalal, H. (2020) It's not the years in your life that matter, it's the life in your years. Heart, 106(22), 1707. (doi: 10.1136/heartjnl-2020-317497) (PMID:32826287)
Bonell, C., Moore, G., Warren, E. and Moore, L. (2018) Are randomised controlled trials positivist? Reviewing the social science and philosophy literature to assess positivist tendencies of trials of social interventions in public health and health services. Trials, 19(1), 238. (doi: 10.1186/s13063-018-2589-4) (PMID:29673378) (PMCID:PMC5907717)
Simpson, S. (2018) The Helpmedoit! weight loss trial: Main results. International Journal of Behavioural Medicine 25(1):S159-S160. Meeting abstract: 15th International Congress of Behavioral Medicine, Santiago, Chile, 14-17 Nov 2018. (doi: 10.1007/s12529-018-9740-1)
Patterson, C. , McDaid, L. M. and Hilton, S. (2015) Gay and bisexual men’s perceptions of the donation and use of human biological samples for research: a qualitative study. PLoS ONE, 10(6), e0129924. (doi: 10.1371/journal.pone.0129924) (PMID:26053741) (PMCID:PMC4459996)
Purcell, C. , Purvis, A., Cleland, J. G.F. , Cowie, A., Dalal, H. M., Ibbotson, T. , Murphy, C. and Taylor, R. S. (2023) Home-based cardiac rehabilitation for people with heart failure and their caregivers: a mixed-methods analysis of the roll out an evidence-based programme in Scotland (SCOT:REACH-HF study). European Journal of Cardiovascular Nursing, (doi: 10.1093/eurjcn/zvad004) (PMID:36617216) (Early Online Publication)
Palmer, V. J., Gray, C. M. , Fitzsimons, C., Mutrie, N., Wyke, S. , Der, G. , Chastin, S. F.M. and Skelton, D. A. (2021) Sitting as a moral practice: older adults’ accounts from qualitative interviews on sedentary behaviours. Sociology of Health and Illness, 43(9), pp. 2102-2120. (doi: 10.1111/1467-9566.13383) (PMID:34724232)
Maclachlan, A. , McMellon, C. and Inchley, J. (2022) Public mental health during the COVID-19 pandemic: impacts on children’s rights. International Journal of Human Rights, (doi: 10.1080/13642987.2022.2057958) (Early Online Publication)
Skivington, K. , Matthews, L. , Craig, P. , Simpson, S. and Moore, L. (2018) Developing and evaluating complex interventions: updating Medical Research Council guidance to take account of new methodological and theoretical approaches. The Lancet 392(S2):S2. Meeting abstract: Public Health Science 2018, Belfast, Northern Ireland, 23 Nov 2018. (doi: 10.1016/s0140-6736(18)32865-4)
Segrott, J., Holliday, J., Rothwell, H., Foxcroft, D., Murphy, S., Scourfield, J., Hood, K. and Moore, L. (2014) Cultural adaptation and intervention integrity: a response to Skärstrand, Sundell and Andréasson. European Journal of Public Health, 24(3), pp. 354-355. (doi: 10.1093/eurpub/cku039)
Wright, C. M. et al. (2021) Development of a scale to measure infant eating behaviour worldwide. Nutrients, 13(8), 2495. (doi: 10.3390/nu13082495)
Devlin, A. M. and Wight, D. (2023) Transfer and adaptation of a drug recovery model from San Patrignano, Italy to River Garden, Scotland: a qualitative study. Drugs: Education, Prevention and Policy, 30(2), pp. 141-153. (doi: 10.1080/09687637.2021.1991889)
Lyall, L. M. et al. (2020) Accelerometry-assessed sleep duration and timing in late childhood and adolescence in Scottish schoolchildren: a feasibility study. PLoS ONE, 15(12), e0242080. (doi: 10.1371/journal.pone.0242080) (PMID:33259503) (PMCID:PMC7707491)
Martin, M., Lachman, J. , Wamoyi, J., Shenderovich, Y., Mgunga, S., Ndyetabura, E., Ally, A., Barankena, A., Exavery, A. and Manjengenja, N. (2021) A mixed methods evaluation of the large-scale implementation of a school- and community-based parenting program to reduce violence against children in Tanzania: A study protocol. Implementation Science Communications, 2, 52. (doi: 10.1186/s43058-021-00154-5) (PMID:34016191) (PMCID:PMC8136373)
Gostoli, U. and Silverman, E. (2019) Social and Child Care Provision and Kinship Networks: An Agent-Based Model. In: 15th Annual Social Simulation Conference (SSC 2019), Mainz, Germany, 23-27 Sept 2019,
Daw, P., van Beurden, S. B., Greaves, C., Veldhuijzen van Zanten, J. J. C. S., Harrison, A., Dalal, H., McDonagh, S. T. J., Doherty, P. J. and Taylor, R. S. (2020) Getting evidence into clinical practice: protocol for evaluation of the implementation of a home-based cardiac rehabilitation programme for patients with heart failure. BMJ Open, 10(6), e036137. (doi: 10.1136/bmjopen-2019-036137) (PMID:32565467) (PMCID:PMC7307528)
Oldridge, N. and Taylor, R. S. (2020) Cost-effectiveness of exercise therapy in patients with coronary heart disease, chronic heart failure and associated risk factors: a systematic review of economic evaluations of randomized clinical trials. European Journal of Preventive Cardiology, 27(10), pp. 1045-1055. (doi: 10.1177/2047487319881839) (PMID:31657233)
Purcell, C. , McDaid, L. , Forsyth, R., Simpson, S. A. , Elliott, L., Bailey, J. V., Moore, L. and Mitchell, K. R. (2023) A peer-led, school-based social network intervention for young people in the UK, promoting sexual health via social media and conversations with friends: intervention development and optimisation of STASH. BMC Public Health, 23, 675. (doi: 10.1186/s12889-023-15541-x) (PMID:37041542) (PMCID:PMC10088210)
Pulford, A., Thapa, A., Thomson, R. , Guilding, A., Green, M. , Leyland, A. H. , Popham, F. and Katikireddi, S. V. (2022) Does persistent precarious employment affect health outcomes among working age adults? A systematic review and meta-analysis. Journal of Epidemiology and Community Health, 76(11), pp. 909-917. (doi: 10.1136/jech-2022-219292) (PMID:36137738) (PMCID:PMC9554022)
Long, E. , Stevens, S., Topciu, R., Williams, A. J., Taylor, T. J. and Morrissey, K. (2022) Wellbeing and social network characteristics in rural communities: findings from a cohort in social housing in Cornwall, United Kingdom. International Journal of Community Well-Being, 5(3), pp. 559-570. (doi: 10.1007/s42413-022-00167-5) (PMID:35611238) (PMCID:PMC9118807)
Traynor, O., Martin, A. , Johnstone, A. , Chng, N. R. , Kenny, J. and Mccrorie, P. (2022) A low-cost method for understanding how nature-based early learning and childcare impacts on children’s health and wellbeing. Frontiers in Psychology, 13, 889828. (doi: 10.3389/fpsyg.2022.889828) (PMID:35814071) (PMCID:PMC9260060)
Parkes, A. , Chambers, S. and Buston, K. (2021) Nonresident fathers' and grandparents' early years support and middle childhood socio-emotional adjustment. Journal of Marriage and Family, 83(2), pp. 358-374. (doi: 10.1111/jomf.12752) (PMID:34880506) (PMCID:PMC8629113)
Thomson, M. , Martin, A. , Long, E. , Logue, J. and Simpson, S. A. (2022) A qualitative exploration of weight management during COVID-19. Clinical Obesity, 12(3), e12512. (doi: 10.1111/cob.12512) (PMID:35194943) (PMCID:PMC9286397)
Smillie, S. and Riddell, J. (2023) Supporting emotionally demanding research: developing guidance for a university research centre. In: Clift, B. C., Batlle, I. C., Bekker, S. and Chudzikowski, K. (eds.) Qualitative Researcher Vulnerability: Negotiating, Experiencing and Embracing. Routledge: Abingdon, Oxon ; New York, NY, pp. 77-93. ISBN 9781032393339 (doi: 10.4324/9781003349266-6)
Boniel-Nissim, M. et al. (2023) Adolescent use of social media and associations with sleep patterns across 18 European and North American countries. Sleep Health, 9(3), pp. 314-321. (doi: 10.1016/j.sleh.2023.01.005) (PMID:36804326)
Holmes, J., Angus, C., Sasso, A., Stevely, A. K. and Meier, P. S. (2021) What proportion of on-trade alcohol is served to those who are already potentially intoxicated? An analysis of event-level data. Journal of Studies on Alcohol and Drugs, 82(5), pp. 602-609. (doi: 10.15288/jsad.2021.82.602) (PMID:34546906) (PMCID:PMC7611694)
Olsen, J. R. , Patterson, C. , Caryl, F. M. , Robertson, T., Mooney, S. J., Rundle, A. G., Mitchell, R. and Hilton, S. (2021) Exposure to unhealthy product advertising: Spatial proximity analysis to schools and socio-economic inequalities in daily exposure measured using Scottish Children’s individual-level GPS data. Health and Place, 68, 102535. (doi: 10.1016/j.healthplace.2021.102535) (PMID:33636594)
Littlecott, H. J. et al. (2023) Perceptions of friendship, peers and influence on adolescent smoking according to tobacco control context: a systematic review and meta-ethnography of qualitative research. BMC Public Health, 23, 424. (doi: 10.1186/s12889-022-14727-z) (PMID:36869343) (PMCID:PMC9983235)
Shah, A. S.V. et al. (2021) Clinical burden, risk factor impact and outcomes following myocardial infarction and stroke: a 25-year individual patient level linkage study. Lancet Regional Health - Europe, 7, 100141. (doi: 10.1016/j.lanepe.2021.100141) (PMID:34405203) (PMCID:PMC8351196)
Dibben, G. O. et al. (2023) Adolescents’ interactive electronic device use, sleep and mental health: a systematic review of prospective studies. Journal of Sleep Research, (doi: 10.1111/jsr.13899) (PMID:37029099) (Early Online Publication)
Dibben, G. O. , Faulkner, J., Oldridge, N., Rees, K., Thompson, D. R., Zwisler, A.-D. and Taylor, R. S. (2023) Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis. European Heart Journal, 44(6), pp. 452-469. (doi: 10.1093/eurheartj/ehac747) (PMID:36746187) (PMCID:PMC9902155)
