title: In search of synergy: strategies for combining interventions at multiple levels.
abstract: The social ecological perspective provides a compelling justification for multilevel intervention. Yet, it offers little guidance for selecting interventions that work together in complementary or synergistic ways. Using a causal modeling framework, we describe five strategies for increasing potential complementarity or synergy among interventions that operate at different levels of influence: accumulation, amplification, facilitation, cascade, and convergence. We illustrate these strategies with examples of multilevel interventions to improve the quality of cancer treatment.
authors.affiliation: Department of Health Policy and Management, CB 7411, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7411, USA. Bryan_Weiner@unc.edu
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Weiner
authors.forename: Megan A
authors.initials: MA
authors.lastname: Lewis
authors.forename: Steven B
authors.initials: SB
authors.lastname: Clauser
authors.forename: Karyn B
authors.initials: KB
authors.lastname: Stitzenberg
mesh_terms: D003131:Combined Modality Therapy / Q000592:standards*; D003266:Continuity of Patient Care / Q000592:standards / Q000639:trends; D019033:Delivery of Health Care, Integrated / Q000592:standards / Q000639:trends; D015987:Effect Modifier, Epidemiologic; D006801:Humans; D017146:Models, Organizational; D017008:Negotiating; D009369:Neoplasms / Q000175:diagnosis / Q000628:therapy; D010348:Patient Care Team / Q000592:standards / Q000639:trends; D011787:Quality of Health Care / Q000592:standards / Q000639:trends; D012931:Social Environment; D014481:United States