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All of these trials involve the design and implementation of complex interventions for changing the behaviors of providers and patients.
The nine studies described involved the design and implementation of complex interventions targeting providers, patients and the public.
The challenges encountered during implementation of complex interventions are often unpredictable; however, adoption of a systematic process will allow investigators to address them in a consistent yet flexible manner, protecting fidelity.
The implementation of complex interventions such as CCMs requires careful consideration and planning.
NPT has four components which can be used to evaluate implementation of complex interventions.
Implementation of complex interventions in a primary care setting is challenging [ 54].
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While others have suggested that the implementation of complex intervention primarily depends on the behaviour of healthcare providers, this review suggests that patients can also act to facilitate or impede the implementation of CCMs.
Assessing the implementation process of complex interventions (36) helps to 1) provide feedback for improving the intervention, 2) replicate an intervention in other settings, 3) interpret the outcomes of the intervention, and 4) appraise the generalizability and the transferability of the intervention.
Systemic features of the patient perspective identified through meta-evaluations can inform design improvements, implementation and evaluation of complex interventions for individuals with chronic diseases.
7 13 Protocols for the implementation and evaluation of complex interventions for patients with multiple chronic diseases often assume a single, universal patient trajectory or journey.
Finally, our analysis also emphasises the importance of incorporating a social science lens and systems perspective to data analysis, and the value of a qualitative meta-evaluation approach in the design, implementation and evaluation of complex interventions.
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