Advancing Complexity Theory in Health Services Research: The Logic of Logic Models

Journal article


Mills, T., Lawton, R. and Sheard, L. (2019). Advancing Complexity Theory in Health Services Research: The Logic of Logic Models. BMC Medical Research Methodology. 19 (55). https://doi.org/10.1186/s12874-019-0701-4
AuthorsMills, T., Lawton, R. and Sheard, L.
Abstract

Background: Logic models are commonly used in evaluations to represent the causal processes through which interventions produce outcomes, yet significant debate is currently taking place over whether they can describe complex interventions which adapt to context. This paper assesses the logic models used in healthcare research from a complexity perspective. A typology of existing logic models is proposed, as well as a formal methodology for deriving more flexible and dynamic logic models.

Analysis: Various logic model types were tested as part of an evaluation of a complex Patient Experience Toolkit (PET) intervention, developed and implemented through action research across six hospital wards/departments in the English NHS. Three dominant types of logic model were identified, each with certain strengths but ultimately unable to accurately capture the dynamics of PET. Hence, a fourth logic model type was developed to express how success hinges on the adaption of PET to its delivery settings. Aspects of the Promoting Action on Research Implementation in Health Services (PARIHS) model were incorporated into a traditional logic model structure to create a dynamic “type 4” logic model that can accommodate complex interventions taking on a different form in different settings.

Conclusion: Logic models can be used to model complex interventions that adapt to context but more flexible and dynamic models are required. An implication of this is that how logic models are used in healthcare research may have to change. Using logic models to forge consensus among stakeholders and/or provide precise guidance across different settings will be inappropriate in the case of complex interventions that adapt to context. Instead, logic models for complex interventions may be targeted at facilitators to enable them to prospectively assess the settings they will be working in and to develop context-sensitive facilitation strategies. Researchers should be clearas to why they are using a logic model and experiment with different models to ensure they have the correct type.

KeywordsLogic models, program theory, implementation models, Complexity, Complexity science, Complex interventions, Facilitation, Context
Year2019
JournalBMC Medical Research Methodology
Journal citation19 (55)
PublisherBMC
ISSN1471-2288
Digital Object Identifier (DOI)https://doi.org/10.1186/s12874-019-0701-4
Web address (URL)https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-019-0701-4
Publication dates
Print12 Mar 2019
Publication process dates
Accepted03 Mar 2019
Deposited31 Aug 2022
Publisher's version
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File Access Level
Open
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