What is population health intervention research?

Generation Pep - study protocol for an intersectoral community-wide physical activity and healthy eating habits initiative for children and young people in Sweden

Background

There is overwhelming evidence for the preventive effects of regular physical activity and healthy eating habits on the risk for developing a non-communicable disease (NCD). Increasing attention has been paid to community-wide approaches in the battle against NCDs. Communities can create supportive policies, modify physical environments, and foster local stakeholder engagement through intersectoral collaboration to encourage communities to support healthy lifestyles. The Pep initiative is based on intersectoral community-wide collaboration among Sweden's municipalities. Primary targets are municipality professionals who work with children and young people as well as parents of children <18 years. The goal is to spread knowledge and create commitment to children's and young people's health with a special focus on physical activity and healthy eating habits to facilitate and support a healthy lifestyle. The overarching aim of the research project described in this study protocol is to investigate factors that influence the implementation of the Pep initiative in Sweden, to inform tailored implementation strategies addressing the needs and local prerequisites of the different municipalities.

Methods

The project includes a qualitative and a quantitative study and is framed by a theoretical model involving four complementary forms of knowledge, explicitly recognized in the Pep initiative: knowledge about the issue; knowledge about interventions; knowledge about the context; and knowledge about implementation. Study 1 is a focus group study exploring barriers and facilitators for implementing the Pep initiative. The study will be carried out in six municipalities, selected purposively to provide wide variation in municipality characteristics, including population size and geographical location. Data will be analyzed using thematic analysis. Study 2 is a cross-sectional web-based survey investigating the implementability of the Pep initiative in Sweden's 290 municipalities. Conditions for implementing different areas of the Pep initiative will be examined in terms of the acceptability, appropriateness, and feasibility, three predictors of implementation success. Data will be analyzed using non-parametric statistics.

Discussion

The findings of the two studies will increase understanding of the prerequisites for implementing the Pep initiative in Swedish municipalities, which will provide valuable input into how implementation of the Pep initiative can best be facilitated in the different municipality settings.

What is a population-level approach to prevention, and how could we apply it to dementia risk reduction?

The World Health Organisation's 2022 'blueprint for dementia research' highlights the need for more research into population-level risk reduction. However, definitions of population-level prevention vary, and application to dementia is challenging because of its multi-factorial aetiology and a maturing prevention evidence base. This paper compares and contrasts key concepts of 'population-level prevention' from the literature, explores related theoretical models and policy frameworks, and applies this to dementia risk reduction. We reach a proposed definition of population-level risk reduction of dementia, which focusses on the need to change societal conditions such that the population is less likely to develop modifiable risk factors known to be associated with dementia, without the need for high-agency behaviour change by individuals. This definition, alongside identified policy frameworks, can inform synthesis of existing evidence and help to co-ordinate the generation of new evidence.

Artificial intelligence for dementia prevention

INTRODUCTION

A wide range of modifiable risk factors for dementia have been identified. Considerable debate remains about these risk factors, possible interactions between them or with genetic risk, and causality, and how they can help in clinical trial recruitment and drug development. Artificial intelligence (AI) and machine learning (ML) may refine understanding.

METHODS

ML approaches are being developed in dementia prevention. We discuss exemplar uses and evaluate the current applications and limitations in the dementia prevention field.

RESULTS

Risk-profiling tools may help identify high-risk populations for clinical trials; however, their performance needs improvement. New risk-profiling and trial-recruitment tools underpinned by ML models may be effective in reducing costs and improving future trials. ML can inform drug-repurposing efforts and prioritization of disease-modifying therapeutics.

DISCUSSION

ML is not yet widely used but has considerable potential to enhance precision in dementia prevention.

HIGHLIGHTS

Artificial intelligence (AI) is not widely used in the dementia prevention field. Risk-profiling tools are not used in clinical practice. Causal insights are needed to understand risk factors over the lifespan. AI will help personalize risk-management tools for dementia prevention. AI could target specific patient groups that will benefit most for clinical trials.

Work as a social determinant of health in high-income countries: past, present, and future

This paper, the first in a three-part Series on work and health, provides a narrative review of research into work as a social determinant of health over the past 25 years, the key emerging challenges in this field, and the implications of these challenges for future research. By use of a conceptual framework for work as a social determinant of health, we identified six emerging challenges: (1) the influence of technology on the nature of work in high-income countries, culminating in the sudden shift to telework during the COVID-19 pandemic; (2) the intersectionality of work with gender, sexual orientation, age, race, ethnicity, migrant status, and socioeconomic status as codeterminants of health disparities; (3) the arrival in many Organisation for Economic Co-operation and Development countries of large migrant labour workforces, who are often subject to adverse working conditions and social exclusion; (4) the development of precarious employment as a feature of many national labour markets; (5) the phenomenon of working long and irregular hours with potential health consequences; and (6) the looming threat of climate change's effects on work. We conclude that profound changes in the nature and availability of work over the past few decades have led to widespread new psychosocial and physical exposures that are associated with adverse health outcomes and contribute to increasing disparities in health. These new exposures at work will require novel and creative methods of data collection for monitoring of their potential health impacts to protect the workforce, and for new research into better means of occupational health promotion and protection. There is also an urgent need for a better integration of occupational health within public health, medicine, the life sciences, and the social sciences, with the work environment explicitly conceptualised as a major social determinant of health.

Short-term impact of a neighbourhood-based intervention on mental health and self-rated health in Hamilton, Ontario, Canada

The Hamilton Neighbourhoods Study aimed to measure the short-term impact of a neighbourhood-based intervention known as the City of Hamilton's Neighbourhood Action Strategy on health and neighbourhood outcomes. A quasi-experimental study with 881 intervention participants across six targeted neighbourhoods and 173 control participants was conducted to investigate changes in self-rated health and mental health from baseline to follow-up. There was evidence of small improvements in mental health in two neighbourhoods, but there was no change in self-rated health. Place-based interventions aimed at high poverty neighbourhoods may have only modest impacts on health in the short-term.

A RE-AIM framework analysis of a sports club health promotion MOOC: the PROSCeSS MOOC

Acquisition of health promotion (HP) skills and knowledge is essential for interventions development in this field. In sports clubs (SC), little HP training exists even though it was requested by SC actors. In response, the PROSCeSS (PROmotion de la Santé au sein du Clubs SportifS) MOOC (Massive Open Online Course) was developed to support actors of HP in the SC in the development of HP interventions. The present study evaluates the MOOC's effectiveness and learning process. The RE-AIM framework, measuring reach, effectiveness, adoption, implementation and maintenance was used to structure this study. Surveys were sent before and after the MOOC to the 2814 learners. Among the 502 (18%) respondents to the pre-survey, 80% reported belonging to a SC as a coach (35%) or manager (25%). The 14% of pre-survey respondents who completed the post-survey increased their HP knowledge score by 42% and their confidence to implement HP actions by 6%. Results present the strategies considered most important and feasible by the learners and the main barriers to the implementation of HP actions in the SC. This study shows that MOOC appears to be an appealing (93% of learners were satisfied) and effective solution (as long as it is followed) to develop HP knowledge and skills of SC actors in HP, meeting their needs and constraints. Although improvements should be made (especially in terms of promoting adoption), this type of educational format should be encouraged to support the HP potential of SC.

Little Doctors: Agents of change in Indian rural communities

The child-to-child approach to health advocacy is one that draws on the strengths and agency of children to make a positive impact within their communities. The approach has been popularly used for health education in low- and middle-income countries. This article describes the 'Little Doctors' program that implemented the child-to-child approach in the towns of KC Patty and Oddanchatram, located in remote hilly regions of Tamil Nadu, India starting in 1986 to train middle- and high school children to respond to diseases prevalent in their communities along with practices for preventative measures. The program involved sessions that used a combination of creative instructional methods to engage students and provided take-home messages for them to act on with their families and community. The program was successful in creating a creative learning environment for children, offering a shift from the traditional methods of classroom instruction. Students who successfully completed the program were awarded certificates as 'Little Doctors' in their communities. Although the program did not conduct formal evaluations of the program effectiveness, students reported successfully recalling complex topics such as early signs of diseases like tuberculosis and leprosy that were prevalent in the community during the time. The program experienced several challenges and had to be discontinued despite its continued benefits to the communities.

Multi-level stakeholders' perspectives on implementation and scaling up community-based health promotion in Germany

Community-based health promotion has the potential to address existing health inequities, although such approaches are scarcely scaled up. For a successful scale up, various stakeholders at different levels and sectors need to be involved. The article's aims are to assess what kind of external support communities need for implementation and to identify facilitators and barriers for scaling up community-based health promotion. Two national digital workshops were conducted in Germany with stakeholders at the community level (n = 161) and with stakeholders at the federal and state levels (n = 84). Protocols were compiled and coded using qualitative content analysis. During the first workshop, we revealed 11 themes for external support needs ('Strategic approach', 'Define & compare indicators', 'International human resource', 'Tools & Aids', 'External conduction of the assessment', 'Involvement of people in difficult life situations', 'Overview of actors', 'Moderation', 'Obtain funding', 'Quality assurance/evaluation' and 'External support'). Eleven facilitators and barriers were identified for scaling up ('Assessment and evaluation', 'Intersectoral collaboration and partnerships', 'Communication', 'Characteristics of the program', 'Political and legal conditions', 'Political support', 'Local coordinator', 'Resources', 'Participation', 'Strategic planning/methods' and 'Intermediary organization'). The identified results provide practice-based evidence on support needed for scaling up, facilitators that promote scaling up and barriers that might hinder scaling up community-based health promotion in Germany. In a next step, this practice-based evidence needs to be systematically integrated with scientific-based evidence on key components for scaling up such approaches for the development of an effective scaling-up concept.

[Population Health Intervention Research, Health Technology Assessment, Health Services Research and Intervention Implementation Research : Convergences and Singularities]

In public health, intervention is an object of research and evaluation which, over time, has given rise to numerous approaches. The first part of the article proposes to reposition intervention research in population health and intervention evaluation on a continuum. Although the former has a more cognitive objective and the latter a more pragmatic objective, they are not mutually exclusive. The distinction between these two practices is based on the predominance of the following characteristics: the objectives pursued, the scope of the investigations, the regulatory constraints, the financing obtained, the ethical approaches taken, and the deliverables established. The second part of the article offers a glance different fields and approaches within the continuum between these two poles: Health Technology Assessment, Health Services Research and Implementation Research. While all of them have the study of health interventions at their core, but each has developed through specialisation in one or the other type of intervention, in a particular scope or context, in certain evaluation questions, or in specific approaches. all as gateways to the study of public health intervention, these different approaches are by no means mutually exclusive.

Participation in Population Health Interventions by Older Adults in Poland: Barriers and Enablers

BACKGROUND

The participation of older adults in population health interventions constitutes a key factor in their physical, mental and social health. The aim of this study was to determine variables considered as enablers and barriers to participation in health programmes.

METHODS

The conceptual framework of the study was developed and population health interventions were operationalised as health programmes. A total of 805 older adults participated in a questionnaire survey. The questionnaire included questions about socio-demographic, health and social connectedness-related factors as well as participation in population health interventions/programmes. Multiple logistic regression was used to examine the relationship between respondents' characteristics and participation in the intervention.

RESULTS

Participation in health programmes was declared by 316 respondents. The enablers of participation were general practitioner's affability (OR = 2.638 [1.453-4.791], p = 0.001), three or more social activities (OR = 3.415 [1.477-7.894], p = 0.004), taking part in support groups (OR = 4.743 [1.255-17.929], p = 0.022) and involvement in Universities of the Third Age (OR = 2.829 [1.093-7.327], p = 0.032). The barriers were primary education (OR = 0.385 [0.215-0.690], p = 0.001), infrequent general practitioner's appointments (OR = 0.500 [0.281-0.888], p = 0.018) and lack of social activity (OR = 0.455 [0.299-0.632], p < 0.001).

CONCLUSION

The enablers of participation appeared to solely include variables regarding health service utilisation, patient experience and social activity, i.e., interpersonal and community relationships, not intrapersonal factors.

Population-based physical activity promotion with a focus on health equity: a review of reviews

BACKGROUND

The extent to which people are physically active is dependent upon social gradients. Numerous studies have shown that especially people with social disadvantages do not meet the physical activity (PA) recommendations. A promising strategy to alleviate this issue are approaches that promote PA in the general population. In addition, several researchers have raised concerns that population-based health interventions may increase health inequities. The aim of the current review of reviews was therefore to identify successful population-based PA promotion approaches with a particular focus on health equity.

METHODS

Six electronic databases were examined for systematic reviews on population-based PA promotion for the period 2015 to 2021. A reference list and grey literature search were also conducted. Two independent reviewers used inclusion/exclusion criteria to screen titles and abstracts of the potentially relevant literature and conducted a quality assessment for each identified review. All included reviews of population-based approaches for PA promotion with a focus on disadvantaged populations and/or health equity were narratively summarized.

RESULTS

Our search resulted in 4,411 hits. After a systematic review process, six reviews met the inclusion criteria and were included after they were all rated as high quality. We identified that mass-media campaigns, point-of-decision prompts, environmental approaches, policy approaches, and community-based multi-component approaches can promote PA in the general population. Across populations with social disadvantages mass-media campaigns, point-of-decision prompts and policy approaches are likely to be effective as long as they are tailored. Regarding environmental approaches, the results are inconsistent. None of the reviews on community-based multi-component approaches provided evidence on health equity.

CONCLUSION

There are several effective approaches to promote PA in the general population but evidence regarding health equity is still sparse. Future studies should therefore pay more attention to this missing focus. Furthermore, there is a lack of evidence regarding the type of tailoring and the long-term impact of population-based approaches to PA promotion. However, this requires appropriate funding programmes, complex study designs and evaluation methods.

Patient navigation for colorectal cancer screening in deprived areas: the COLONAV cluster randomized controlled trial

BACKGROUND

The objective of this study was to assess the effectiveness of a Patient Navigation Intervention targeting deprived patients for Colo-Rectal Cancer (CRC) screening participation.

METHODS

A cluster randomized controlled trial was conducted in 5 districts. Peer Lay Patient Navigators were recruited to operate in deprived areas. Eligible participants had to be between 50 and 74 years old, live in these deprived areas and receive an invitation to the nationally organized Colo-Rectal Cancer (CRC) screening during the study period. The theory-driven navigation intervention was deployed for 18 months. A population Health Intervention Research assessment method was used to assess effectiveness and context interaction. The primary criterion was screening participation at 12 months.

RESULTS

Twenty-four thousand two hundred eighty-one individuals were included inside 40 clusters. The increase in participation in the intervention group was estimated at 23%, (ORa = 1.23, CI95% [1.07-1.41], p = 0.003). For the subgroup of individuals who participated, the time delay to participating was reduced by 26% (ORa = 0.74, CI95% [0.57-0.96], p = 0.021). Main factors modulating the effect of the intervention were: closeness of navigator profiles to the targeted population, navigators' abilities to adapt their modus operandi, and facilitating attachment structure.

CONCLUSION

The ColoNav Intervention succeeded in demonstrating its effectiveness, for CRC screening. Patient Navigation should be disseminate with broader health promotion goals in order to achieve equity in health care.

TRIAL REGISTRATION

clinicaltrials.gov NCT02369757 24/02/2015.

Insights on the COVID-19 pandemic: Youth engagement through Photovoice

Youth engagement in disaster risk reduction is a growing area of research, practice and policy. The COVID-19 pandemic highlighted the need for improved opportunities for youth to participate and have their voices heard. Our Photovoice study explores experiences, perceptions, and insights of youth regarding the COVID-19 pandemic, while providing an opportunity for youth to participate in disaster risk reduction and contribute to resilient communities. We conducted nine focus groups from February 2019 to August 2020 with four teenaged youth; we analyzed the data using reflexive thematic analysis and hosted two virtual Photovoice exhibitions. Our results explore youth experiences of public health measures, impacts of the pandemic, pandemic magnification of social inequities, and the power of youth to create change. We provide six calls to action, focusing on a holistic, upstream, all-of-society approach for stakeholders to collaborate with youth in creating change on complex social justice issues to support COVID-19 recovery.

Realizing the potential of artificial intelligence in healthcare: Learning from intervention, innovation, implementation and improvement sciences

Introduction

Artificial intelligence (AI) is widely seen as critical for tackling fundamental challenges faced by health systems. However, research is scant on the factors that influence the implementation and routine use of AI in healthcare, how AI may interact with the context in which it is implemented, and how it can contribute to wider health system goals. We propose that AI development can benefit from knowledge generated in four scientific fields: intervention, innovation, implementation and improvement sciences.

Aim

The aim of this paper is to briefly describe the four fields and to identify potentially relevant knowledge from these fields that can be utilized for understanding and/or facilitating the use of AI in healthcare. The paper is based on the authors' experience and expertise in intervention, innovation, implementation, and improvement sciences, and a selective literature review.

Utilizing knowledge from the four fields

The four fields have generated a wealth of often-overlapping knowledge, some of which we propose has considerable relevance for understanding and/or facilitating the use of AI in healthcare.

Conclusion

Knowledge derived from intervention, innovation, implementation, and improvement sciences provides a head start for research on the use of AI in healthcare, yet the extent to which this knowledge can be repurposed in AI studies cannot be taken for granted. Thus, when taking advantage of insights in the four fields, it is important to also be explorative and use inductive research approaches to generate knowledge that can contribute toward realizing the potential of AI in healthcare.

Combatting malaria disease among gold miners: a qualitative research within the Malakit project

Malaria is endemic in French Guiana, in particular, where illegal gold mining activities take place. Gold miners travel from Brazil to remote camps in the Guiana forest to carry out mining activities, exposing themselves to the presumed contamination area. This article presents the results of a qualitative case study of the Malakit project, an intervention where health facilitators offer appropriate training and distribution of self-diagnosis and self-treatment kits to manage an episode of malaria at resting sites on the French Guiana borders. The objectives were: (i) Determine the contextual elements influencing the use of Malakit; (ii) Understand the way gold miners perceive Malakit; (iii) Identify the elements that are favorable and unfavorable to the use of Malakit; (iv4) Identify what can be improved in the project. The data were collected using three methods: on-site observation, semi-structured individual interviews (n = 26), and group interviews (n = 2). The results indicate that Malakit responds to the need for treatment and facilitates access to care. Gold miners say they trust the facilitators and receive accurate explanations, the kit is easy to use and carry, and explanations given are sufficient. Nonetheless, the results lead us to believe that contextual elements influence exposure to numerous risk factors and that malaria among gold miners working illegally in French Guiana is a question of social inequalities in health. Thus, malaria intervention practices such as Malakit cannot be carried out without considering the complexity generated by social inequalities in health.

Evaluation of a mobile mammography unit: concepts and randomized cluster trial protocol of a population health intervention research to reduce breast cancer screening inequalities

BACKGROUND

Breast cancer is the leading cancer in women in France both in incidence and mortality. Organized breast cancer screening (OBCS) has been implemented nationwide since 2004, but the participation rate remains low (48%) and inequalities in participation have been reported. Facilities such as mobile mammography units could be effective to increase participation in OBCS and reduce inequalities, especially areas underserved in screening. Our main objective is to evaluate the impact of a mobile unit and to establish how it could be used to tackle territorial inequalities in OBCS participation.

METHODS

A collaborative project will be conducted as a randomized controlled cluster trial in 2022-2024 in remote areas of four French departments. Small geographic areas were constructed by clustering women eligible to OBCS, according to distance to the nearest radiology centre, until an expected sample of eligible women was attained, as determined by logistic and financial constraints. Intervention areas were then selected by randomization in parallel groups. The main intervention is to propose an appointment at the mobile unit in addition to current OBCS in these remote areas according to the principle of proportionate universalism. A few weeks before the intervention, OBCS will be promoted with a specific information campaign and corresponding tools, applying the principle of multilevel, intersectoral and community empowerment to tackle inequalities.

DISCUSSION

This randomized controlled trial will provide a high level of evidence in assessing the effects of mobile unit on participation and inequalities. Contextual factors impacting the intervention will be a key focus in this evaluation. Quantitative analyses will be complemented by qualitative analyses to investigate the causal mechanisms affecting the effectiveness of the intervention and to establish how the findings can be applied at national level.

TRIAL REGISTRATION

Registered on ClinicalTrials.gov, December 21, 2021: NCT05164874 .

Development of a Framework for Scaling Up Community-Based Health Promotion: A Best Fit Framework Synthesis

Community-based health promotion with a focus on people with social disadvantages is essential to address persistently existing health inequities. However, achieving an impact on public health requires scaling up such approaches beyond manifold funded pilot projects. The aim of this qualitative review is to provide an overview of scaling-up frameworks in health promotion and to identify key components for scaling up community-based health promotion. First, we conducted a systematic search for scaling-up frameworks for health promotion in PubMed, CINAHL, Scopus, Web of Science, PsycInfo, and SportDiscus. Based on the included frameworks, we created an a priori framework. Second, we searched for primary research studies in the same databases that reported scaling-up processes of community-based health promotion. We coded the data using the a priori framework. From 80 articles, a total of 12 frameworks were eligible, and 5 were included for data extraction. The analysis yielded 10 a priori defined key components: “innovation characteristics”; “clarify and coordinate roles and responsibilities”; “build up skills, knowledge, and capacity”; “mobilize and sustain resources”; “initiate and maintain regular communication”; “plan, conduct, and apply assessment, monitoring, and evaluation”; “develop political commitment and advocacy”; “build and foster collaboration”; “encourage participation and ownership”; and “plan and follow strategic approaches”. We further identified 113 primary research studies; 10 were eligible. No new key components were found, but all a priori defined key components were supported by the studies. Ten key components for scaling up community-based health promotion represent the final framework. We further identified “encourage participation and ownership” as a crucial component regarding health equity.

Comment mener une recherche interventionnelle en psycho-oncologie ? Développement, évaluation et implémentation en pratique clinique

Cet article a pour objectif de décrire les méthodes pouvant être utilisées pour développer, évaluer et implémenter en pratique clinique de nouvelles interventions en psycho-oncologie. Pour cela, deux modèles de référence à l’international sont présentés afin d’apporter un éclairage scientifique aux différents acteurs impliqués dans ces recherches. Ce travail concerne cliniciens, chercheurs, acteurs institutionnels et patients ; cela afin de développer de nouveaux projets utilisant une rigueur méthodologique et d’intérêt pour améliorer les conditions des patients et des proches.

[Handling the first wave of the COVID-19: lessons learned from a French regional health agency]

The crisis linked to COVID-19 has shaken up the organization of healthcare in France, particularly its administration. However, little is known about the crisis management action by the regional health agencies (ARS), at the crisis' forefront.Based on an internal feedback exercise, thanks to a qualitative method dealing with cross-referencing documentary sources and semi-structured interviews (90), this monograph reports on the regional management of the COVID-19 crisis of an administrative organization over the first half of 2020 by analyzing the temporal and organizational dynamics of crisis management, the role of this public authority, the public health strategies mobilized to tackle the epidemic in interaction with regional and national actors.From January to June 2020, COVID-19 management has been characterized by the sudden disruption of the usual benchmarks and agendas of priorities and by an unusual installation over time. The agency found itself in a permanent adaptation-reaction situation, setting up an ad hoc crisis management organization. It positioned itself as a key player, interacting with various actors and relying upon a wide range of public policy tools to do so.This monograph highlights the management of a recent and unprecedented social and healthcare crisis which questions usual health management knowledge and skills, at national and regional levels in France. It demonstrates the interest of crisis feedback discussions, with both internal and heuristic objectives.

Quarantots, quarankids, and quaranteens: how research can contribute to mitigating the deleterious impacts of the COVID-19 pandemic on health behaviours and social inequalities while achieving sustainable change

The adoption and maintenance of healthy behaviours including age-appropriate amounts of physical activity, limited sedentary and screen time, and healthy eating are the foundations for youth development and thriving. In reviewing extant evidence, we observe that the COVID-19 pandemic has been associated with marked reductions in physical activity, increased sedentary and screen time, and increased food intake and unhealthy snacking. Deleterious effects in movement behaviours appear to be more pronounced among vulnerable groups and food insecurity has become more widespread. To contribute to mitigating these impacts, we advocate for strengthened evidence-based public health. Towards this end, ongoing surveillance should be intensified and augmented with additional indicators of social inequalities. More importantly, substantial efforts must be devoted to developing, implementing, and evaluating complex interventions aimed at equitably promoting recommended 24-hour movement behaviours and healthy eating guidelines in home, childcare, school, and neighbourhood settings.

Increased interaction and procedural flexibility favoured participation: Study across European cohorts of preterm born individuals

OBJECTIVE

To understand participation and attrition phenomena variability in European cohorts of individuals born preterm through in-depth exploration of the interplay of situational elements involved.

STUDY DESIGN AND SETTING

Multi-situated qualitative design, using focus groups, semi-structured interviews and collaborative visual methodology with a purposive sample of adults born preterm, parents and professionals (N=124) from eight cohorts in seven European countries.

RESULTS

Most cohort participants were motivated by altruism/solidarity and gratitude/sense of duty to reciprocate (only absent in adults aged 19-21), followed by expectation of direct benefit to one's health and knowledge amongst participating adults. Common deterrents were perceived failure in reciprocity as in insufficient/inadequate interaction and information sharing, and postal questionnaires. Combining multipurpose, flexible strategies for contact and assessment, reminders, face-to-face and shorter periodicity and not simply adding retention strategies or financial incentives favoured participation. Professionals' main challenges entailed resources, funding and, European societal changes related to communication and geopolitical environment.

CONCLUSION

Retention would benefit from tailoring inclusive strategies throughout the cohorts' life cycle and consistent promotion of reciprocal altruistic research goals. Investing in regular interaction, flexibility in procedures, participant involvement and return of results can help mitigate attrition as well as considering mothers as main facilitators to participating children and impaired adults.

Weekday bicycle traffic and crash rates during the COVID-19 pandemic

INTRODUCTION

One of the most consequential effects of the COVID-19 lockdowns was a dramatic reduction in travel during peak hours. Transportation modes also shifted-in particular, travel by car became more rare while bicycling saw a resurgence. Given that a typical year sees the most severe bicycle crashes in peak commuter traffic, the shift toward bicycle travel that occurred in 2020 will likely have been accompanied by unique changes in rider behavior (e.g., where and when they choose to ride) as well as the frequency and severity of vehicle-bicycle crashes.

METHODS

The current study compared weekday bicycle traffic and crashes in Arlington, VA from March-December 2020 with the same period from years prior, 2013-2019. Bicycle traffic data were obtained from 16 embedded counters placed throughout the study area, in both off-road trails and on-road bike lanes.

RESULTS

We found that 2020 midday traffic nearly doubled compared to the year before, increasing from an average of 68 riders per hour to 120 (+76%). By contrast, morning traffic fell from an average of 87 riders per hour to just 45 (-49%). Change in evening traffic depended on the location of the counters: more evening bicycles were counted on off-road, multi-use trails (+6%) but fewer on on-road lanes (-27%). The changes to 2020 bicycle traffic patterns were also associated with a 28% reduction in bicycle injury crash rate per counted cyclist.

CONCLUSION

The reduced crash risk observed in 2020 was likely due in part to the reduction of morning, on-road bicycle travel, which past research has found to be particularly dangerous for riders. Conversely, the availability of multi-use off-road trails seems to have been a protective factor against bicycle-motor vehicle crash risk in the face of greater bicycle travel volume.

Adaptation, Student Participation and Gradual Withdrawal by Researchers as Sustainability Strategies in the High School-Based Young and Active Intervention: School Coordinators' Perspectives

Ensuring the sustainability of school-based public health intervention activities remains a challenge. The Young and Active (Y&A) intervention used peer-led workshops to promote movement and strengthen students' sense of community in 16 Danish high schools. Peer mentors inspired first-year students to implement movement activities. To support sustainability, we applied a three-year stepwise implementation strategy using university students as peer mentors in year 1 and senior high school students in the following two years. This study explores the sustainability potential of Y&A, focusing on school coordinators' reflections on the intervention's fit to their schools and the student-driven approach, and we assess the three-step implementation strategy. The study is based on telephone interviews with coordinators (n = 7) from schools that participated in all three years and participant observations of four workshops (a total of approximately 250 participating students). Results were generated through an abductive analysis. Seven schools continued the intervention throughout the three years and adapted it to fit their priorities. The student-driven approach was perceived to be valuable, but few student-driven activities were initiated. Teacher support seemed crucial to support students in starting up activities and acting as peer mentors in workshops. The three-step implementation strategy proved valuable due to the peer-approach and the possibility of gradual adaptation. In future similar initiatives, it is important to address how the adequate staff support of students can be facilitated.

Is randomized trial design adapted to population health intervention research?

Randomized trials are frequently used in clinical research and considered the gold standard, but they are less common in population health intervention research (PHIR). We discuss issues that are sometimes shared and sometimes distinct between PHIR and clinical research, notably the randomization unit, design, standardization of the intervention, outcome(s) and ethical issues. In the end, both PHIR and clinical research share the common aim of assessing interventions, and randomized trials should be more widely used in PHIR, provided that how they are planned and conducted is adapted to the PHIR context.

Créer une communauté de pratique sur la recherche interventionnelle en santé mondiale

INTRODUCTION

In the French-speaking world, specifically in France, intervention research in global health has yet to be fully developed institutionally. The Institute of Research for Development (IRD) is one of the major public actors in global health research in France. Within this institute, researchers publish and communicate little on intervention research despite the fact that this is part of their daily work. This is why, for the past several years, the health and society department of the IRD has been working towards institutionalizing a network of IRD actors in population health intervention research (PHIR).

OBJECTIVE

The objective of this article is to analyze the needs of global health actors and elements that will allow for the construction of a community of practice in order to initiate an institutional anchoring of intervention research in global health through the mobilization of IRD actors.

METHOD

Qualitative research was carried out in 2017 including individual and group interviews. The results yielded several observations: 1) a definition of PHIR that differs according to the participants, 2) a need to strengthen formal and informal interactions to respond to the need for training and sharing experiences, to reinforce encounters and interpersonal bonds, to increase communication and visibility of implemented actions, 3) the participants&#8217; desire to evolve together to overcome certain inherent challenges of global health such as interdisciplinarity, North-South partnerships, or communication with different populations.

CONCLUSION

Conducting population health intervention research requires a certain amount of reflection on the ways in which research is done and implies significant changes in the daily lives and work of researchers. It is essential to have institutional support to develop this, such as a community of practice. However, the absence of this community of practice three years later illustrates the operational challenges of implementing such an initiative.

Revisiting the Innovation Strategy performance measurement process: insights from practice

Performance measurement (PM) aims to ensure transparency and effectiveness in public spending. More specifically, it provides a foundation that allows funders to determine whether an intervention has achieved its stated objective, thus improving understanding of what interventions should be funded in the future. Ideally, performance measurement should help us understand "what works, for whom, and in what context." Unfortunately, more often than not, performance reports are limited to a collection of indicators that make it difficult to answer this question. Based on our work with the Public Health Agency of Canada Innovation Strategy (PHAC-IS), we offer several recommendations to address this issue and support the performance measurement process, especially for complex interventions. We discuss the importance of contextualizing results to better understand impact and associating these results to a well-defined intervention. We also suggest using a validated tool to improve data collection and analysis and critically appraise the methods used to collect impact information. The integration of these key considerations will save time in data analysis and ensure funded recipients are not overburdened by the data collection process. Although this commentary is presented within the context of a complex multi-year population health funding program, we believe our approach can be applied to any performance management process and ultimately improve decisions such as whether an intervention should be continued, scaled up, or adapted to different contexts.

Core competencies for strategic grantmaking: lessons learned from the Innovation Strategy

SETTING

The Public Health Agency of Canada Innovation Strategy (PHAC-IS) was a national strategic funding program designed to test, deliver, scale up and evaluate complex population health interventions to determine how they bring about change, the context in which they worked best and for which populations.

INTERVENTION

The PHAC-IS experience provides an opportunity to reflect on the core competencies (skills, knowledge and attitudes) for strategic grantmakers to meet the goals of a national strategic funding program focused on population health intervention research.

OUTCOMES

A literature review, PHAC-IS content analysis, a document review and semi-structured interviews provided insight into a set of core competencies-organized by specific domains-that fostered a team focused on continuous improvement to apply learning and evidence from the funded projects to advance the goals of the strategic funding program.

IMPLICATIONS

Given its multiple complexities and based on the experience of the PHAC-IS team, it is proposed that funding programs aimed toward bringing change at individual and systems levels for population health promotion may draw upon a set of competencies incorporating the fields of strategic grantmaking; intervention research and evaluation; and public administration. The authors suggest that competency in the field of cultural safety is also pertinent to the successful management and leadership of public health programs, innovations and knowledge mobilization.

Theoretical conceptions of intervention research addressing cancer control issues

Population health intervention research (PHIR) involves the use of scientific methods to produce knowledge about policy and program interventions that operate within or outside of the health sector and have the potential to impact health at the population level. PHIR is a relatively new research field that has gained momentum internationally. When developing PHIR, it is important to have a program theory with the potential to increase intervention success by identifying underlying mechanisms, areas of failure and unintended outcomes. Since 2010, the French National Cancer Institute (Institut National du Cancer-INCa) has supported a national, competitive, dedicated call for proposals in PHIR to tackle cancer control issues. After 5 years of activity, specific analysis of the proposals submitted for funding and/or funded (n = 63) from descriptive and analytic perspectives was called for. Analysis of the data revealed diversity in terms of targeted populations, partnerships engaged and methodological approaches. Projects were more likely to be funded (n = 15) if presented with a robust methodological approach and diversity in methodology, and/or with research objectives at different levels of action. The analysis also revealed that researchers do not explicitly describe theoretical constructs underpinning their interventions to combat cancer. PHIR still needs improvement to better incorporate social, institutional and policy approaches to cancer control. Researchers should apply a theory-driven approach to distinguish between 'program failure' and 'theory failure'. Following up the funded projects will allow successes and failures to be evaluated with respect to the use (or non-use) of theory-driven approaches.

Promoting proactive bystander responses to racism and racial discrimination in primary schools: a mixed methods evaluation of the 'Speak Out Against Racism' program pilot

Background

Racism and racial discrimination are fundamental causes and determinants of health and health inequalities globally, with children and adolescents particularly vulnerable. Racial discrimination is a common stressor in the lives of many children and adolescents, with growing evidence of negative associations between racial discrimination and multiple domains of child and adolescent health. Addressing racism and racial discrimination must be core public health priorities, even more so among children and young people.

Schools are key settings in the lives of children and adolescents and become increasingly more important to identity formation. School communities, teachers and peers greatly influence children and adolescents’ beliefs about race and difference. Schools are therefore key sites for the delivery of population-based programs to reduce racism and promote proactive bystander behaviour and healthy resistance to racism among all children and adolescents as well as among the adults.

Methods

This study examines the feasibility and acceptability of the ‘Speak Out Against Racism (SOAR)’ program, a whole of school, multi-level, multi-strategy program that aimed to promote effective bystander responses to racism and racial discrimination in primary schools. A mixed-methods, quasi-experimental design was used. Students in Years 5 and 6 (10–12 years) across six schools completed surveys pre- and post- intervention (N = 645; 52% female; 6% Indigenous, 10% Middle Eastern, African, Latinx or Pacific Islander, 21% Asian, 52% Anglo/European). Focus groups with students and interviews with staff collected qualitative data about their experiences of the program and their views about the program’s perceived need, implementation, impacts and suggested improvements.

Results

Quantitative data showed student prosocial skills and teacher inter-racial climate improved in intervention schools compared to comparison schools. Qualitative data highlighted teacher attitudinal and behaviour change regarding racism, and student reduced interpersonal racial discrimination, improved peer prosocial norms, commitment to anti-racism, knowledge of proactive bystander responses and confidence and self-efficacy to intervene to address racism.

Conclusions

This study provides quantitative evidence of the potential of the SOAR program to improve the prosocial skills of students and their perceptions of the inter-racial school climate provided by their teachers. This program also provided qualitative evidence of the potential to promote teacher and student attitudinal and behavioural change. Further refinement and testing of the program in a large scale implementation trial is recommended.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11469-2.

The role and challenges of cluster randomised trials for global health

Evaluating whether an intervention works when trialled in groups of individuals can pose complex challenges for clinical research. Cluster randomised controlled trials involve the random allocation of groups or clusters of individuals to receive an intervention, and they are commonly used in global health research. In this paper, we describe the potential reasons for the increasing popularity of cluster trials in low-income and middle-income countries. We also draw on key areas of global health research for an assessment of common trial planning practices, and we address their methodological shortcomings and pitfalls. Lastly, we discuss alternative approaches for population-level intervention trials that could be useful for research undertaken in low-income and middle-income countries for situations in which the use of cluster randomisation might not be appropriate.

Which public health interventions are effective in reducing morbidity, mortality and health inequalities from infectious diseases amongst children in low- and middle-income countries (LMICs): An umbrella review

Despite significant progress in the last few decades, infectious diseases remain a major threat to child health in low- and middle-income countries (LMICs)—particularly amongst more disadvantaged groups. It is imperative to understand the best available evidence concerning which public health interventions reduce morbidity, mortality and health inequalities in children aged under five years. To address this gap, we carried out an umbrella review (a systematic reviews of reviews) to identify evidence on the effects of public health interventions (promotion, protection, prevention) on morbidity, mortality and/or health inequalities due to infectious diseases amongst children in LMICs. Ten databases were searched for records published between 2014–2021 alongside a manual search of gray literature. Articles were quality-assessed using the Assessment of Multiple Systematic Reviews tool (AMSTAR 2). A narrative synthesis was conducted. We identified 60 systematic reviews synthesizing 453 individual primary studies. A majority of the reviews reported on preventive interventions (n = 48), with a minority on promotion (n = 17) and almost no reviews covering health protection interventions (n = 2). Effective interventions for improving child health across the whole population, as well as the most disadvantaged included communication, education and social mobilization for specific preventive services or tools, such as immunization or bed nets. For all other interventions, the effects were either unclear, unknown or detrimental, either at the overall population level or regarding health inequalities. We found few reviews reporting health inequalities information and the quality of the evidence base was generally low. Our umbrella review identified some prevention interventions that might be useful in reducing under five mortality from infectious diseases in LMICs, particularly amongst the most disadvantaged groups.

Evaluations of public health interventions produced by health technology assessment agencies: A mapping review and analysis by type and evidence content

OBJECTIVES

Health technology assessments (HTAs) have been suggested as a strategy to bridge the evidence-to-policy gap in public health. It is unclear to what extent HTAs have been prepared to assist decisions to implement public health interventions (PHIs). We aimed to describe the experience of HTA agencies by mapping, classifying, and analyzing the evidence content of HTAs of PHIs.

METHODS

We systematically searched databases of 35 HTA agencies from 18 countries for evaluations of PHIs between 2008-2018. Interventions were classified using the International Classification of Health Interventions and the evidence content analysed with the INAHTA Product-Type-mark checklist.

RESULTS

Only 1010 (9%) of HTAs were on PHIs. 500 (50%) publications targeted Body Systems and Functions, 302 (30%) Health-related Behaviours, 137 (14%) the Environment and 44 (4%) Activities and Participation Domains. Out of 734 publications perused, few met the criteria of full-HTAs (71;10%) or mini-HTAs (110;15%). Most were rapid reviews (420;57%). 72% of all reports came from only 6 countries.

CONCLUSION

HTAs on PHIs were uncommon relative to clinical interventions. HTAs on population-based PHIs were less comprehensive in quality and rigor of the evidence. Countries with more resources and mature HTA-systems had done the most evaluations. Exploring the experiences of forerunners could help overcome barriers to evaluations of PHIs and exploit the full potential of HTAs to promote evidence-based public health.

Health research and knowledge translation for achieving the sustainable development goals: tackling the hurdles

We are far from reaching the sustainable development goals (SDGs) for health despite a wealth of novel insights in disease mechanisms and possible solutions. Why have we failed in knowledge translation and implementation? Starting from the case of cardiovascular diseases as one of the most prevalent non-communicable diseases, we examine barriers and hurdles, and perspectives for future health research. Health has multiple links with other SDGs. To accelerate the progress towards a healthy society, health research needs to take a broader view and become more cross-disciplinary and cross-sectoral. As one example, behavioural studies will underpin better prevention and treatment adherence. The next generation workforce in health and research needs an adapted education and training to implement more effective health approaches. As well, only effective dialogue and communication between researchers, practitioners, society and policymakers can lead to translation of evidence into policies, addressing the complexity of socioeconomic factors and commercial interests. Within Europe, health research needs a comprehensive vision and strategy that connects to achieving better health, as one of the interconnected SDGs.

Leçons d’un colloque : les enjeux épistémiques et politiques de la recherche interventionnelle en santé des populations

Ce texte explore deux grands enjeux, engageant à la fois des questions épistémiques et politiques qui nous semblent majeures pour l’implantation durable de la recherche interventionnelle en santé des populations (RISP) comme champ de recherche en santé. Nous interrogeons la notion de « données probantes » en montrant l’intérêt d’une appréhension à la fois exigeante et ouverte de cette catégorie dans le contexte d’expertises plurielles des RISP qui visent des modes de coordination plus fluides et étendus entre chercheurs, décideurs, intervenants et bénéficiaires des interventions dont les rapports sont potentiellement marqués par des inégalités épistémiques. Nous questionnons ensuite la nature de ces partenariats en invitant à une analyse plus approfondie de la dynamique des collaborations. Il semble en effet pertinent de considérer à la fois les séquences temporelles mais aussi les différentes échelles de contexte qui marquent les modes de coordination entre ces acteurs-experts du dispositif considéré.

Temporalités et appropriations des connaissances dans une démarche de recherche partenariale : les décalages à l’œuvre dans le projet GREENH-City

Cet article interroge les effets des modalités partenariales de recherche du projet GREENH-City associant des chercheur.e.s au Réseau français des Villes-Santé OMS (RfVS). Il propose une analyse de l’appropriation des connaissances scientifiques liées au projet par les villes membres du RfVS à partir du modèle de partage de connaissances. L’article montre qu’un décalage temporel peut s’opérer entre la production et l’utilisation des données liées au projet et interroge les modalités de partage de connaissances comme les pratiques de cette recherche interventionnelle.

COVID-19 street reallocation in mid-sized Canadian cities: socio-spatial equity patterns

Intervention

Street reallocation interventions in three Canadian mid-sized cities: Victoria (British Columbia), Kelowna (British Columbia), and Halifax (Nova Scotia) related to the COVID-19 pandemic.

Research question

What street reallocation interventions were implemented, and what were the socio-spatial equity patterns?

Methods

We collected data on street reallocations (interventions that expand street space for active transportation or physical distancing) from April 1 to August 15, 2020 from websites and media. For each city, we summarized length of street reallocations (km) and described implementation strategies and communications. We assessed socio-spatial patterning of interventions by comparing differences in where interventions were implemented by area-level mobility, accessibility, and socio-demographic characteristics.

Results

Two themes motivated street reallocations: supporting mobility, recreation, and physical distancing in populous areas, and bolstering COVID-19 recovery for businesses. The scale of responses ranged across cities, from Halifax adding an additional 20% distance to their bicycle network to Kelowna closing only one main street section. Interventions were located in downtown cores, areas with high population density, higher use of active transportation, and close proximity to essential destinations. With respect to socio-demographics, interventions tended to be implemented in areas with fewer children and areas with fewer visible minority populations. In Victoria, the interventions were in areas with lower income populations and higher proportions of Indigenous people.

Conclusion

In this early response phase, some cities acted swiftly even in the context of massive uncertainties. As cities move toward recovery and resilience, they should leverage early learnings as they act to create more permanent solutions that support safe and equitable mobility.

Recherche interventionnelle en santé des populations et lutte contre les inégalités sociales de santé : les partenariats « en train de se faire » de la Case de Santé de Toulouse, France

Une recherche interventionnelle en santé des populations permet d’analyser les modalités de lutte contre les inégalités sociales de santé que pratique la Case de Santé de Toulouse (France). Créée en 2006, selon une approche de santé communautaire, cette organisation associative comprend un centre de santé de premier recours et un pôle santé-droits visant à accroître les capacités, individuelles et collectives, d’agir des très nombreux usagers-patients démunis qu’elle accueille afin d’améliorer leur santé et leurs conditions de vie. Cette expérimentation à visée de changement social rend nécessaires des arrangements partenariaux qu’une étude menée par le bas, selon les principes de la sociologie de l’action organisée, autorise à porter au jour. Il apparaît alors que la difficulté réside dans l’articulation entre, d’une part, la création, l’entretien et le bon fonctionnement des partenariats institutionnels induits par le projet et son financement et, d’autre part, les désajustements de ces derniers provoqués par des modes d’intervention associatifs proposant un modèle alternatif en santé.

An economic analysis of the health-related benefits associated with bicycle infrastructure investment in three Canadian cities

Objectives

Decision-makers are increasingly requesting economic analyses on transportation-related interventions, but health is often excluded as a determinant of value. We assess the health-related economic impact of bicycle infrastructure investments in three Canadian cities (Victoria, Kelowna and Halifax), comparing a baseline reference year (2016) with the future infrastructure build-out (2020).

Methods

The World Health Organization’s Health Economic Assessment Tool (HEAT; version 4.2) was used to quantify the economic value of health benefits associated with increased bicycling, using a 10-year time horizon. Outputs comprise premature deaths prevented, carbon emissions avoided, and a benefit:cost ratio. For 2016–2020, we derived cost estimates for bicycle infrastructure investments (including verification from city partners) and modelled three scenarios for changes in bicycling mode share: ‘no change’, ‘moderate change’ (a 2% increase), and ‘major change’ (a 5% increase). Further sensitivity analyses (32 per city) examined how robust the moderate scenario findings were to variation in parameter inputs.

Results

Planned bicycle infrastructure investments between 2016 and 2020 ranged from $28–69 million (CAD; in 2016 prices). The moderate scenario benefit:cost ratios were between 1.7:1 (Victoria) and 2.1:1 (Halifax), with the benefit estimate incorporating 9–18 premature deaths prevented and a reduction of 87–142 thousand tonnes of carbon over the 10-year time horizon. The major scenario benefit:cost ratios were between 3.9:1 (Victoria) and 4.9:1 (Halifax), with 19–43 premature deaths prevented and 209–349 thousand tonnes of carbon averted. Sensitivity analyses showed the ratio estimates to be sensitive to the time horizon, investment cost and value of a statistical life inputs.

Conclusion

Within the assessment framework permitted by HEAT, the dollar value of health-related benefits exceeded the cost of planned infrastructure investments in bicycling in the three study cities. Depending on the decision problem, complementary analyses may be required to address broader questions relevant to decision makers in the public sector.