title: Multilevel interventions: measurement and measures.
abstract: BACKGROUND
  Multilevel intervention research holds the promise of more accurately representing real-life situations and, thus, with proper research design and measurement approaches, facilitating effective and efficient resolution of health-care system challenges. However, taking a multilevel approach to cancer care interventions creates both measurement challenges and opportunities.
  
  
  METHODS
  One-thousand seventy two cancer care articles from 2005 to 2010 were reviewed to examine the state of measurement in the multilevel intervention cancer care literature. Ultimately, 234 multilevel articles, 40 involving cancer care interventions, were identified. Additionally, literature from health services, social psychology, and organizational behavior was reviewed to identify measures that might be useful in multilevel intervention research.
  
  
  RESULTS
  The vast majority of measures used in multilevel cancer intervention studies were individual level measures. Group-, organization-, and community-level measures were rarely used. Discussion of the independence, validity, and reliability of measures was scant.
  
  
  CONCLUSIONS
  Measurement issues may be especially complex when conducting multilevel intervention research. Measurement considerations that are associated with multilevel intervention research include those related to independence, reliability, validity, sample size, and power. Furthermore, multilevel intervention research requires identification of key constructs and measures by level and consideration of interactions within and across levels. Thus, multilevel intervention research benefits from thoughtful theory-driven planning and design, an interdisciplinary approach, and mixed methods measurement and analysis.
authors.affiliation: Center for Organization, Leadership and Management Research, US Department of Veterans Affairs, Boston, MA, USA.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Charns
authors.forename: Mary K
authors.initials: MK
authors.lastname: Foster
authors.forename: Elaine C
authors.initials: EC
authors.lastname: Alligood
authors.forename: Justin K
authors.initials: JK
authors.lastname: Benzer
authors.forename: James F
authors.initials: JF
authors.lastname: Burgess
authors.forename: Donna
authors.initials: D
authors.lastname: Li
authors.forename: Nathalie M
authors.initials: NM
authors.lastname: McIntosh
authors.forename: Allison
authors.initials: A
authors.lastname: Burness
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Partin
authors.forename: Steven B
authors.initials: SB
authors.lastname: Clauser
mesh_terms: D002173:Cancer Care Facilities / Q000592:standards / Q000706:statistics & numerical data; D015986:Confounding Factors, Epidemiologic; D003266:Continuity of Patient Care / Q000592:standards / Q000639:trends; D019033:Delivery of Health Care, Integrated / Q000592:standards / Q000639:trends; D006302:Health Services Research / Q000379:methods / Q000639:trends; D006801:Humans; D033183:Interdisciplinary Communication; D009369:Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000592:standards / Q000639:trends; D011787:Quality of Health Care / Q000592:standards / Q000639:trends; D012107:Research Design; D014481:United States