Health promotion intervention research in complex adaptive systems: The contextual action-oriented research approach (CARA)

Health promotion interventions often have suboptimal effects due to implementation challenges (Deschesnes et al., Health Promot Int 18:387-396, 2003; Lee, Appl Health Econ Health Policy 7:11-17, 2009; Langford et al., Cochrane Database Syst Rev 4:CD008958, 2014; Darlington, BMC Public Health 18:163, 2018; Schaap et al., Int J Behav Nutr Phys Act 15:75, 2018; Mohammadi et al., Soc Sci Med 70:1467-1474, 2010). To successfully implement an intervention in a specific setting and thereby create a meaningful impact, it requires introducing, managing, and sustaining the intervention in all aspects of that setting including the individual health behaviour; the physical, social, and economic environments; the policies; and even the surroundings of that particular setting (Mohammadi, Complexity science, schools and health: Applications for management of change in schools to promote health and education. Lambert Academic Publishing, 2010). In other words, the whole system is potentially impacted by health promotion actions. The implementation of health promotion interventions, and also its evaluation, has been considered as a complex task to fulfil, since each system has its own unique context and therefore reacts and interacts differently to changes. Altogether, this results in a considerable gap between the intended goal of the health promotion intervention, its real-life implementation, and the final impact on health (Mohammadi, Complexity science, schools and health: Applications for management of change in schools to promote health and education. Lambert Academic Publishing, Saarbrucken, 2010; Deschesnes et al., Health Promot Int 18:387-396, 2003). This chapter aims to contribute to an understanding of the challenges in health promotion by providing a better insight into the complex and adaptive nature of systems. Moreover, the chapter aims to help health promotion researchers by providing a research approach that can assist them in dealing with complex adaptive systems in health promotion intervention research.