Table 3 Summary of data reported for creating synergy (propositions two and three)

Proposition two: Combinations and sequencing/staging of interventions

Descriptions of the deliberate combination of interventions (implemented at the same time) and sequencing/staging of interventions (ordered in time) within and across levels of the system relative to their potential for enhanced synergistic and minimized antagonistic effects

Description regarding the combining and sequencing/staging of interventions at multiple levels of the system as an approach to optimizing overall program effectiveness and/or sustainability ranged from inferences to explicit details

'Staff training was implemented in work sites and churches to facilitate offering of health promotion programs such as quit smoking [30: p.203]

The program consists of a 'complex set of projects and initiative which combine and interact in different ways to produce overall effect which is being measured through the outcome evaluation' [38: p.14]

'The aim is to promote synergism whereby each component reinforces the others' [43: p.89]

Some referencing regarding the combining and sequencing/staging of interventions potentially attributable to both the anticipated positive outcomes, as well as explanation for shortfalls in expected outcomes.

The 'combination of mass communication and community organization.... was a valuable device for accelerating the diffusion of health innovation' [30: p.321]

'Intervention program may have focused on the wrong population segments or used the wrong mix of intervention components' [36: p.1391]

More specific details were reported for the combining and sequencing/staging of interventions within levels of the system (such as interventions directed at the intrapersonal individual level), compared to across levels in the system (such as a combination of intrapersonal and policy level changes)

'In the two direct intervention schools, butter used on bread was replaced by soft margarine...These changes were also recommended for...meals at home...a nutritionist visited the homes of the children... Healthy diet was also discussed during school lessons. Parent gatherings, leaflets, posters, written recommendations, a project magazine, and the general mass media were used... Screening results were explained... A school nurse repeated the screening...and good advice and counseling to children...' [30: p.293]

Compared to...

'With an effective political system, public health leaders can gain authority to strenuously exert influence over personal behaviours without arousing resistance.... this was accomplished through a blended approach which included both manipulation and empowerment [30: p.319]

Reporting on the timing (sequential versus simultaneous) of interventions spanned from specific detail to general descriptions

'Actual screening programmes were often run simultaneously.' [30: p.97]

'Staggered entry of communities to intervention to allow for gradual development of the intervention program and strengthened the design through replication' [36: p.1384]

'The model Choice-Change-Champion process for health promotion' [was] constructed for 'idealized sequence of events' and intended to 'guide planning and priority setting'. [38: p.9]

'...individuals are supported to move from stage one of having a 'choice' for lifestyle... through stage two of making 'changes' successfully... and stage three becoming a 'champion' for health at the local level which requires whereby individuals move from being a recipient to provider' [43: p.48]

Proposition three: Coordinating and integrating intervention efforts

Descriptions of complementary interventions across sectors (e.g., health, education, recreation, labour, environment, housing, etc) and across jurisdictions (i.e., local/regional, provincial/state, federal/national).

Reporting on the importance and deliberate combining and sequencing/staging of interventions through use of multiple channels that crossed sectors and jurisdictions was both implicit and explicit

'The programme must be founded on intersectoral activity, community organization and grassroots participation.' [30: p.34]

The development of advisory boards 'were made up of influential political business, health, and other leaders in the community and citizen task force' [35: p.202]

'The intervention comprises a wide range of locally organized projects together with centrally led initiatives...across all sectors of Welsh life, including the health and educational authorities, local and central government, commerce, industry, mass media, agricultural and voluntary sectors' [38: p.6]