A fresh outlook for complex intervention research – the new MRC/NIHR framework

Published: 30 September 2021

It has been 15 years since the framework for developing and evaluating complex interventions was last updated. A lot has happened in that time!

By Lynsay Matthews and Kathryn Skivington on behalf of the framework’s project team. 

It has been 15 years since the framework for developing and evaluating complex interventions was last updated. A lot has happened in that time!

When we embarked on this project back in 2018 we enthusiastically planned out our timeline of being ‘done and dusted’ within 18 months.  Fast forward 3 years later, our tired (but happy) team can tell you that this update was huge…and challenging.

The end result is a framework which highlights the big steps made in complex intervention research. It will, however, also push our comfort zones in influencing how we all go about developing and evaluating complex interventions from now on.

We know that many of you have been awaiting this new framework with anticipation. So to make the framework as accessible, and quick to ‘pick up’ as possible, we have added several helpful tools to the document, including:

  • boxes highlighting key points and signposts to relevant reading at the end of each chapter;
  • case studies relating to all the key aspects of the framework; and
  • a handy checklist for steps needed at each phase of the research process.

Although we know you’ll all be diving in it to the new framework soon (and reading its accompanying article in the BMJ), it might be helpful to quickly outline what the key parts of the new framework are. These can be considered in three chunks:

1. Choosing an appropriate research perspective

Complex intervention research has often been undertaken from an efficacy and effectiveness perspective i.e. ‘To what extent does the intervention produce the intended outcome(s) in experimental or ideal settings?’However, additional perspectives should be considered depending on what is already known and what new data will be useful, including a theory-based (i.e. What works in which circumstances and how?) or systems perspective (i.e. How do the system and intervention adapt to one another?)

2. Addressing issues relevant to the ‘phase’ of the research process

The four original phases of research remain unchanged –development, feasibility, evaluation and However, there is the important new addition of ‘identifying an intervention’ from policy or practice, and how that should be considered in relation to the research process

3. Addressing the new ‘core elements’ of complex intervention research

*Drum roll please*…introducing our 6 new core elements:

  • how does the intervention interact with its context?
  • what is the underpinning programme theory?
  • how can diverse stakeholder perspectives be included in the research?
  • what are the key uncertainties?
  • how can the intervention be refined?
  • do the effects of the intervention justify its cost?

Frequently and repeatedly coming back and addressing these core elements at all phases of the research process is something which positively impacts the quality of complex intervention development, evaluation and implementation.

Talking of implementation, it’s one of the areas that has been further developed in this framework.

"Implementation should not be an ‘after thought’ but should be considered meaningfully from the outset – after all the long-term goal of our research is to achieve well implemented and sustainable interventions." Professor Laurence Moore, Director of SPHSU

A lot of work has gone into producing this new framework. Although it’s difficult to cover all areas of progress, or specific topics, the resulting document presents the most up to date evidence and information. We have read hundreds of articles, held workshops with UK and international experts, gathered insight from multiple conference workshops, met with researchers involved in related guidance, analysed feedback from an open consultation of the draft framework, and received continual input from a Scientific Advisory Group representing multiple areas of health research.

We hope the new framework helps inform researchers, policymakers, clinicians, journal editors and funders on the key aspects of quality intervention development and evaluation.

One thing we have learned while working on this project, is that theoretical and methodological advances for complex intervention research are happening as we speak. With this is mind we are looking into ways to continuously update the framework ... rather than wait another 15yrs. Watch this space!

We’d love to hear how you are applying the framework to your research. Tell us via Twitter @theSPHSU


First published: 30 September 2021