Development of a Complex Intervention for Secondary Prevention of Coronary Heart Disease in Primary Care Using the UK Medical Research Council Framework

Objective: To apply the UK Medical Research Council (MRC) framework for development and evaluation of trials of complex interventions to a primary healthcare intervention to promote secondary prevention of coronary heart disease. Study Design: Case report of intervention development. Methods: First, literature relating to secondary prevention and lifestyle change was reviewed. Second, a preliminary intervention was modeled, based on literature findings and focus group interviews with patients (n = 23) and staff (n = 29) from 4 general practices. Participants’ experiences of and attitudes toward key intervention components were explored. Third, the preliminary intervention was pilot-tested in 4 general practices. After delivery of the pilot intervention, practitioners evaluated the training sessions, and qualitative data relating to experiences of the intervention were collected using semistructured interviews with staff (n = 10) and patient focus groups (n = 17). Results: Literature review identified 3 intervention components: a structured recall system, practitioner training, and patient information. Initial qualitative data identified variations in recall system design, training requirements (medication prescribing, facilitating behavior change), and information appropriate to the prospective study participants. Identifying detailed structures within intervention components clarified how the intervention could be tailored to individual practice, practitioner, and patient needs while preserving the theoretical functions of the components. Findings from the pilot phase informed further modeling of the intervention, reducing administrative time, increasing practical content of training, and omitting unhelpful patient information. Conclusion: Application of the MRC framework helped to determine the feasibility and development of a complex intervention for primary care research.

Crisis Management in the Eastern Mediterranean (Implications for Policymakers)

This article examines Greek-Turkish crisis behaviour in the Eastern Mediterranean over the past two decades. Crises are first defined and classified, after which a number of common misperceptions are then addressed in light of recent experience. Three broad categories of foreign policy crises are analyzed: 1) those involving ethnically related minorities across the border; 2) those with 'alien' minorities within borders; and 3) those with third countries involving territories and resources. The article examines whether crises are simply elite-driven or partly endorsed and motivated by mass publics in both countries, and whether Greek-Turkish crisis behaviour reflects enduring ethnic rivalries, 'genuine' security interests, or domestic political needs and norms. The article draws upon the Greek-Turkish experience of the past two decades to illuminate contemporary dilemmas and issues which policymakers face in this region.