‘Dark logic: theorising the harmful consequences of public health interventions’ (Bonell et al., 2014) argued that intervention design should seek to anticipate the unintended adverse effects of interventions, understand the mechanisms through which they might occur and aim to avert them. It suggested that one method for doing this is to consult relevant stakeholders.
This paper describes how dark logic was incorporated into a service design process involving Family Nurse Partnership, an evidence-based programme for young mothers.
A major RCT in the UK published in 2015 found no impact of FNP on primary outcomes but some encouraging findings for a subset of secondary outcomes. The FNP National Unit and Dartington Social Research Unit have sought to respond constructively to these findings by adapting the programme and testing the emerging adaptations. In addition to developing logic models for clinical adaptations, co-production teams in each site have been encouraged to articulate the dark logic of their respective adaptation, rate the likelihood of each unintended harmful consequence and identify suitable mitigating actions. The paper outlines the method used to develop dark logic models and identifies the overarching categories that together capture the theorised unintended harmful consequences from all eight sites. It also describes the most common mitigating actions and reflects on the relative success of the method and how it could be improved.
This informal seminar is presented by Nick Axford, PenCLAHRC Associate Professor (Reader) in Health Services and is open to Plymouth University staff, postgraduate students and researchers. Contact firstname.lastname@example.org for any queries.