In search of synergy: strategies for combining interventions at multiple levels

J Natl Cancer Inst Monogr. 2012 May;2012(44):34-41. doi: 10.1093/jncimonographs/lgs001.


The social ecological perspective provides a compelling justification for multilevel intervention. Yet, it offers little guidance for selecting interventions that work together in complementary or synergistic ways. Using a causal modeling framework, we describe five strategies for increasing potential complementarity or synergy among interventions that operate at different levels of influence: accumulation, amplification, facilitation, cascade, and convergence. We illustrate these strategies with examples of multilevel interventions to improve the quality of cancer treatment.

MeSH terms

  • Combined Modality Therapy / standards*
  • Continuity of Patient Care* / standards
  • Continuity of Patient Care* / trends
  • Delivery of Health Care, Integrated* / standards
  • Delivery of Health Care, Integrated* / trends
  • Effect Modifier, Epidemiologic
  • Humans
  • Models, Organizational*
  • Negotiating
  • Neoplasms* / diagnosis
  • Neoplasms* / therapy
  • Patient Care Team* / standards
  • Patient Care Team* / trends
  • Quality of Health Care* / standards
  • Quality of Health Care* / trends
  • Social Environment
  • United States