Table 1

Examples of the types of questions associated with complex interventions, systems and evidence to decision (EtD) frameworks

Aspect of complexity or complex interventions of interest to the guideline4 7Possible questions that could be asked in a QES
What ‘is’ the system? How can it be described?What are stakeholders’ interpretations of the current system?
Interactions between components of complex interventionsHow do the components work in combination to produce effects?
Interactions of interventions with contextHow and why does the implementation of an intervention vary across contexts?
System adaptivity: how does the system change?Why does the system change in the way it does?
Emergent propertiesWhat events were anticipated/unanticipated and what was the impact of these?
Multiple (health and non-health) outcomesWhy were outcomes not as anticipated?
Balance of health benefits and harmsTo what extent do stakeholders value different outcomes?
Sociocultural acceptability of the interventionWhat are stakeholders’ views about acceptability, or preferences or appropriateness of the intervention?
Feasibility and health system considerationsWhat aspects of the health system influence implementation of the intervention?
  • QES, qualitative evidence synthesis.