Agency for Healthcare Research and Quality Evidence-based Practice Center methods for systematically reviewing complex multicomponent health care interventions

J Clin Epidemiol. 2014 Nov;67(11):1181-91. doi: 10.1016/j.jclinepi.2014.06.010. Epub 2014 Oct 17.


Objectives: The purpose of this Agency for Healthcare Research and Quality Evidence-based Practice Center methods white paper was to outline approaches to conducting systematic reviews of complex multicomponent health care interventions.

Study design and setting: We performed a literature scan and conducted semistructured interviews with international experts who conduct research or systematic reviews of complex multicomponent interventions (CMCIs) or organizational leaders who implement CMCIs in health care.

Results: Challenges identified include lack of consistent terminology for such interventions (eg, complex, multicomponent, multidimensional, multifactorial); a wide range of approaches used to frame the review, from grouping interventions by common features to using more theoretical approaches; decisions regarding whether and how to quantitatively analyze the interventions, from holistic to individual component analytic approaches; and incomplete and inconsistent reporting of elements critical to understanding the success and impact of multicomponent interventions, such as methods used for implementation the context in which interventions are implemented.

Conclusion: We provide a framework for the spectrum of conceptual and analytic approaches to synthesizing studies of multicomponent interventions and an initial list of critical reporting elements for such studies. This information is intended to help systematic reviewers understand the options and tradeoffs available for such reviews.

Keywords: Complex interventions; Complexity; Evidence synthesis methods; Evidence-based medicine; Multicomponent interventions; Reporting guideline; Systematic reviews.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Delivery of Health Care / methods*
  • Delivery of Health Care / standards*
  • Evidence-Based Medicine
  • Health Services Research / methods*
  • Health Services Research / standards*
  • Humans
  • Research Design
  • United States
  • United States Agency for Healthcare Research and Quality