Explaining differential socioeconomic effects in population health interventions: development and application of a new tool to classify intervention agentic demand

BACKGROUND

The agentic demand of population health interventions (PHIs) might influence how interventions work. Highly agentic interventions (eg, information campaigns) rely on recipients noticing and responding to the intervention. Resources required for individuals to benefit from highly agentic interventions have a socioeconomical pattern, thus agentic demand might affect intervention effectiveness and equity. Systematic evidence exploring these associations is missing due to the absence of adequate tools to classify agentic demands. We aimed to develop such a tool and test its application.

METHODS

Our iterative development process involved: (1) systematic identification of diet and physical activity PHIs; (2) coding of intervention actors and actions; (3) data synthesis; (4) expert qualitative feedback; and (5) reliability assessment. We searched nine databases for articles published between Jan 1, 2010, and Aug 17, 2020. For all included articles, we coded the actors (people required to act within an intervention) and their actions (what they were required to do for the intervention to have its intended effects). We combined these codes for similar intervention types to develop overarching schematic flow chart diagrams used to identify concepts, and we organised these into a draft tool. After expert feedback, and we assessed inter-rater reliability of the final version. We applied the final tool in a proof-of-concept review, extracting studies from three existing equity-focused systematic reviews on tool category, overall intervention effect, and differential socioeconomic effects and visualised findings.

FINDINGS

We identified three concepts affecting agentic demands of intervention components: exposure, two levels (how recipients encounter the intervention); mechanism of action, five levels; and engagement, two levels (how recipients respond to the intervention). We then combined these concepts to form 20 categories that grouped together interventions with similar agentic demands. In the review, we applied the tool to 26 PHIs that included 163 components. Intervention components were concentrated in a small number of categories, and their categorisation was related to intervention equity but not to effectiveness.

INTERPRETATION

We present a novel tool to classify the agentic demand of PHIs and demonstrate its feasibility within a systematic review. Linking intervention types to their effect on inequalities enables these factors to be considered when designing or selecting interventions. Users of the tool can avoid implementing intervention types that are likely to widen inequalities or implement them alongside counter-strategies to minimise any adverse equity effects. Applying this tool within future research, policy, and practice to design, select, evaluate, and synthesise evidence from PHIs has the potential to advance our understanding of how interventions work and their effect on socioeconomic inequalities.

FUNDING

Public Health Policy Research Unit (PH-PRU), National Institute for Health and Care Research (NIHR) Policy Research Programme.

Adolescents' perspectives on soft drinks after the introduction of the UK Soft Drinks Industry Levy: A focus group study using reflexive thematic analysis

BACKGROUND

The UK Soft Drinks Industry Levy (SDIL), announced in March 2016 and implemented in April 2018, is a fiscal policy to incentivise reformulation of eligible soft drinks. We aimed to explore perceptions of sugar, sugary drinks and the SDIL among adolescents in the UK post-implementation.

METHODS

23 adolescents aged 11-14 years participated in four focus groups in 2018-2019. A semi-structured topic guide elicited relevant perspectives and included a group task to rank a selection of UK soft drinks based on their sugar content. Braun and Clarke's reflexive thematic analysis was used to undertake inductive analysis.

RESULTS

Four main themes were present: 1) Sweetened drinks are bad for you, but some are worse than others; 2) Awareness of the SDIL and ambivalence towards it 3) The influence of drinks marketing: value, pricing, and branding; 4) Openness to population-level interventions. Young people had knowledge of the health implications of excess sugar consumption, which did not always translate to their own consumption. Ambivalence and a mixed awareness surrounding the SDIL was also present. Marketing and parental and school restriction influenced their consumption patterns, as did taste, enjoyment and consuming drinks for functional purposes (e.g., to give them energy). Openness to future population-level interventions to limit consumption was also present.

CONCLUSIONS

Our findings suggest that adolescents are accepting of interventions that require little effort from young people in order to reduce their sugar consumption. Further education-based interventions are likely to be unhelpful, in contexts where adolescents understand the negative consequences of excess sugar and SSB consumption.

Stakeholder experiences of using online spatial data visualisation tools for local public health decision support: A qualitative study

The distribution of food outlets within towns and cities and the provision of active travel infrastructure have been associated with health behaviours that can contribute to obesity risk. Decision-makers describe a lack of local data and research evidence as a barrier to policy adoption to improve the public's health. Online spatial data visualisation tools created by researchers can help to bridge this gap. We explored stakeholder experiences of using such tools for decision-support, with a focus on facilitators and barriers to use. We conducted 16 qualitative interviews with Public Health, Planning and Transport Planning professionals, who had used two recently-developed tools. Participants described the importance of tools being open access; their use in “story-telling”, particularly to non-experts; and more broadly their use even when imperfect. They expressed that ‘robustness’ of underpinning data was important, however this was not easily defined. Participants employed personal heuristics, principally based on endorsement and developer credibility, to determine suitability for use. We present key learning points for future developers to maximise engagement and impact.

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We conducted 16 interviews with Planners, Transport planners & Public Health professionals in England.

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These stakeholders were users of online spatial data visualisation tools, who deemed them acceptable.

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Robustness of underpinning data was an important precursor to use but was not easily defined.

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Participants assessed developer endorsement and credibility as a marker of quality, which affected use.

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Barriers and facilitators to use should be considered by developers to increase engagement & impact.

Interventions to reduce the negative effects of alcohol consumption in older adults: a systematic review

BACKGROUND

Older individuals are consuming alcohol more frequently yet there is limited evidence on the effectiveness of current interventions. This systematic review aims to investigate interventions that target alcohol use in individuals aged 55 + .

METHODS

CINAHL, ERIC, MEDLINE, Science Direct, PsychInfo, SCOPUS, Web of Science and socINDEX were searched using terms devised from the PICO (Population, Intervention, Comparison and Outcome) tool. Studies using pharmaceutical interventions, or those that investigated comorbidities or the use of other substances were excluded. Peer reviewed empirical studies written in the English language that compared the outcomes of alcohol related interventions to standard care were included in this review. Studies were appraised and assessed for quality using the relevant Critical Appraisal Skills Programme checklist.

RESULTS

Seven papers were included in this review. Six were conducted in the United States of America and one in Denmark. The interventions were carried out in primary care centres and in community based groups. The studies included in this review showed varying levels of success. Participants showed improvements in at least one area of alcohol consumption or frequency of consumption however, these did not always reach significance.

CONCLUSION

Individuals in this age group appear to respond well to interventions aimed at reducing alcohol consumption. However, included studies had limitations, in particular many did not include a clear intervention description; leaving us unable to fully investigate the components required for success. Further research is needed on the effective components of alcohol interventions targeting older people.