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The Contribution of Population Health Intervention Research (PHIR) to the Science of Health Promotion

The Contribution of Population Health Intervention Research (PHIR) to the Science of Health Promotion. Louise Potvin Université de Montréal Health promotion research centre annual conference NUI Galway june 2014. OBJECTIVES.

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The Contribution of Population Health Intervention Research (PHIR) to the Science of Health Promotion

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  1. The Contribution of Population Health Intervention Research (PHIR) to the Science of Health Promotion Louise Potvin Université de Montréal Health promotion research centre annualconference NUI Galway june 2014

  2. OBJECTIVES Propose population health intervention research as a fundamental scientific perspective in health promotion Explore the interface between population health intervention research and health promotion POTVIN, Galway June 2014

  3. PART I A question of scope: what is the distinguishing niche for health promotion researcH? POTVIN, Galway June 2014

  4. OTTAWA CHARTER : AN ACTION-ORENTED DOCUMENT • Strong ideological foundations for health promotion: it provides a normative framework for public health* • Orientation for action • Defines targets for change: the social determinants of health • Proposes strategies of action: advocate, enable mediate • Suggests values and principles for change processes: participation, empowerment, equity, intersectoral action, holism, sustainability, multiple strategies, contextualism • No mention on the nature of the proper knowledge base for action * Potvin, L., & Jones, C. M. (2011). Twenty-five years after the Ottawa Charter: The critical role of health promotion for public health. CJPH, 102, 244-248. POTVIN, Galway June 2014

  5. WHO’S PROPOSITIONS OF THEMES FOR HEALTH RESEARCH Measuring the magnitude and distribution of health problems Understanding the diverse causes or the determinants of the problem, whether they are due to biological, behavioural, social or environmental factors Developing solutions or interventions that will help to prevent or mitigate the problem Implementing or delivering solutions through policies and programmes Evaluating the impact of these solutions on the level and distribution of the problem. World Health Organization. (2009). Draft WHO Strategy on Research for Health. Report by the Secretariat to the Executive Board, 124th Session. On line: http://apps.who.int/gb/ebwha/pdf_files/EB124/B124_12-en.pdf POTVIN, Galway June 2014

  6. MAPPING THE DOMAIN OF HEALTH RESEARCH Scaling up solutions Testing solutions population ecosystem individual gene system organ Level of analysis Finding causes Documenting problem Research Purpose POTVIN, Galway June 2014

  7. MAPPING THE DOMAIN OF HEALTH RESEARCH Scaling up solutions SCIENCES OF SOLUTIONS Testing solutions population ecosystem individual gene system organ Level of analysis Finding causes SCIENCES OF PROBLEMS Documenting problem Research Objective POTVIN, Galway June 2014

  8. THE SPACE OF HEALHT PROMOTION Scaling up solutions SCIENCES OF SOLUTIONS Testing solutions population ecosystem individual gene system organ Level of analysis Finding causes SCIENCES OF PROBLEMS Documenting problem Research Objective POTVIN, Galway June 2014

  9. PART II Population health intervention research POTVIN, Galway June 2014

  10. POPULATION HEALTH INTERVENTION RESEARCH “Population health intervention research involves the use of scientific methods to produce knowledge about policy and program interventions that operate within or outside of the health sector and have the potential to impact health at the population level.” (PHIRIC, cited by Hawe & Potvin, 2009) Hawe, P. & Potvin, L. (2009). What is population health intervention research? Canadian Journal of Public Health, 100, (1), I8-I14. POTVIN, Galway June 2014

  11. POPULATION HEALTH INTERVENTIONS • Population health is mainly produced by conditions that result from decisions and actions taken by social actors (organisations, institutions), most of whom are situated outside of the health sector • Population health interventions are coordinated actions to change the conditions that shape population health: • Policies : attempts to modify the norms and rules that govern the distribution of resources (power, money and other) at various levels (nation, region, local) • Programs: activities and services directed at specific groups to modify the quantity and quality of resources for health • Health promotion is a form of population health interventions POTVIN, Galway June 2014

  12. POPULATION HEALTH INTERVENTIONS Population health interventions take the form of programs or policythat (re)distributehealth-related ressources from the health and othersectors. These interventions aim at affecting the entire the population Population or collective level interventions focus on social/communityfactorsthat affect the distribution of riskwithin a population. Population health interventions do not focus on individuals, not even on lots of individuals, theyincludepoliticies and programs that affect sociallydefined groups or segments of populations POTVIN, Galway June 2014

  13. THE SPACE OF POPULATOPM HEALTH INTERVENTION RESEARCH Scaling up solutions SCIENCES OF SOLUTIONS Testing solutions population ecosystem individual gene system organ Level of analysis Finding causes SCIENCES OF PROBLEMS Documenting problem Research Objective POTVIN, Galway June 2014

  14. WHY PHIR AND NOT HEALTH PROMOTION EVALUATION ? Positions population healthinterventions as objectsfor scientificenquiry Contributes to a project to develop cumulative and transferableknowledge about HOW TO change the distribution of risk in a population Moves the focus awayfromproject management and decision-making and emphasisesknowledge production Avoids the confusion of « evaluation of » or « evaluation in » health promotion POTVIN, Galway June 2014

  15. EVALUATION VS PHIR POTVIN, Galway June 2014 Hawe, P., & Potvin, L. (2009) CJPH, 100 (1) special insert

  16. VALID QUESTIONS IN PHIR • There exist a variety of questions (and variations) that need to be answered by PHIR (science of solutions): • What could work: theoretical exploration of potential solutions given actual state of knowledge • Could it work: trial of given interventions in controlled conditions with adequate counterfactual • Does it work: observation of the chain of effects (proximate, intermediary and distal) that follow an intervention implemented with contextual constraints • How does it work: observation of the interactions between context and intervention that produce (or not) the intended chain of effects • Is it the best possible intervention: comparative analysis of strategic options, their value proposition, benefits and potentialsideeffects • Is it replicable: observation of an intervention’s capacity to produce similar chain of effects in various contexts POTVIN, Galway June 2014

  17. METHODOLOGIES IN PHIR Knowledge synthesis / simulation / theory development What could work? Is it the best possible intervention? IMPLEMENTION Social experimentation Designed for research purposes Could it work? Does it work? Social observation How does it work? Designed for service purposes Is it replicable? POTVIN, Galway June 2014

  18. METHODOLOGIES IN PHIR Knowledge synthesis and theory development Aggregate context What could work? Is it the best possible intervention? IMPLEMENTION Control for context Social experimentation Designed for research purposes Could it work? Does it work? Take context into account Social observation How does it work? Designed for service purposes Is it replicable? POTVIN, Galway June 2014

  19. PART III RESEARCH AND Implementation systems for population health interventions RESEARCH POTVIN, Galway June 2014

  20. PHI IMPLEMENTATION SYSTEM: ACTORS Civil society Found-ations Public administration (varioussectors) Private sector Institutions POTVIN, Galway June 2014

  21. PHI IMPLEMENTATION SYSTEMS SETTING Civil society POPULATION Activities and services Foundations Public administration (varioussectors) Private sector Institutions POTVIN, Galway June 2014

  22. CHARACTERISTICS OF PHI IMPLEMENTATION SYSTEMS Complex systems Arbitrary frontiers between systems and context Implementation systems are evolving and adaptive systems; they change with time and according to local conditions POTVIN, Galway June 2014

  23. PHIR AND IMPLEMENTATION SYSTEMS SETTING Civil society POPULATION Activities and services Foundations Public administration (varioussectors) RESEARCH APPARATUS Private sector Institutions POTVIN, Galway June 2014

  24. CHARATERISTICS OF PHIR IN RELATION TO IMPLEMENTATION SYSTEMS All components of the system [actors, collaborative arrangements, activities and services, impacts, effects] are of potential interest for research Necessary interactions between the research apparatus and the implementation system; these interactions need to be problematized in the research project: continuum of participation Necessary integration of a multidisciplinary perspective to capture the complexity POTVIN, Galway June 2014

  25. Fourthspecial collection of papers about PHIR • 11 peer-reviewedpapersaccrosstwo issues (Novembre 2013 et février 2014) • Four conclusions from the Editors • Where are the capacity for PHIR? • Wellbeyond the RCT a diversity of methods • Diversity of sectorsinvolved in studied interventions • Appetite for thisresearch POTVIN, Galway June 2014

  26. CONCLUSION Necessity of developing a knowledge base for health promotion on « how to » promote health in populations  / communities through population health interventions Population health intervention research provides an adequate niche for developing health promotion knowledge base that pertains to « how to ». PHIR is distinct from evaluation; it aims to create cumulative and transposable knowledge about population health interventions, their functioning and effective mechanisms PHIR includes a wide range of scientific methods that should be selected as a function of the specific aspects of PHI under study and the state of knowledge POTVIN, Galway June 2014

  27. TO KNOW MORE ABOUT PHIR Potvin, L., Petticrew, M. & Cohen E. (2014). Population health intervention research: Developing a much needed science of solutions. Preventive Medicine 61: 114-115 Breton, E., Guichard, A., et al. (2013). La recherche interventionnelle en santé des populations. La santé en action, no 425, Frankish, J., Bruce, T., Beanland, H., Di Rugiero, E., Muhajarine, N., Potvin, L., Van Winsberghe, R. (2012). Population health intervention research: Advancing the field. Canadian Journal of Public Health 103 suppl 1.  Potvin, L., Hawe, P., & Di Ruggiero, E. (2009). The population health intervention research for Canada. Canadian Journal of Public Health, Insert 1. Population health intervention research initiative of Canada. http://www.cihr-irsc.gc.ca/e/38731.html POTVIN, Galway June 2014

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