Developing a Research Structure for Complex Interventions in Health Care


Marcy McCall Macbain

The Medical Research Council’s framework has assisted me in the development of a yoga intervention to improve the health-related quality of life (HRQoL) in adult cancer patients. The evidence-based strategy I used to desgin the intervention included a multiphase mixed methods design – outlined in Figure 1.

Figure 1. The MRC framework for developing complex interventions in health care








Source: Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., Petticrew, M., & Medical Research Council Guidance. (2008). Developing and evaluating complex interventions: The new medical research council guidance. BMJ (Clinical Research Ed.), 337, a1655.

Yoga Intervention and Mixed Methods Research
The extensive complexity of some interventions means their development (and evaluation) should consider contextual factors, as well as information about its variable components, modes of delivery, clinical opinions and patient values. Such variables impact an intervention’s efficacy and uptake in health care, and benefit from mixed methods data collection to interpret the context and meaning of such factors[1].

As a case study for evidence-based medicine (EBM) research should  consider the MRC’s research methodology, which is presented below, in the context of a mixed methods set of studies. While an inherent goal of the MRC framework is to develop a randomised controlled trial (RCT) to evaluate efficacy, the following research structure outlines how both qualitative and quantitative measures can be fundamental to the development and evaluation of complex interventions.

The development phase consisted of primary and secondary research projects, including: a literature review, bibliometric analysis, overview of systematic reviews, component analysis, patient interviews, and oncologist surveys. This evidence was synthesised to develop a randomised feasibility trial of yoga intervention (see Figure 2).

Figure 2. Example of MRC framework and research structure






The development and design of a research structure is helpful to communicate the relationship between methodology, methods and established frameworks for health care research.
A mixed methods research design has been useful to satisfy the information requirements as outlined by the MRC’s framework and EBM guidelines for developing high-quality health care research.

For questions, or if you wish to modify or replicate this research structure, please contact

[1] Creswell, J. W., & Plano Clark, V. L. (2007). Designing and conducting mixed research methods. Thousand Oaks: Sage.

Marcy McCall MacBain

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