Population Health Interventions Research Articles

Shared decision making for patients with kidney failure to improve end-of-life care: Development of the DESIRE intervention.

To describe the development of a shared decision making intervention for planning end-of-life care for patients with kidney failure, their relatives and health professionals in kidney services. End-of-life care conversations within standard disease management consultations are challenging for patients with kidney failure, their relatives and health professionals. End-of-life care planning is about making difficult decisions in advance, which is why health professionals need shared decision making skills to be able to initiate end-of-life conversations. Health professionals report needing more skills to raise the issue of end-of-life care options within consultations and patients want to be able to discuss issues important to them about future care plans. The development design was guided by the UK Medical Research Council's framework and a user-centred approach was applied. Four workshops were conducted with end users. The Template for Intervention Description and Replication for Population Health and Policy interventions was used to shape which questions needed to be answered through the workshops and to present the intervention. The International Patient Decision Aid Standards (IPDAS) criteria set the standards to be achieved. Areas considered significant to a shared decision making intervention were training of health professionals, conversations about end-of-life care, planning and evaluation of the decisions, reporting decisions in health records and repetition of consultation. The development process went through 14 iterations. An intervention named DESIRE was developed that comprises: (1) a training programme for health professionals; (2) shared decision making conversations; and (3) a patient decision aid. The intervention met 30 out of 33 IPDAS criteria. DESIRE is intended to support shared decision making about planning end-of-life care among patients with kidney failure, their relatives and health professionals. The study provides important tools for the stakeholders engaged that can be used within different models of care. What problem did the study address? International guidelines recommend health professionals involve patients with kidney failure in making decisions about end-of-life care, but there is variation in how this is implemented within and across kidney services. Furthermore, patients, relatives and health professionals find it challenging to initiate conversations about end-of-life care. What were the main findings? The study resulted in the development of a complex intervention, called DESIRE, about shared decision making and planning end-of-life care for patients with kidney failure, their relatives and health professionals in kidney services, including a training programme for health professionals, shared decision making conversations and a patient decision aid. Where and on whom will the research have an impact? The research contributes a shared decision making intervention to patients in the later stage of kidney failure, their relatives and health professionals. We believe that the DESIRE intervention could be introduced during consultations with health professionals at an earlier stage of the patient's illness trajectory, as well as being applied to other chronic diseases. This intervention development research is reported according to the GUIDance for the rEporting of intervention Development (GUIDED) checklist and the DEVELOPTOOLS Reporting Checklist. Patients, relatives and health professionals have been involved throughout the research process as part of the research team and advisory board. For this study, the advisory board has particularly contributed to the development process of the DESIRE intervention by actively participating in the four workshops, in the iterations between the workshops and in the preparation of the manuscript.

Exploring residential relocation– differences between newcomers and settled residents in health, travel behaviour and neighbourhood perceptions

This study explores whether people who have recently moved to an area differ from longer-term residents in their health, travel behaviour, and perceptions of the environment. Using a large, representative sample from the UKHLS, Newcomers demonstrate significantly lower mental and physical health, reduced car commuting, and a higher likelihood of liking their neighbourhood. Area deprivation, urbanicity, household income, and age emerge as influential moderators with i.e. Newcomers in affluent areas experiencing lower physical health than Settled Residents, and rural Newcomers expressing less neighbourhood satisfaction. Our findings highlight that Newcomers' perceptions of their environment diverge and environmental influences vary among population segments, potentially impacting related health behaviours such as active travel. Furthermore, residential relocation introduces Newcomers with distinct characteristics into areas, affecting the context in which potential population health interventions aiming to influence health behaviours operate. This necessitates a deeper understanding of what influences reactions to the environment as well as ongoing adaptation of environmental interventions to respond to changing contexts within the same location over time.

Schistosome infection among pregnant women in the rural highlands of Madagascar: A cross-sectional study calling for public health interventions in vulnerable populations.

Schistosomiasis is a parasitic infection highly prevalent in sub-Saharan Africa (SSA) with Madagascar being among the countries with highest burden of the disease worldwide. Despite WHO recommendations, suggesting treatment of pregnant women after the first trimester, this group is still excluded from Mass Drug Administration programs. Our study, had the objective to measure the prevalence of schistosome infection among pregnant women in Madagascar in order to inform public health policies for treatment in this vulnerable population. Women were recruited for this cross-sectional study between April 2019 and February 2020 when attending Antenatal Care Services (ANCs) at one of 42 included Primary Health Care Centers. The urine-based upconverting reporter particle, lateral flow (UCP-LF) test detecting circulating anodic antigen was used for the detection of schistosome infections. To identify factors associated with the prevalence of schistosome infection crude and adjusted prevalence ratios and 95% CIs were estimated using mixed-effect Poisson regression. Among 4,448 participating women aged between 16 and 47 years, the majority (70.4%, 38 n = 3,133) resided in rural settings. Overall, the prevalence of schistosome infection was 55.9% (n = 2486, CI 95%: 53.3-58.5). A statistically significant association was found with age group (increased prevalence in 31-47 years old, compared to 16-20 years old (aPR = 1.15, CI 95%: 1.02-1.29) and with uptake of antimalaria preventive treatment (decreased prevalence, aPR = 0.85, CI 95%: 0.77-0.95). No other associations of any personal characteristics or contextual factors with schistosome infection were found in our multivariate regression analysis. The high prevalence of schistosome infection in pregnant women supports the consideration of preventive schistosomiasis treatment in ANCs of the Malagasy highlands. We strongly advocate for adapting schistosomiasis programs in highly endemic contexts. This, would contribute to both the WHO and SDGs agendas overall to improving the well-being of women and consequently breaking the vicious cycle of poverty perpetuated by schistosomiasis.

Prevalence of Cardiovascular Disease and Risk Factors Among Former National Football League Players

BackgroundCardiovascular disease (CVD) is the leading cause of death worldwide, but prevalence estimates in former professional athletes are limited. ObjectivesHUDDLE (Heart Health: Understanding and Diagnosing Disease by Leveraging Echocardiograms) aimed to raise awareness and estimate the prevalence of CVD and associated risk factors among members of the National Football League (NFL) Alumni Association and their families through education and screening events. MethodsHUDDLE was a multicity, cross-sectional study of NFL alumni and family members aged 50 years and older. Subjects reported their health history and participated in CVD education and screening (blood pressure, electrocardiogram, and transthoracic echocardiogram [TTE] assessments). Phone follow-up by investigators occurred 30 days postscreening to review results and recommendations. This analysis focuses on former NFL athletes. ResultsOf 498 participants screened, 57.2% (N = 285) were former NFL players, the majority of whom were African American (67.6%). The prevalence of hypertension among NFL alumni was estimated to be 89.8%, though only 37.5% reported a history of hypertension. Of 285 evaluable participants, 61.8% had structural cardiac abnormalities by TTE. Multivariable analysis showed that hypertension was a significant predictor of clinically relevant structural abnormalities on TTE. ConclusionsHUDDLE identified a large discrepancy between participant self-awareness and actual prevalence of CVD and risk factors, highlighting a significant opportunity for population health interventions. Structural cardiac abnormalities were observed in most participants and were independently predicted by hypertension, affirming the role of TTE for CVD screening in this population aged older than 50 years. (Heart Health: Understanding and Diagnosing Disease by Leveraging Echocardiograms [HUDDLE]; NCT05009589)

Post-Acute Care: Advancing Population Health Interventions, Risk Assessment, and Implications for Readmissions and Cost-Effectiveness through Telehealth

Post-Acute Care: Advancing Population Health Interventions, Risk Assessment, and Implications for Readmissions and Cost-Effectiveness through Telehealth

Digital Health Interventions in Older Adult Populations Living With Chronic Disease in High-Income Countries: Protocol for a Scoping Review.

Globally, around 80% percent of adults aged 65 years or older are living with at least 1 chronic disease, and 68% percent have 2 or more chronic diseases. Older adults living with chronic diseases require greater health care services, but these health care services are not always easily accessible. Furthermore, the COVID-19 pandemic has resulted in unprecedented changes in the provision of health care services for older adults. During the COVID-19 pandemic, digital health interventions for chronic disease management were developed out of necessity, but the evidence regarding these and developed interventions is lacking. In this scoping review, we aim to identify available digital health interventions such as emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms for chronic disease management for older adults in high-income countries. We will follow the Arksey and O'Malley framework to conduct the scoping review. Our full search strategy was developed following a preliminary search on MEDLINE. We will include studies where older adults are at least 65 years of age, living with at least 1 chronic disease (eg, cancer, cardiovascular disease, chronic obstructive pulmonary disease, and diabetes), and residing in high-income countries. Digital health interventions will be broadly defined to include emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms. This scoping review is currently ongoing. As of March 2023, our full search strategy has resulted in a total of 9901 records. We completed the screening of titles and abstracts and obtained 442 abstracts for full-text review. We are aiming to complete our full-text review in October 2024, data extraction in November 2024, and data synthesis in December 2024. This scoping review will generate evidence that will contribute to the further development of digital health interventions for future chronic disease management among older adults in high-income countries. More evidence-based research is needed to better understand the feasibility and limitations associated with the use of digital health interventions for this population. These evidence-based findings can then be disseminated to decision-makers and policy makers in other high-income countries. DERR1-10.2196/49130.

Development and application of the Demands for Population Health Interventions (Depth) framework for categorising the agentic demands of population health interventions

BackgroundThe ‘agentic demand’ of population health interventions (PHIs) refers to the capacity, resources and freedom to act that interventions demand of their recipients to benefit, which have a socio-economical pattern. Highly agentic interventions, e.g. information campaigns, rely on recipients noticing and responding to the intervention and thus might affect intervention effectiveness and equity. The absence of an adequate framework to classify agentic demands limits the fields’ ability to systematically explore these associations.MethodsWe systematically developed the Demands for Population Health Interventions (Depth) framework using an iterative approach: (1) developing the Depth framework by systematically identifying examples of PHIs aiming to promote healthier diets and physical activity, coding of intervention actors and actions and synthesising the data to develop the framework; (2) testing the Depth framework in online workshops with academic and policy experts and a quantitative reliability assessment. We applied the final framework in a proof-of-concept review, extracting studies from three existing equity-focused systematic reviews on framework category, overall effectiveness and differential socioeconomic effects and visualised the findings in harvest plots.ResultsThe Depth framework identifies three constructs influencing agentic demand: exposure — initial contact with intervention (two levels), mechanism of action — how the intervention enables or discourages behaviour (five levels) and engagement — recipient response (two levels). When combined, these constructs form a matrix of 20 possible classifications. In the proof-of-concept review, we classified all components of 31 interventions according to the Depth framework. Intervention components were concentrated in a small number of Depth classifications; Depth classification appeared to be related to intervention equity but not effectiveness.ConclusionsThis framework holds potential for future research, policy and practice, facilitating the design, selection and evaluation of interventions and evidence synthesis.

Unearthing organic ideology in population health interventions: the case of water fluoridation provision in the Health and Care Act 2022

Departing from Keith Syrett’s article in this issue, this commentary critically considers the place of organic ideology in population health interventions, using water fluoridation provisions contained in the Health and Care Act 2022 as an example. It demonstrates that liberal capitalist and neoliberal capitalist conceptions of the state as protector ground these provisions and, in so doing, it shows that population health interventions must be grounded in resonant politico-philosophical ideas prior to considerations around the opening of a policy window. This comment concludes by noting the need for further work to grasp the positive and negative role of appealing to organic ideology in public health law, regulation and policy.

Digital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities

Hypertension remains a leading factor associated with cardiovascular disease, and demographic and socioeconomic disparities in blood pressure (BP) control persist. While advances in digital health technologies have increased individuals' access to care for hypertension, few studies have analyzed the use of digital health interventions in vulnerable populations. To assess the association between digital health interventions and changes in BP and to characterize tailored strategies for populations experiencing health disparities. In this systematic review and meta-analysis, a systematic search identified studies evaluating digital health interventions for BP management in the Cochrane Library, Ovid Embase, Google Scholar, Ovid MEDLINE, PubMed, Scopus, and Web of Science databases from inception until October 30, 2023. Included studies were randomized clinical trials or cohort studies that investigated digital health interventions for managing hypertension in adults; presented change in systolic BP (SBP) or baseline and follow-up SBP levels; and emphasized social determinants of health and/or health disparities, including a focus on marginalized populations that have historically been underserved or digital health interventions that were culturally or linguistically tailored to a population with health disparities. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Two reviewers extracted and verified data. Mean differences in BP between treatment and control groups were analyzed using a random-effects model. Primary outcomes included mean differences (95% CIs) in SBP and diastolic BP (DBP) from baseline to 6 and 12 months of follow-up between digital health intervention and control groups. Shorter- and longer-term follow-up durations were also assessed, and sensitivity analyses accounted for baseline BP levels. A total of 28 studies (representing 8257 participants) were included (overall mean participant age, 57.4 years [range, 46-71 years]; 4962 [60.1%], female). Most studies examined multicomponent digital health interventions incorporating remote BP monitoring (18 [64.3%]), community health workers or skilled nurses (13 [46.4%]), and/or cultural tailoring (21 [75.0%]). Sociodemographic characteristics were similar between intervention and control groups. Between the intervention and control groups, there were statistically significant mean differences in SBP at 6 months (-4.24 mm Hg; 95% CI, -7.33 to -1.14 mm Hg; P = .01) and SBP changes at 12 months (-4.30 mm Hg; 95% CI, -8.38 to -0.23 mm Hg; P = .04). Few studies (4 [14.3%]) reported BP changes and hypertension control beyond 1 year. In this systematic review and meta-analysis of digital health interventions for hypertension management in populations experiencing health disparities, BP reductions were greater in the intervention groups compared with the standard care groups. The findings suggest that tailored initiatives that leverage digital health may have the potential to advance equity in hypertension outcomes.

Implementation of digital health in rural populations with chronic musculoskeletal conditions: A scoping review protocol.

Musculoskeletal conditions are a major source of disability worldwide, and its burden have been rising in the last decades. Rural areas, in particular, are associated with higher prevalence of these conditions as well as higher levels of disability, which is likely related to other determinants that affect these communities. Although digital health has been identified as a potential solution to mitigate the impact of these determinants, it is also known that these populations may face barriers that limit the implementation of these interventions. Therefore, the aim of this scoping review is to comprehensively map the evidence regarding the implementation of digital health interventions in rural populations with chronic musculoskeletal conditions. We will include studies published from the year 2000; that report the use of digital interventions that promote prevention, treatment or monitoring of any chronic musculoskeletal condition or chronic pain from musculoskeletal origin, in patients that live in rural areas. This protocol follows the methodological framework for scoping reviews proposed by Arksey and O'Malley, as well as the Joana Briggs Institute (JBI) approach. We will conduct the search on Medline (PubMed), EMBASE, Web of Science and Scopus, as well as grey literature databases. Two independent reviewers will screen titles and abstracts followed by a full-text review to assess the eligibility of the articles. Data extracted will include the identification of the digital interventions used, barriers and enablers identified by the patients or healthcare providers, the patient-level outcomes measured, and the implementation strategies and outcomes reported. By mapping the evidence on the implementation of digital health interventions in rural communities with musculoskeletal conditions, this scoping review will enhance our understanding of their applicability in real-world settings.

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

BackgroundThe 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. MethodsOur 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. FindingsWe 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. InterpretationWe 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. FundingPublic Health Policy Research Unit (PH-PRU), National Institute for Health and Care Research (NIHR) Policy Research Programme.

Education components of school vaccine mandates: An environmental scan

BackgroundSchool vaccine mandates (SVMs) are population health interventions that require monitoring and communicating about vaccination of school-aged children, with an aim of controlling infectious disease outbreaks. While 43 % of World Health Organization member states report having some sort of SVM, their details vary. A newer element of some SVMs is an “education component” requiring compulsory information, education, or counseling of parents/guardians who decline to vaccinate their children for non-medical reasons. MethodsThis environmental scan sought, mapped, and synthesized evidence on the existence, format, and impacts of education components of SVMs in 18 affluent Organization for Economic Co-operation and Development comparator countries. FindingsWe found current SVMs in nine of the 18 comparator countries, but education components to those SVMs only in Canada (n = 2) and the U.S. (n = 9), where such policies were made at the provincial/state level. The earliest was implemented in 2011 and most recent has not yet been implemented. Education components were used as requirements for obtaining non-medical exemptions from SVMs, and involved either an informational paper to be read and signed, a counseling or information session from a health professional (public health worker or licensed provider such as family doctor), or an online module to be completed. Peer-reviewed research on in-person sessions suggests association with at least short-term increased vaccine uptake and reduction of non-medical exemptions. Available data on online module education components suggests similar impacts, but research to date is limited. ConclusionSVMs with educational components are uncommon but have been increasing since 2011. The details of these education components vary, although topics covered in online modules are relatively consistent. Evidence to date suggests at least short-term reduction in non-medical exemptions associated with implementation of SVM education components, but additional research is required to follow-up and confirm, especially as regards online education modules.

Assessing and validating the specialized competency framework for pharmacists in sales and marketing (SCF-PSM): a cross-sectional analysis in Lebanon

ObjectivesCompetencies refer to the knowledge, skills, attitudes, and behaviors individuals develop through education, training, and experience. These competencies can be formulated into a framework to support practitioner development for effective and sustained performance. In the absence of a national framework for pharmacy education and practice in Lebanon, the Order of Pharmacists of Lebanon (OPL, the official association of pharmacists in Lebanon) pioneered the development of a pharmacy competency framework in 2017. This study aimed to validate and assess the specialized competency framework for pharmacists in sales and marketing (SCF-PSM) after updating the framework previously published by the OPL. The secondary objective was to assess, in a pilot survey, the personal characteristics associated with these competencies.MethodsAfter validating the content of the specialized competency framework, a survey involving Lebanese pharmacists was performed through a 15-min online questionnaire distributed over social media platforms, groups of pharmacists, and individual pharmacists’ contact numbers.Key findingsPharmaceutical knowledge, communication, emergency response, and operation management during emergencies were satisfactory (more than 80/100). Other activities during emergencies, such as patient care and population health interventions and evaluation, research, and dissemination of research outcomes, received a moderate score (75–78/100), similar to legal practice (78/100), teamwork (76/100), and management skills (75/100). The lowest reported confidence was related to professional communication skills (other than communication per se), mainly negotiation, data processing skills, information technology, self-management, and ethical practice (< 75/100). This study reported deficiencies between what is acquired during undergraduate, postgraduate, and continuing education on the one hand and the competency framework suggested by the OPL on the other hand, showing a mismatch between the competencies of working pharmacists acquired during education and the market needs.ConclusionsThis study validated a competency framework for pharmacists in sales and marketing and explored the current gaps in self-reported competencies. It also identified areas necessitating reinforcement to optimize professional practice and underscored the need for improvement in undergraduate, postgraduate, and continuing professional education.

3.C. Skills building seminar: Guidance on using natural experiments to evaluate population health interventions

Abstract There has been a substantial increase in the conduct of natural experimental evaluations since original guidance was published. There have been advances in relevant methodologies, greater availability of big datasets, and a rise in demand for ‘what works’ evidence amenable to natural experimental evaluation. Therefore, it is important that researchers, public health practitioners, funders, and users of intervention research are aware of recent developments and of the strengths, weaknesses, and applicability of natural experimental evaluations. Updated and extended guidance has been developed for using natural experiments to evaluate population health interventions. Guidance was developed from three international workshops and an online consultation with researchers, journal editors and end users of natural experimental evaluations. The project was funded by The UK Medical Research Council and the National Institute for Health and Care Research, and the project team comprised researchers with expertise in natural experimental evaluations. The project had a funder-assigned oversight group and an advisory group of independent experts, including researchers and practitioners with experience of commissioning natural experimental evaluations. This updated and extended guidance provides an integrated guide to the use of natural experimental methods to evaluate population health interventions, offering a range of tools to support its use and detailed, evidence-based information for researchers, funders, publishers, and users of evidence. The objective of this skills building seminar is to upskill public health researchers and practitioners on the design and use of natural experimental methods. The seminar will present key aspects of the guidance and provide the opportunity to discuss and explore each aspect. The first presentation will highlight important considerations when designing and planning a natural experimental evaluation and introduce recommendations for planning, commissioning, conducting, and using evidence from natural experimental evaluations. The second presentation will outline the value and roles of qualitative methods, explaining how qualitative evidence strengthens evaluations. There will then be a discussion and collaborative learning session, providing an opportunity for researchers and public health practitioners to share experiences and engage with the guidance. The discussions will be prompted by examples of natural experimental evaluations relevant to the presentations. Key messages • Natural experimental evaluations are valuable for assessing the impacts of population health interventions. • This workshop provides an opportunity to engage with and discuss new guidance, highlighting good practice in the design, planning, conduct and use of evidence from natural experimental evaluations.

2.K. Skills building seminar: Nutrition: A Challenge For The Intervention Research And Health Promotion

Abstract Cancer is the leading cause of death in Europe, the second in North America and it's estimated that 40% of cancers are preventable. Among these cancers, it's estimated that 10,8% are attributable to unbalanced diet (5.4%) and overweight (5,4%), and in addition, a smaller proportion is attributable to lack of physical activity (0,9%). In France, it's estimated that one in two people is overweight and particular attention is paid to young people. It's recognised that the risk of cancer can be reduced when the risk factor is known and acted upon: experience has shown that this knowledge is necessary but insufficient to know how to act. Population health intervention research (PHIR), a “solutions” science, fills this gap. It's concerned with the design, implementation, evaluation, adaptation, transferability and sustainability of interventions aimed at improving the health of populations, in order to produce valid knowledge with high potential for social and health impacts. This scientific approach apprehends interventions as “events in systems” and challenges the methodological hegemony imposed for many years by the biomedical sciences and especially epidemiology approach. Finally, this approach follows to act and intervene with and for the targeted populations, particularly people in vulnerable situations. Today, the development of PHIR in health promotion and in the field of cancer on the topic of nutrition, faces three major challenges: - Political; - Methodology; - Transferability. It's therefore proposed to give three complementary presentations directly addressing these issues on the topic of nutrition, each based on concrete examples of implementation in health promotion and in the field of cancer. The aim of this workshop is to offer a time for exchange and discussion on the challenges to be met in developing PHIR in health promotion - on the topic of nutrition - as an innovative model of research within an innovative paradigm shift. It will enable participants to clarify their conceptions of PHIR for the advancement of health promotion in oncology and to evolve these concepts in relation to these three key issues. An interactive format is proposed, including time for discussion based on participants’ perceptions and time for presentations. Key messages • PHIR: an effective scientific approach and a relevant tool for thinking about and developing health promotion policies on the topic of nutrition. • New research paradigm in health promotion and the fight against cancers, particularly linked to unbalanced diet and overweight, based on intervention with populations to act on the determinants of health.

Value and roles of qualitative methods in natural experimental evaluations

Abstract Background For natural experimental evaluations that estimate effect sizes of population health interventions, qualitative evidence contributes multiple benefits. Incorporating qualitative methods strengthens natural experimental evaluations, particularly when studying interventions in complex systems, and contributes to minimising evaluation design weaknesses. Methods Guidance was developed from three international workshops and an online consultation with researchers, journal editors and end users of natural experimental evaluations. The project team comprised researchers with expertise in natural experimental evaluations. The project included an oversight group and an advisory group of independent experts, including researchers, a journal editor, and scientific and public health advisors on central and local government. Results The guidance recommends that most evaluations of natural experiments will require the inclusion of qualitative evidence. Qualitative methods are valuable when describing the natural experiment intervention, the system and context it exists within, and theories of change. Qualitative work can help appropriately define exposed and unexposed groups, investigate causal mechanisms, facilitate meaningful selection of outcomes, and understand stakeholder perspectives on the intervention and its effects. Conclusions Gaining an understanding of the value and application of qualitative evidence will help producers and users of natural experimental evaluations conduct and identify robust evaluations. To fully benefit the evaluation, qualitative methods should be integrated throughout.

A systematic scoping review evaluating sugar-sweetened beverage taxation from a systems perspective

Systems thinking can reveal surprising, counterintuitive or unintended reactions to population health interventions (PHIs), yet this lens has rarely been applied to sugar-sweetened beverage (SSB) taxation. Using a systematic scoping review approach, we identified 329 papers concerning SSB taxation, of which 45 considered influences and impacts of SSB taxation jointly, involving methodological approaches that may prove promising for operationalizing a systems informed approach to PHI evaluation. Influences and impacts concerning SSB taxation may be cyclically linked, and studies that consider both enable us to identify implications beyond a predicted linear effect. Only three studies explicitly used systems thinking informed methods. Finally, we developed an illustrative, feedback-oriented conceptual framework, emphasizing the processes that could result in an SSB tax being increased, maintained, eroded or repealed over time. Such a framework could be used to synthesize evidence from non-systems informed evaluations, leading to novel research questions and further policy development.

Development and validation of the Trust in Government measure (TGM)

BackgroundTrust in government is associated with health behaviours and is an important consideration in population health interventions. While there is a reported decline in public trust in government across OECD countries, the tools used to measure trust are limited in their use for informing action to (re)build trust, and have limitations related to reliability and validity. To address the limitations of existing measures available to track public trust, the aim of the present work was to develop a new measure of trust in government.MethodsFifty-six qualitative interviews (Aug-Oct 2021; oversampling for equity-deserving populations) were conducted to design a national survey, including factor analyses and validation testing (N = 878; June 1-14th 2022) in Canada.ResultsThe measure demonstrated strong internal consistency (α = 0.96) and test validity (CFI = 0.96, RMSEA = 0.09, SRMR = 0.03), suggesting that trust in government can be measured as a single underlying construct. It also demonstrated strong criterion validity, as measured by significant (p < 0.0001) associations of scores with vaccine hesitancy, vaccine conspiracy beliefs, COVID-19 conspiracy beliefs, trust in public health messaging about COVID-19, and trust in public health advice about COVID-19. We present the Trust in Government Measure (TGM); a 13-item unidimensional measure of trust in Federal government.ConclusionsThis measure can be used within high-income countries, particularly member countries within the OECD already in support of using tools to collect, publish and compare statistics. Our measure should be used by researchers and policy makers to measure trust in government as a key indicator of societal and public health.

Traditional surveys versus ecological momentary assessments: Digital citizen science approaches to improve ethical physical activity surveillance among youth.

The role of physical activity (PA) in minimizing non-communicable diseases is well established. Measurement bias can be reduced via ecological momentary assessments (EMAs) deployed via citizen-owned smartphones. This study aims to engage citizen scientists to understand how PA reported digitally by retrospective and prospective measures varies within the same cohort. This study used the digital citizen science approach to collaborate with citizen scientists, aged 13-21 years over eight consecutive days via a custom-built app. Citizen scientists were recruited through schools in Regina, Saskatchewan, Canada in 2018 (August 31-December 31). Retrospective PA was assessed through a survey, which was adapted from three validated PA surveys to suit smartphone-based data collection, and prospective PA was assessed through time-triggered EMAs deployed consecutively every day, from day 1 to day 8, including weekdays and weekends. Data analyses included paired t-tests to understand the difference in PA reported retrospectively and prospectively, and linear regressions to assess contextual and demographic factors associated with PA reported retrospectively and prospectively. Findings showed a significant difference between PA reported retrospectively and prospectively (p = 0.001). Ethnicity (visible minorities: β = - 0.911, 95% C.I. = -1.677, -0.146), parental education (university: β = 0.978, 95% C.I. = 0.308, 1.649), and strength training (at least one day: β = 0.932, 95% C.I. = 0.108, 1.755) were associated with PA reported prospectively. In contrast, the number of active friends (at least one friend: β = 0.741, 95% C.I. = 0.026, 1.458) was associated with retrospective PA. Physical inactivity is the fourth leading cause of mortality globally, which requires accurate monitoring to inform population health interventions. In this digital age, where ubiquitous devices provide real-time engagement capabilities, digital citizen science can transform how we measure behaviours using citizen-owned ubiquitous digital tools to support prevention and treatment of non-communicable diseases.

Caught Between a Well-Intentioned State and a Hostile Federal System: Local Implementation of Inclusive Immigrant Policies.

In the United States, inclusive state-level policies can advance immigrant health and health care access by extending noncitizens' access to public benefits, workplace rights, and protections from immigration enforcement. Although state policies carry promise as structural population health interventions, there has been little examination of their implementation at the local level. Local jurisdictions play multiple roles in state policy implementation and possess distinct immigration climates. Examining the local implementation of state immigrant policy can address challenges and opportunities to ensure the health benefits of inclusive policies are realized equitably across states' regions. To examine the local implementation of state immigrant policies, we selected a purposive sample of California counties with large immigrant populations and distinct social and political dynamics and conducted and analyzed in-depth interviews with 20 community-based organizations that provided health, safety net, and other services. We found that there were tensions between the inclusionary goals of state immigrant policies and local anti-immigrant climates and federal policy changes. First, there were tensions between state policy goals and resistance from local law enforcement agencies and policymakers (e.g., Board of Supervisors). Second, because of the ongoing threats from federal immigration policies, there was a mismatch between the services and resources provided by state policies and local community needs. Finally, organizations that served immigrants were responsible for contributing to policy implementation but lacked resources to meet community needs while countering local resistance and federal policy threats. This study contributes knowledge regarding the challenges that emerge after state immigrant policies are enacted. The tensions among state immigrant policies, local immigration climates, and federal policy changes indicate that state immigrant policies are not implemented equally across state communities, resulting in challenges and limited benefits from policies for many immigrant communities.