This report is provides guidance for research teams who are currently planning or are in the midst of implementing an e-health intervention in rural communities. It describes the important factors which need to be considered when scaling - up a pilot project from one context to another, and demonstrates what a successful project needs to maximize the probability that it will achieve the desired level of spread within the healthcare system. This report can be used as a reference for people who wish to implement a novel intervention into a new environment. Ideally it will be used in the early stages of intervention design to help researchers understand how a complex adaptive system functions and why navigating one is important for the outcome of their intervention. To begin, the report covers some basic terminology used when discussing complex adaptive systems and highlights the importance of working with these ideas moving forward. Next, in-depth discussions about sense-making, leverage points, self-organization, and agent-based modelling provide evidence of the complexity of implementation. Finally, the principle of antifragility is discussed, as well as a tangible example of an intervention which has been designed with antifragility in mind. Finally, the conclusion summarizes the key findings of the report, offers future directions, and identifies some of the limitations.

Carleton University, Department of Health Sciences

This report was prepared for the Centre for Rural Medicine in Storuman, Sweden, as part of the Free Range international student exchange program. See also Carleton's Spatial Determinants of Health Lab

Spatial Determinants of Health Lab

Petrie, Samuel, & Peters, P. (2018, September 22). Implementation considerations in a Complex Adaptive System. Department of Health Sciences. doi:10.22215/sdhlab/2018.9