Design Of Interventions Research Articles

Using in vivo intact structure for system-wide quantitative analysis of changes in proteins

Mass spectrometry-based methods can provide a global expression profile and structural readout of proteins in complex systems. Preserving the in vivo conformation of proteins in their innate state is challenging during proteomic experiments. Here, we introduce a whole animal in vivo protein footprinting method using perfusion of reagents to add dimethyl labels to exposed lysine residues on intact proteins which provides information about protein conformation. When this approach is used to measure dynamic structural changes during Alzheimer’s disease (AD) progression in a mouse model, we detect 433 proteins that undergo structural changes attributed to AD, independent of aging, across 7 tissues. We identify structural changes of co-expressed proteins and link the communities of these proteins to their biological functions. Our findings show that structural alterations of proteins precede changes in expression, thereby demonstrating the value of in vivo protein conformation measurement. Our method represents a strategy for untangling mechanisms of proteostasis dysfunction caused by protein misfolding. In vivo whole-animal footprinting should have broad applicability for discovering conformational changes in systemic diseases and for the design of therapeutic interventions.

Leveraging Systemic Contributors and Adaptations to Sharpen Interventions: The IMPActS Workshop

A common pattern among intervention implementations is that, in many cases, initial adoption and early signals of success are followed by dwindling participation, signals that the intervention is not achieving its goals, and abandonment of the intervention as it was originally conceived. The IMPActS Framework facilitates anticipation of misalignment among stakeholders during the design, pitch, implementation, and sustainability of a candidate intervention’s implementation. We adapted the IMPActS Framework to design an IMPActS Workshop to occur within the context of an ongoing research with a partner organization to develop their proactive performance monitoring and sustained adaptability management program. The IMPActS Workshop prospectively tests the implementation sustainability of candidate interventions and sharpened intervention design to improve the likelihood of sustainment across the organization. We report the motivation, methods, results, and lessons learned from this effort.

An Experimental Study of Virtual Space Design for Emotional Intervention in Autistic Children with Eye Movement Technology

In this thesis, virtual technology is combined to study the eye-tracking status of children with Autism Spectrum Disorder (ASD) towards their preference for space. Aided by virtual technology, experimental research is conducted to capture the Eye-tracking data of the subjects, so as to determine their degree of preference for space. A one-week experiment of virtual space preference is performed on ten children with ASD aged 8-14, and the experimental data are collected and organized by the researcher from two parts, namely, eye-tracking data validity and spatial validity. By comparing the experimental data processing, it is figured out that the subjects are more inclined to Space 2 in the experiment, and most of the subjects show a strong interest in Space 2. These results preliminarily indicate that eye-tracking data of children with ASD can serve as a basis for judging their preferences.

Does Socioeconomic Status Moderate the Association Between Screen Time, Mobile Phone Use, Social Networks, Messaging Applications, and Mental Health Among Adolescents?

The aim of this study was to examine the relationship between different screen time (ST)-related behaviors and mental health conditions such as depression, anxiety, and stress. In addition, this study aimed to determine the moderating role of socioeconomic status (SES). This was a cross-sectional study and included data from 620 adolescents, aged 12-17 years, from the Valle de Ricote, Region of Murcia, Spain. Mental health was assessed using the Depression, Anxiety, and Stress Scale (DASS-21). Overall ST, mobile phone use, social network use, and messaging application use were measured using validated questionnaires. SES was assessed using the Family Affluence Scale-III. The results indicated that overall ST was significantly associated with symptoms of depression at the mean SES (unstandardized beta coefficient [B] = 0.005, p = 0.023) and 1 standard deviation (SD) below the mean (B = 0.007, p = 0.011), and with stress only 1 SD below the mean (B = 0.006, p = 0.011). No significant associations were found for anxiety and stress across all socioeconomic levels. Mobile phone use exhibited a strong positive association with symptoms of depression (B = 0.891, p < 0.001), anxiety (B = 0.530, p = 0.014), and stress (B = 0.790, p < 0.001) at 1 SD below the mean SES. Similar patterns were observed for mean SES, albeit with slightly weaker associations. Conversely, social network use was positively associated with all three DASS-21 scales, particularly at 1 SD below the mean SES, with the strongest associations found for symptoms of depression (B = 0.327, p < 0.001), anxiety (B = 0.325, p < 0.001), and stress (B = 0.318, p < 0.001). Furthermore, messaging application use did not show significant associations with symptoms of depression, anxiety, or stress across any SES levels. In conclusion, social inequalities may influence the associations between various ST-related behavior and symptoms of depression, anxiety, and stress among adolescents. These findings may have implications for the design of effective interventions to improve symptoms of depression, anxiety, and stress in this population.

Behavioral Nudges to Encourage Appropriate Antimicrobial Use Among Health Professionals in Uganda

Background/Objectives: Antimicrobial resistance (AMR) is a global public health concern exacerbated by inappropriate antimicrobial prescribing practices, particularly in low-resource settings such as Uganda. The research aimed to develop a culturally sensitive behavioral intervention, leveraging a “nudge” strategy, to improve healthcare provider adherence to the 2016 Uganda Clinical Guidelines (UCG 2016) in five Ugandan hospitals. This intervention formed part of broader antimicrobial stewardship initiatives led by the United States Agency for International Development Medicines, Technologies, and Pharmaceutical Services Program. Methods: This study employed a mixed-methods approach, combining formative research and behavioral intervention. Guided by the Deloitte Behavioral Insights Framework, the research team conducted key informant interviews to identify prescribing barriers and motivators and developed three suitable behavioral interventions: perceived monitoring, ward leaderboards, and educational workshops. The study evaluated the interventions’ impact through point prevalence surveys (PPS), using the World Health Organization PPS methodology at three stages: pre-intervention, immediate post-intervention, and one-month post-intervention. Results: Key behavioral themes across individual, social, environmental, and organizational elements informed the intervention design and implementation. The behavioral intervention package increased antimicrobial prescription compliance with the UCG 2016 from 27% at baseline to 50% immediately post-intervention, though these effects diminished at one-month post-intervention. Conclusions: Our study addresses an existing gap in behavioral nudges-based operational research on antimicrobial prescribing in low- and middle-income countries. These results showed an immediate improvement in adherence to the UCG 2016 among healthcare providers in Ugandan hospitals, though the effect was attenuated at one-month follow-up. Despite the attenuation, behavior change presents a feasible, cost-effective, and sustainable approach to improving antimicrobial prescribing practices and addressing AMR.

Multi-Domain Environmental Quality of Indoor Mixed-Use Open Spaces and Insights into Healthy Living—A Quarantine Hotel Case Study

In the post-pandemic context, data-driven design interventions that can endow architectural spaces with mixed-use and open characteristics that are adaptable and environmentally resilient are increasingly important. Ubiquitous semi-public architecture, such as hotel buildings, plays a crucial role in public health emergencies. Many hotels adopt mixed-use and open room spatial layouts, integrating diverse daily functions into a single tiny space, fostering flexible utilization and micro-scale space sharing; however, these also introduce potential health risks. This study offers a comprehensive evaluation of the indoor environmental quality (IEQ) of a hotel room space and discusses feasible intervention strategies for healthier renovation and rehabilitation. Taking a hotel in Shenzhen as a case, a multi-domain environmental assessment was conducted during the COVID-19 quarantine period in the summer of 2022. The study examines the health risks inherent in the hotel’s guest room and the varying patterns of IEQ factors across the hotel’s domains, including volatile organic compound concentrations, physical environmental parameters, and heat stress indices. The results illustrate diverse change trends in the chemical, physical, and heat stress factors present in the tested quarantined hotel room space throughout a typical summer day. Although most of the examined environmental factors meet local and global standards, some problems draw attention. In particular, the PM2.5 concentration was generally observed to be above the World Health Organization (WHO) air quality guideline (AQG) standards, and the interior lighting did not meet required standards most of the time. Moreover, correlation and multiple regression analyses uncover significant influence by physical environmental conditions on the concentrations of chemical pollutants in the hotel room. The study preliminarily identifies that higher relative humidity could lead to a lower concentration of CO2 while a higher PM2.5 concentration. Wet bulb globe temperature (WBGT) was observed to positively affect CO2 concentration. Further, the results suggest that even with relatively rigorous initial adjustment and re-renovation, multi-domain environmental quality in air-conditioned quarantine hotel rooms should be monitored and ameliorated from time to time. Overall, this study offers a scientific foundation for healthier upgrades of existing hotel buildings as well as provides insights into achieving environmental resilience in newly constructed hotel buildings for the post-pandemic era.

Design-Driven Sustainable Poverty Alleviation: A Case Study of Precise Identification and Resource Optimization in Rural Areas

China’s transition from precise poverty alleviation to rural revitalization represents a critical development stage. This study aims to explore how a design-driven approach can achieve sustainable poverty alleviation and development by addressing challenges such as relative poverty, imprecise targeting, insufficient endogenous motivation, and the risk of returning to poverty. Understanding the inherent relationship between poverty alleviation and sustainable development is crucial for deepening precise poverty alleviation strategies and promoting rural revitalization. This study employs the TOPSIS method to accurately identify target groups for poverty eradication and select optimal poverty alleviation strategies based on multidimensional poverty governance criteria. A case study of Village M in Guangdong Province is conducted, where questionnaire surveys and sampling methods are used to establish the TOPSIS model for precise identification and the design of targeted interventions to support poverty eradication. Both qualitative and quantitative approaches are applied to ensure comprehensive analysis and results. The findings indicate that targeted design interventions, particularly those leveraging local bamboo resources, led to a significant increase in the annual per capita income of identified families by approximately 176.32%, from RMB 3146 (approximately USD 431) to RMB 8700 (approximately USD 1192). This design-driven approach effectively stimulated the innovation consciousness of impoverished farmers, demonstrating the critical role of sustainable design strategies in optimally matching resources to the needs of the poor. This study contributes to the development of a novel framework integrating design methodologies with poverty alleviation strategies, providing empirical evidence on the effectiveness of these interventions. The findings highlight the importance of user-centered design in promoting sustainable development and underscore the need to incorporate design-driven methodologies in poverty alleviation efforts.

A process evaluation of a LifeLab Dublin; an interactive health literacy intervention

Abstract The argument for targeting adolescent health has been made strongly, with poor lifestyle behaviours often emerging during this life stage. Furthermore, there is consistent evidence of a widening socioeconomic gap in health indicators. Developing health literacy (HL) in youth populations to improve lifelong health behaviours has garnered increased interest in recent years. This process evaluation examines the acceptability, fidelity and dose delivered of the pilot of LifeLab Dublin: a nine-week, school-based HL intervention for low socioeconomic adolescents. The intervention, which comprised of two out-of-school, interactive HL experiences in conjunction with seven school-based lessons, took place between September and December in 2021 and involved students aged 11 - 13. The health issues targeted were previously identified by the teachers and students of the target population, and the learning activities within the out-of-school experiences were co-designed by adolescents of a similar demographic. Overall, the intervention was perceived positively by the students and teachers, particularly the two interactive out-of-school experiences. The teachers, however, highlighted issues with the volume and content of the school-based lessons, resulting in a reduced number of lessons being delivered. The fidelity of the two LifeLab experiences was high, demonstrating that the students engaged well with the learning activities and that the experience aligned with LifeLab’s core principles and underpinning theoretical constructs. The findings from this study highlight the value in implementing experiential style learning in school-based HL education and the benefit of involving participants in the design of intervention. The evaluation provided valuable insight into the refinements required to enhance the efficacy of the intervention, as well as providing an evidence-base to inform future school-based HL interventions for low socioeconomic adolescents. Key messages • The benefit of adopting experiential style health literacy education with young people. • The benefit of including young people in the design of a health literacy intervention.

Effectiveness of Digital Education on Human Papillomavirus Knowledge, Vaccination Intent and Completion Rates in Adolescents and Young Adults: A Meta-Analysis.

To examine the effects of digital educational intervention on HPV knowledge, vaccination intent and completion rates among adolescents and young adults. A systematic review and meta-analysis. The study followed PRISMA guidelines. Studies included randomised controlled trials assessing digital HPV educational interventions on individuals aged 9-26 years. Odds ratios (ORs), confidence intervals (CIs) and standardised mean differences (SMDs) were calculated and analysed with fixed- and random-effects models, depending on the degree of heterogeneity. Seven databases (Medline, PubMed, CINAHL, Cochrane Library, Web of Science, EMBASE and ASC) were searched from inception through April 9, 2024. Twelve studies enrolled 4925 participants were included. Six studies demonstrated that the intervention group significantly had higher HPV knowledge compared to the control group. Five studies reported a significant improvement on vaccination intent and vaccine completion rate. Subgroup analysis of the completion rates indicated that male participants demonstrated significantly greater vaccine competed rates. A tailored educational intervention was likely to effectively enhance HPV vaccine completion rates. Our findings confirmed that digital education was beneficial in enhancing adolescents and young adults' HPV knowledge, vaccination intention and vaccine completion rates. The tailored education might be considered prioritised in the design of interventions, while also considering the impact of gender on digital education. Digital interventions for HPV vaccinations require at least 7 months of follow-up, highlighting the vital role of tailored education for high-risk groups in designing effective interventions. The efficacy of digital interventions for HPV vaccination may differ across genders. There was no direct patient or public contribution, as this is a review of previous research. CRD-42023406919.

5.A. Scientific session: From theory to action - Applying the Medical Research Council framework on complex interventions

Abstract The reasons for the workshop: Globally, public health problems such as obesity, poor mental health, and social inequality in health are on the rise. Tackling these significant challenges requires well-designed complex interventions. Interventions rarely follow linear sequences from intervention design toward large-scale implementation. Rather, they take non-linear trajectories by constantly adapting the intervention design according to the context. This thinking is outlined in the British Medical Research Council’s (MRC) 2021 framework for developing and evaluating complex interventions. This workshop encompasses four case projects, each corresponding to one of the four phases in the framework: i) development, ii) feasibility, iii) implementation, and iv) evaluation. However, recognising the deliberately generic nature of this framework, our workshop also encompasses co-creation, process evaluation, and implementation theories and methodology. Combining these methodologies presents challenges that necessitate clear argumentation and critical reflection. In this workshop, we will share the challenges encountered when applying the MRC 2021 framework and hopefully inspire future innovative opportunities in intervention research. Specifically, this workshop aims to: i) exchange challenges from intervention research methods and theories drawing on presenters’ experiences across four public health case projects. Presenters will critically reflect on the key concepts from the MRC framework including context, programme theory, engagement of stakeholders, uncertainties, and refinement of interventions. ii) discuss opportunities for future complex intervention research and outline best practices for using the MRC 2021 framework for complex interventions. The added value of organising the workshop: The audience attending this workshop will reflect on multiple on-the-ground experiences of applying methodology and principles from the MRC 2021 framework as well as methods and theories relevant to intervention research: co-creation, qualitative (e.g., ethnography, interviews) and quantitative (e.g. experimental, observational) methods applied to all core phases of complex interventions. At the end of the workshop, the audience will be invited to participate in an open, plenary discussion facilitated by the workshop’s chairs: two international experts on complex interventions, Reader Rhiannon Evans and Prof. Helle Terkildsen Maindal. The experts will encourage the presenters and audience to reflect critically on the case projects and ways forward for complex intervention research. Coherence between the presentations in relation to the workshop topic: The four case projects are guided by the MRC 2021 framework for complex interventions and involve public health interventions at the individual, interpersonal, and structural levels in Denmark and Canada. Key messages • Tackling public health challenges demands innovative and well-designed complex interventions combining research traditions, principles from health promotion, and cutting-edge best-practice frameworks. • The symposium will create a platform for cross-disciplinary knowledge exchange through case projects and expert-led joint discussions on how to apply the MRC 2021 framework for complex interventions.

9.N. Practice session: From Data to Action – Joining forces to close the inequity gap in adolescent health

Abstract Persistent adolescent health inequalities exist in Europe, necessitating interventions that address both individual and societal factors, especially those pertinent to youths in unfavourable contexts. Collaborative efforts involving cross-sectoral partnerships and adolescent engagement are crucial in identifying and mitigating these disparities. Three case studies exemplify this approach. Case study 1: Effective intervention development hinges upon the translation of epidemiological insights into tangible actions. Heiko Schmengler will discuss how individual and contextual-level data is made actionable for the development of ePro-schools, an e-health intervention to promote healthy dietary habits and physical activity amongst adolescents in socially disadvantaged settings. ePro-schools brings together stakeholders from academia, the health sector, the education system, and local communities. This collaborative approach ensures that the intervention is not only grounded in solid scientific evidence but also fits the specific cultural, social, and economic contexts of the adolescents it aims to serve. Case study 2: Adolescents are not passive consumers of interventions, but active agents who frequently understand best what they need to improve regarding their health. Lourdes Cantarero Arevalo will share innovative methodologies and best practices for involving adolescents in data collection, intervention design, and policy development processes with the final aim to empower the voices of adolescents in vulnerable situations while addressing problems that are relevant for them. Case study 3: Filipa Alves da Costa will draw attention to the health concerns of adolescents resulting from incarceration. This talk will outline the development of a policy brief derived from UN global study data, which highlights the importance of cross-sectoral collaboration in developing actions to safeguard access to high quality healthcare for adolescents within the criminal justice system. A cross-sectoral approach is critical given that criminal justice systems typically fall outside the direct oversight of health ministries. The goal is to encourage policymakers, practitioners, and advocates to consider inter-sectoral strategies to address the complex health challenges these adolescents face. Following the presentations, we will facilitate a dynamic discussion with the audience, encouraging an exchange of ideas on strategies to address adolescent health inequalities from a multilevel perspective. This discussion aims to draw on the collective expertise of participants from diverse backgrounds, including practitioners, researchers, and policymakers. This dialogue aims to identify common barriers and opportunities, fostering a collaborative approach to tackling inequalities. The goal is to emerge from the workshop with a richer understanding of effective strategies that can be leveraged to close the gap in adolescent health across Europe. Key messages • Health inequalities among adolescents must be tackled collaboratively across different sectors and with participation of adolescents. • Participants will gain valuable insights on innovative solutions and effective methodologies from the case studies to inform their own efforts in addressing adolescent health inequalities.

3.O. Scientific session: Migrant labour exploitation and health: How can research foster protection of migrant workers?

Abstract Migrant workers sustain essential industries such as the food supply chain, construction, and domestic and care work. They tend to perform onerous and risk-laden tasks at low pay without employment or health protections, and often under exploitative terms (e.g., debt bonding, piecework). Current evidence on associations between migration, employment terms and conditions, and health indicates profound inequities in work-related health outcomes for migrant workers. Although the COVID-19 pandemic highlighted these disparities and their potential social and public health implications, migrant workers continue to be overlooked by public health scholars and policymakers. Supranational regulations (such as EU directives) and national policies rarely consider migrants in their role as workers, and little research is dedicated to questions at the intersection of migration, employment, and health. The invisibility of migrant workers is also a matter of disciplinary and sectoral silos, with different aspects of migrant labour regulated separately by Ministries of Immigration, Labour, Agriculture, Health, and others. These silos create incompatible, context-contingent definitions, terminologies, and administrative categorizations, leading to inconsistent data collection and data gaps which, in turn, translate into policy blind spots. Data that are comparable across contexts and that refer to migration, employment/work and health are generally scarce. For some sectors and contexts, virtually no data exist; e.g., for migrant workers in agriculture, construction, and domestic work, and for migrant workers in low- and middle-income countries. There is barely any evidence about interventions to improve the structures that dictate migrant workers’ employment conditions or obligations of employers. Given the limited participatory research with migrant workers, we have a very poor understanding of their views and viable intervention options, and migrant workers’ voices thus also remain absent from policymaking. This workshop aims to contribute to greater visibility of - and ultimately action on - migrant labour exploitation in research and policy. To this end, it will map current challenges and shortcomings in generating evidence on the links between migration, work/employment, and health; and it will suggest ways to improve research and interventions to address migrant workers’ health, based on the speakers’ experience in developing intervention-focused evidence in different contexts. The workshop will conclude with an open discussion to identify further relevant questions and elaborate steps towards better research and greater protections for mobile worker populations. Key messages • Harm from exploitative working conditions among migrant workers is substantial, yet data collection methods and intervention designs are limited. • For public health research to effectively help protect the health and rights of migrant workers, it is essential to share methods and insights across disciplines to drive research for action.

Design and implementation of interventions to improve unplanned pregnancy experiences: a mixed-methods study protocol with an interventional design

Design and implementation of interventions to improve unplanned pregnancy experiences: a mixed-methods study protocol with an interventional design

Co-creation of migrant health interventions in Portugal: Insights from the VO(I)CES project

Abstract Background International migration is increasing both globally and in Europe, highlighting the need for responsive interventions that cater to the diverse needs and strengths of migrants. Although genuine involvement of stakeholders in the design and implementation of interventions is vital to enhance their relevance, responsiveness, and ownership, co-created migrant health interventions remain limited. This study aims to address this gap by collaboratively developing health literacy interventions with meaningful involvement from migrants and professionals from both the social and health sectors. Methods As part of the VO(I)CES project, twelve idea-generation workshops were conducted in Portugal, applying the Ophelia (Optimising Health Literacy and Access) process, engaging over 70 stakeholders (migrants, social and healthcare professionals). To guide discussions, these workshops used case vignettes developed from 16 health literacy profiles that were identified in a previous study among 1,126 migrants. The discussions aimed at eliciting detailed insights into the potential actions that are responsive to migrants’ challenges. Results Several key interventions were identified by the stakeholders, including the enhancement of cultural and linguistic training for healthcare providers, the use of community health agents/mediators to improve service delivery and community engagement, and the creation and dissemination of multilingual, multi-format health information materials. Specific interventions for groups experiencing increased vulnerabilities such as pregnant women were also proposed, alongside suggestions for creating citizen spaces and improving digital skills among healthcare staff. Conclusions The co-creation approach facilitated the development of tailored context-specific interventions that are anticipated to enhance health literacy, improve healthcare accessibility, and promote health equity for migrants. Key messages • Ideas Generation Workshops provide a platform for a wide range of groups to have their say and know their voice is being heard. • Co-creation tailors interventions to diverse needs, avoiding a one-size-fits-all approach.

3.B. Scientific session: Why do we need clear understanding of digital public health interventions?

Abstract The rapid proliferation of digital technologies in health and public health has led to various terms and concepts, often used interchangeably or inconsistently. This ambiguity hampers communication, complicates research efforts, and undermines the effectiveness and adaptation of interventions. Without a clear understanding of such concepts, stakeholders face difficulties using, evaluating, and regulating digital public health (DiPH) initiatives. Thus, there is an urgent need to establish a common language - across academic disciplines and in the science-to-practice/policy transfer - to foster collaboration, ensure accountability, and maximize the impact of DiPH interventions globally. This workshop highlights the need for a cross-sectoral understanding of terms and concepts related to DiPH interventions. For this, we identify effective strategies for engaging diverse populations in DiPH interventions, considering accessibility, usability, and cultural sensitivity. Additionally, we present how a more precise understanding of these concepts will impact positive population-health outcomes of DiPH interventions. Finally, we discuss DiPH terminology enhancement regarding data protection, highlighting the boundaries of digital interventions within and outside health policies and public health systems, given the diversity of the legal frameworks applicable in either case. We aim to facilitate interdisciplinary collaboration and knowledge exchange, fostering a shared understanding of terminology and best practices. This will advance DiPH by promoting clarity, rigor, and transparency in research and practice. Shared understandings of key concepts will eventually enhance the design, implementation, and evaluation of DiPH interventions, leading to improved population health outcomes and informing evidence-based policymaking and regulatory frameworks. The workshop consists of four presentations and a 20-minute panel discussion on increasing understanding dissemination. The first talk highlights multi-stakeholder perspectives (including researchers, technicians, health and medical practitioners, and the general public) on the ever-changing terminology of DiPH concepts. The second presentation showcases how these varying perceptions influence the academic representation of DiPH interventions and that interventions - although summarized under the same terminology - drastically vary concerning their use case and characteristics. The third speaker will discuss why a clearer understanding of these terms is needed to increase engagement with DiPH interventions for positive population health outcomes and identify effective DiPH interventions based on evidence. The last talk explains why unclear terminology or standards threaten populations and result in over- or under-regulation of DiPH interventions. Overall, this workshop catalyzes advancing the DiPH agenda in Europe, empowering stakeholders to harness the full potential of technology for promoting population health. Key messages • When we create technical terms, it is our professional approach, characterized by our academic background. It does not necessarily transfer to other domains or the general population. • Digital Public Health can transform global healthcare. However clear &amp; harmonized terminologies are crucial for comparing evolving technologies &amp; paving the way for transformative digital healthcare.

A Multi-Modal Approach for A Healthier Weight and More Active Lifestyle

Abstract Background Obesity and overweight has been increasing globally and in the UK over the last few years, bringing along a wide array of challenges in health and wellbeing. Not only do they take a heavy toll on those affected, but obesity and overweight-related ill-health is costing the UK National Health Service £6.1 with projected costs to run up to £9.7 billion in 2050. This project aimed to apply artificial intelligence to identify the predictive indicators for obesity and co-create an intervention with public health practitioners and stakeholders. Methods Using health and wellbeing public health population data from the 2015, 2018 and 2022 from a city in the East Midlands, we applied artificial intelligence that uses machine learning techniques to discover insights, find hidden patterns and discover relationships in the data about engaging in physical activity and a healthy diet. The data on dietary choices and physical activity preferences were further analysed using advanced machine learning techniques. Results The outcomes from our machine learning process revealed patterns of physical activity engagement and diet from specific locations, along with a range of demographic variables that influence individuals’ patterns of physical ability and dietary practices. These findings, which will be presented in detail, have been integrated into a comprehensive city map. This map not only showcases opportunities for engaging in a healthy lifestyle but also aids in prioritising interventions in areas of greatest need. Conclusions The AI technology we employed allowed us to parameterise and generalise our findings with the possibility of scaling up the machine learning approach to other similar datasets. The findings facilitated the development of bespoke training for public health officers working with underserved communities, further demonstrating the impact of applying AI to inform the design of public health interventions. Key messages • Applying Artificial Intelligence to public health data has the potential to inform the development of effective interventions and increase precision. • Using AI in public health data can generate new insights into population health and well-being and inform public health policy.

11.D. Scientific session: Participatory approaches and co-creation in complex interventions to reduce inequity in health

Abstract Health disparities are linked to social inequalities, necessitating health researchers to address the health gaps that exist between different social groups, particularly in the realm of health interventions. This workshop delves into the significance of co-creation processes and participatory approaches in complex health interventions to reduce social inequities in health outcomes. Through empirical cases illustrating co-creation processes in intervention research, the workshop aims to enlighten the audience on the continuum of participatory approaches. The MRC/NIH framework of complex interventions highlights the importance of engagement with relevant stakeholders throughout the research phases to enhance the likelihood of developing or identifying interventions that can positively impact health outcomes. However, the extent and nature of stakeholder involvement may vary depending on the specific context and stage of the research. While stakeholder involvement has been a longstanding focus, the concept of co-creation, where stakeholders actively participate in the entire process of intervention development, implementation, and evaluation, has emerged more recently. This shift from creating interventions for the target population to collaborating with them in the intervention’s creation has led to the emergence of more inclusive health interventions that are contextually relevant and tailored to the local settings where they are intended to create change. Yet, introducing participatory approaches in intervention research may raise new questions about decision-making and power dynamics. While interventions led solely by experts and researchers may overlook the empowerment and capacity-building potential among stakeholders and intervention sites, co-creation processes have the capacity to empower stakeholders and address health inequities effectively. However, challenges persist in ensuring equal collaboration between researchers and participants, especially in disadvantaged groups. This workshop aims to prompt reflection on ethical issues arising from traditional health intervention approaches and approaches to ensure participants’ ownership of interventions when they are adapted in new contexts. Moreover, this workshop will discuss the design of participatory interventions: What methods can we use to co-create? What stakeholders to involve? At what stages of the intervention should co-creation occur? The workshop program begins with an introductory presentation of participatory approaches and co-creation in health intervention research, with examples from a school-based intervention. Next, three empirical cases of co-creation processes introduced in interventions in different contexts are presented. Finally, the audience is invited to a take part in a discussion focusing on how participatory approaches among disadvantaged populations can potentially contribute to reduced social inequity in health. Key messages • The involvement of stakeholders in the development, implementation and evaluation of health interventions can take many forms, and what is meaningful for the specific context needs to be considered. • Co-creation approaches in health interventions empower participants and address unequal power dynamics between those who deliver and those who receive health interventions.

OHL-ALL: a theory-informed and practice-orientated organizational health literacy equity approach

Abstract Background The OHL-ALL initiative was launched by Steno Diabetes Center Sjaelland and the Department of Public Health, Aarhus University and the OHL-ALL scientific group in cooperation with EUPHA-HL and M-POHL in November 2023. The OHL-ALL (Organizational Health Literacy for All) approach offers an opportunity to rethink and develop organizational health literacy (OHL) with an explicit normative basis for equity. The goal is to establish a theory-informed, practice-oriented, multifaceted, and implementable approach. In the OHL-ALL approach, we define equity as the normative anchor, and we suggest using the Capabilities Approach to embed improved equity in design, implementation, and evaluation of interventions. Methods The process of developing the OHL-ALL was guided by applying core ideas from Amartya Sen’s Capability Approach. Five intervention principles were derived from the existing organizational health literacy literature: organizational change, workforce responsiveness, user involvement and person-centered care, access and navigation and internal and external partnerships. After an international expert working group meeting in November 2023, we formed four work packages. Results At the EPH conference, a status of the progress in the four work packages will be presented: WP1. OHL-ALL Framework development based on capability, fairness, and equity. WP2. Initiatives and testing of the OHL-ALL framework. WP3. Evaluation of OHL-ALL (i) the capability approach and (ii) outcome domains. WP4. Plans for the future, including advocacy and outreach - ideally via a conference in 2026. Conclusions The OHL-ALL project presents a novel approach to advancing equity in health by improving users’ capabilities. Based on an explicit normative framework it is expected to offer theoretical and practical guidance for organizations that chose to implement a health literacy approach.

A systematic review of cancer overdiagnosis in multimorbid patients

Abstract Background Cancer screening looks for early signs of cancer in people who do not currently exhibit symptoms. However, screening can also identify abnormalities that do not progress to produce symptoms or death. This could include the identification of tumours, which stop growing or grow very slowly; patients usually die with them rather than from them. We systematically reviewed the literature to investigate the harmful consequences of cancer overdiagnosis in multi-morbid patients. Methods We followed the PRISMA reporting guidelines and registered the review with PROSPERO (CRD42024475175). A Population, Intervention, Comparator, Outcome and Study design (PICOS) framework was used as an organising framework. Peer-reviewed studies were included except case series, case report reviews and conference abstracts. Four large databases (Medline, Embase, APA Psych INFO and Scopus) were searched in Nov23 using appropriate keywords grouped into categories: multimorbidity, overdiagnosis, patient harms, cancer screening. Titles were screened according to the eligibility criteria and their quality assessed. Studies needed to have investigated the extent of harm caused by overdiagnosis (e.g., overtreatment). Results A total of 200 articles were retrieved, with seven meeting our inclusion criteria. All included studies were based in the US. Breast and prostate cancer overdiagnosis was reported to be 15% higher in multimorbid populations compared to the average-risk population. Multimorbid individuals were more vulnerable to the harms of cancer overdiagnosis, with psychological, physical and financial harms reported. Conclusions These findings contribute valuable insights into the intricate interplay between comorbidities, cancer overdiagnosis, and associated harms. Radical treatment interventions in multi-morbid patients can carry greater risk of complications. Current screening guidelines only address average-risk populations; future guidelines need to reflect these findings. Key messages • Cancer overdiagnosis was found to be higher in multimorbid populations compared to the average-risk population. • Multimorbid individuals are also more vulnerable to the harms of cancer overdiagnosis.

Improving physical healthcare for people experiencing mental illness: The COMITMENT project

Abstract Background People experiencing mental illness (PMI) face significant challenges in accessing and using somatic healthcare services, reducing their overall life expectancy by up to 20 years. The COMITMENT project aimed to identify barriers and facilitators in accessing and using somatic healthcare services for PMI and co-design strategies that could address existing challenges. Methods This study employed a qualitative participatory approach, involving a “trialogic” steering group composed of a person with lived experience of mental illness, a family member and caregiver of PMI, as well as a health professional. Two co-design workshops were conducted with members of each trialogic group, based on “World Café” methodology, facilitating open discussion between and among the three perspectives. Data was gathered through participant observations and systematically collecting participants’ workshop contributions, and analyzed thematically. Results Overall, 52 people participated in the two workshops. Findings identified six overarching themes regarding challenges in somatic healthcare access/use for PMI: (1) accessibility and facility design, (2) support and bureaucracy, (3) awareness among healthcare professionals, (4) societal awareness, (5) structural diversity of services, and (6) lack of networking abilities. Notable insights include inclusivity design requirements for healthcare facilities and the importance of integrating lived experiences of PMI into the training of healthcare professionals to reduce stigma. Conclusions This study underscores the critical need for systemic changes to improve somatic care for PMI. It suggests that greater awareness among healthcare professionals, coupled with more inclusive service design and enhanced networking abilities, could substantially improve the quality of healthcare for PMI. The COMITMENT project provides robust and co-designed results for social, systemic, and political reforms aimed at reducing healthcare inequity. Key messages • This study shows how direct involvement of relevant stakeholders improves the design of interventions that truly meet the needs of people with mental illness regarding somatic healthcare services. • To improve healthcare access and treatment for people experiencing mental illness, systemic social, design, educational, and political changes and adaptations are required.