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The complexity of the real world is a fact. Clients live in a complex environment where multiple factors contribute to their health and their capacity to promote healthy living. They may experience one or more health problems associated with a range of determinants. These complex health problems require complex interventions for successful remediation. Several health professionals are involved in the delivery of complex intervention, in a context that is characterized by factors, operating at different levels and contributing to the success (or failure) of the intervention implementation and effectiveness. The complexity of the real world should be accounted for, and not ignored as is the case in the RCT design, when developing and evaluating health interventions in order to generate evidence of relevance to practice.

Accounting for complexity demands acknowledgement of multi‐causality in the design and evaluation of health interventions, as well as of the individuality of clients. This can be achieved with the development of theory of the health problem (see Chapter 3), multicomponent interventions (see Chapter 4), theory of change (see Chapter 4 and 5), as well as examining the influence of contextual factors on the implementation of the intervention (see Chapter 13) and individual variability in clients' responses to interventions.