Transformation of health systems: contribution of population health intervention research François Alla, Linda Cambon To cite this version: François Alla, Linda Cambon. Transformation of health systems: contribution of population health intervention research. Lancet Public Health, Elsevier, 2017, 2 (12), pp.e539. 10.1016/S2468- 2667(17)30216-5. hal-02464728 HAL Id: hal-02464728 https://hal.ehesp.fr/hal-02464728 Submitted on 8 Jun 2021 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Correspondence Transformation of health improve professional practice and in August 2017. This programme systems: contribution of health-care outcomes).5 will include these priorities, with Despite this development, the objective that funded research population health population health intervention contributes to the national aims For more on the adoption of research remains undersized and to invest in health prevention, to research and innovations see intervention research https://eppi.ioe.ac.uk/cms/ the findings are not widely used by improve the efficacy and efficiency Portals/0/PDF%20reviews%20 The growing prevalence of chronic decision makers and practitioners of the health system, and to reduce and%20summaries/Science%20 diseases is a major challenge in the for several reasons. First, the conduct health inequalities. This approach 2016%20Langer%20report. pdf?ver=2016-04-18- sustainability of health systems. of intervention research has several should be considered in a broader 142701-867 There is a need to transform health obstacles, such as inappropriate context of international cooperation. For more on the national public systems by increasing prevention designs derived from clinical We declare no competing interests. health research programme see and by implementating innovative research into drugs.6 In fact, these http://www.gouvernement.fr/ Copyright © The Author(s). Published by Elsevier organisations in management of interventions are generally considered conseil-des-ministres/2017- Ltd. This is an Open Access article under the 08-30/la-strategie-de- these diseases. This transformation to be complex, meaning that further CC BY-NC-ND license. prevention-en-sante will require development and analysis models and methods are required for of research-based and field-based evaluation.7 Logistical, budget, and *François Alla, Linda Cambon interventions and organisations. regulatory constraints compound [email protected] Health system transformation also these obstacles to intervention. For ISPED, University of Bordeaux, Bordeaux 33000, requires the transfer of innovative example, cluster trials are generally France (FA); and EHESP School of Public Health, Paris, France (LC) models into public decisions and needed when investigating collective 1 Potvin L, Petticrew M, Cohen ER. Population practices, and requires these actions to interventions such as population- health intervention research: developing a occur across health systems. based prevention or new health- much needed science of solutions. Prev Med Several questions and challenges can care organisations. In these trials, 2014; 61: 114–15. 2 Hawe P, Shiell A, Riley T. Theorising be distinguished in this context. How individual consent, a fundamental interventions as events in systems. do we assess these innovative models principle of health research, cannot Am J Community Psychol 2009; 43: 267–76. 3 Campbell R, Starkey F, Holliday J, et al. and interventions? How do we scale- be obtained, which can cause An informal school-based peer-led up the interventions recommended practical difficulties in obtaining intervention for smoking prevention in under experimental conditions? How authorisation for the research or adolescence (ASSIST): a cluster randomised trial. Lancet 2008; 371: 1595–602. can sustainability be integrated into publication of results. Second, the 4 Whittaker R, McRobbie H, Bullen C, Rodgers A, the design of innovations? How can use of knowledge by practitioners Gu Y. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev transferability of interventions be and decision makers is not a simple 2016; 4: CD006611. ensured across diverse settings and matter: knowledge produced is not 5 Reeves S, Pelone F, Harrison R, Goldman J, populations? always adapted or usable. Research Zwarenstein M. Interprofessional collaboration to improve professional practice and healthcare Population health intervention needs to provide practitioners and outcomes. Cochrane Database Syst Rev 2017; research—the science of solutions policy makers with robust and relevant 6: CD000072. which is complementary to the evidence that takes adequate account 6 Tarquinio C, Kivits J, Minary L, Coste J, Alla F. Evaluating complex interventions: 8 science of problems (ie, study of of the real-world circumstances. perspectives and issues for health behaviour health determinants)1—is designed There is a need to reconsider the change interventions. Psychol Health 2015; 30: 35–51. to address these issues. This research production of knowledge within an 7 Moore GF, Audrey S, Barker M, et al. is, by nature, contextualised because interacting framework, including all Process evaluation of complex interventions: the results are dependent on both stakeholders. We should also develop Medical Research Council guidance. BMJ 2015; 350: h1258. the intervention and the sociocultural practitioners’ skills to analyse and 8 Rutter H, Savona N, Glonti K, et al. The need and organisational context within transfer innovation into practices and for a complex systems model of evidence for 2 public health. Lancet 2017; published online which the intervention interacts. to transform their organisations to June 13. https://dx.doi.org/10.1016/S0140- Over the past 20 years, this research facilitate the adoption of innovations. 6736(17)31267-9. area has developed, resulting in It is becoming crucial to support projects focusing on new prevention the development of intervention approaches (such as innovative research. A general strategy integ- tobacco prevention programmes in rating research priorities, financial schools);3 technological innovation resources, and infrastructures (such as mobile health or mHealth (such as large databases) should be in prevention strategies);4 and defined. In France, for example, the organisational innovations (such as creation of a national public health interprofessional collaboration to research programme was announced www.thelancet.com/public-health Vol 2 December 2017 e539.