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Thinking about complexity in health: A systematic review of the key systems thinking and complexity ideas in health

Rusoja, Evan; Haynie, Deson; Sievers, Jessica; Mustafee, Navonil; Nelson, Fred; Reynolds, Martin; Sarriot, Eric; Swanson, Robert Chad and Williams, Bob (2018). Thinking about complexity in health: A systematic review of the key systems thinking and complexity ideas in health. Journal of Evaluation in Clinical Practice, 24(3) pp. 600–606.

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Rationale, aims, and objectives

As the Sustainable Development Goals are rolled out worldwide, development leaders will be looking to the experiences of the past to improve implementation in the future. Systems thinking and complexity science (ST/CS) propose that health and the health system are composed of dynamic actors constantly evolving in response to each other and their context. While offering practical guidance for steering the next development agenda, there is no consensus as to how these important ideas are discussed in relation to health. This systematic review sought to identify and describe some of the key terms, concepts, and methods in recent ST/CS literature.


Using the search terms “systems thinkin * AND health OR complexity theor* AND health OR complex adaptive system* AND health,” we identified 516 relevant full texts out of 3982 titles across the search period (2002-2015).


The peak number of articles were published in 2014 (83) with journals specifically focused on medicine/healthcare (265) and particularly the Journal of Evaluation in Clinical Practice (37) representing the largest number by volume. Dynamic/dynamical systems (n = 332), emergence (n = 294), complex adaptive system(s) (n = 270), and interdependent/interconnected (n = 263) were the most common terms with systems dynamic modelling (58) and agent-based modelling (43) as the most common methods.


The review offered several important conclusions. First, while there was no core ST/CS “canon,” certain terms appeared frequently across the reviewed texts. Second, even as these ideas are gaining traction in academic and practitioner communities, most are concentrated in a few journals. Finally, articles on ST/CS remain largely theoretical illustrating the need for further study and practical application. Given the challenge posed by the next phase of development, gaining a better understanding of ST/CS ideas and their use may lead to improvements in the implementation and practice of the Sustainable Development Goals.

Item Type: Journal Item
Copyright Holders: 2018 John Wiley & Sons Ltd
ISSN: 1365-2753
Project Funding Details:
Funded Project NameProject IDFunding Body
Not Set2012158Doris Duke Charitable Foundation
Keywords: complex adaptive system; complexity science; health; systems thinking
Academic Unit/School: Faculty of Science, Technology, Engineering and Mathematics (STEM) > Engineering and Innovation
Faculty of Science, Technology, Engineering and Mathematics (STEM)
Research Group: Citizenship and Governance
Design and Innovation
Harm and Evidence Research Collaborative (HERC)
Health and Wellbeing PRA (Priority Research Area)
Innovation, Knowledge & Development research centre (IKD)
Item ID: 53349
SWORD Depositor: Jisc Publications-Router
Depositing User: Jisc Publications-Router
Date Deposited: 22 Feb 2018 12:27
Last Modified: 01 May 2019 15:56
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