Evaluation of public health interventions from a complex systems perspective: a research methods review

Elizabeth McGill, Vanessa Er, Tarra Penney, Matt Egan, Martin White, Petra Meier, Margaret Whitehead, Karen Lock, Rachel Anderson de Cuevas, Richard Smith, Natalie Savona, Harry Rutter, Dalya Marks, Frank de Vocht, Steven Cummins, Jennie Popay, Mark Petticrew

Research output: Contribution to journalReview articlepeer-review

69 Citations (SciVal)


Introduction: Applying a complex systems perspective to public health evaluation may increase the relevance and strength of evidence to improve health and reduce health inequalities. In this review of methods, we aimed to: (i) classify and describe different complex systems methods in evaluation applied to public health; and (ii) examine the kinds of evaluative evidence generated by these different methods. Methods: We adapted critical review methods to identify evaluations of public health interventions that used systems methods. We conducted expert consultation, searched electronic databases (Scopus, MEDLINE, Web of Science), and followed citations of relevant systematic reviews. Evaluations were included if they self-identified as using systems- or complexity-informed methods and if they evaluated existing or hypothetical public health interventions. Case studies were selected to illustrate different types of complex systems evaluation. Findings: Seventy-four unique studies met our inclusion criteria. A framework was developed to map the included studies onto different stages of the evaluation process, which parallels the planning, delivery, assessment, and further delivery phases of the interventions they seek to inform; these stages include: 1) theorising; 2) prediction (simulation); 3) process evaluation; 4) impact evaluation; and 5) further prediction (simulation). Within this framework, we broadly categorised methodological approaches as mapping, modelling, network analysis and ‘system framing’ (the application of a complex systems perspective to a range of study designs). Studies frequently applied more than one type of systems method. Conclusions: A range of complex systems methods can be utilised, adapted, or combined to produce different types of evaluative evidence. Further methodological innovation in systems evaluation may generate stronger evidence to improve health and reduce health inequalities in our complex world.

Original languageEnglish
Article number113697
JournalSocial Science and Medicine
Early online date11 Jan 2021
Publication statusPublished - 31 Mar 2021


  • Complexity science
  • Evaluation methodologies
  • Practice
  • Public health
  • Systems thinking

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science


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