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Population-level health interventions are policies or programs that shift the distribution of health risk by addressing the underlying social, economic and environmental conditions. These interventions might be programs or policies designed and developed in the health sector, but they are more likely to be in sectors elsewhere, such as education, housing or employment. Population health intervention research attempts to capture the value and differential effect of these interventions, the processes by which they bring about change and the contexts within which they work best. In health research, unhelpful distinctions maintained in the past between research and evaluation have retarded the development of knowledge and led to patchy evidence about policies and programs. Myths about what can and cannot be achieved within community-level intervention research have similarly held the field back. The pathway forward integrates systematic inquiry approaches from a variety of disciplines. Les interventions populationnelles de santé comprennent l'ensemble des actions qui visent à modifier la distribution des risques à la santé en ciblant les conditions sociales, économiques et environnementales qui façonnent la distribution des risques. Sous forme de programmes et politiques, ces interventions peuvent provenir du secteur de la santé mais sont aussi souvent pilotées par d'autres secteurs comme l'éducation, le logement ou l'emploi. La recherche sur les interventions de santé des populations poursuivent l'objectif de documenter la valeur et les effets de ces interventions, les processus par lesquels les changements opèrent et les conditions qui favorisent les effets. Dans le domaine de la recherche en santé, des distinctions inutiles entre la recherche et l'évaluation ont retardé le développement des connaissances sur l'intervention de santé des populations et mené à une mauvaise intégration des données de recherche pour soutenir la pratique et les décisions concernant les programmes et politiques de santé des populations. Cet article déboulonne donc certains mythes pernicieux concernant la recherche sur les interventions, notamment relativement aux coûts associés, à ses visées et à la croyance en un rôle nécessairement marginal des communautés concernées pour développer des interventions efficaces. Cet article retourne aussi comme arbitraire et injustifiée la distinction traditionnelle entre la recherche sur les interventions et la recherche evaluative. En fait cet article montre que la recherche sur les interventions a tout à gagner d'un rapprochement avec la recherche evaluative et d'une intégration des méthodes de recherche appliquée provenant d'une diversité de disciplines.

Intervention Physical inactivity is an important behavioral risk factor for chronic disease in Canada. Individual-level strategies are used in clinical medicine to target individuals for preventive intervention based on one or more risk factors. In contrast, this study examines the impact of a population-level intervention: a municipal policy outside the healthcare sector that influences the built and social environment. Research question What is the preventive effect of a municipal transportation policy to increase active transportation on a chronic disease outcome measure—diabetes incidence—when it is viewed as a population-level health intervention to increase physical activity? Methods The impact of increases in active transportation for regular commuting to work in the city of Ottawa, Ontario was modeled to estimate number of diabetes cases prevented over 10 years. As a health-sector comparison, the reduction in incidence was equated to an individual-level approach to prevention targeting those who are inactive, meant to represent a clinical preventive intervention. Results The population-level policy shift could prevent as many as 1620 incident cases of diabetes over 10 years, the largest number prevented by increases in public transit use. This population effect was equal to 17,300 inactive individuals or 12,300 inactive individuals > 45 years old undertaking a clinical preventive intervention to increase physical activity. Conclusion The results demonstrate why public health matters today as population-level interventions that exist as policies outside the healthcare sector, supported by public health, may have an unrecognized and therefore underappreciated impact on population health.

Objectives: The aim of the Population Health Intervention Research Initiative for Canada (PHIRIC) is to build capacity to increase the quantity, quality and use of population health intervention research. But what capacity is required, and how should capacity be created? There may be relevant lessons from the Canadian Heart Health Initiative (CHHI), a 20-year initiative (1986-2006) that was groundbreaking in its attempt to bring together researchers and public health leaders (from government and non-government organizations) to jointly plan, conduct and act on relevant evidence. The present study focused on what enabled and constrained the ability to fund, conduct and use science in the CHHI. Methods: Guided by a provisional capacity-building framework, a two-step methodology was used: a CHHI document analysis followed by consultation with CHHI leaders to refine and confirm emerging findings. Results: A few well-positioned, visionary people conceived of the CHHI as a long-term, coherent initiative that would have impact, and they then created an environment to enable this to become reality. To achieve the vision, capacity was needed to a) align science (research and evaluation) with public health policy and program priorities, including the capacity to study \"natural experiments\" and b) build meaningful partnerships within and across sectors. Conclusion: There is now an opportunity to apply lessons from the CHHI in planning PHIRIC. Objectifs : L'Initiative de recherche interventionnelle en santé des populations du Canada (IRISPC) a pour but de développer les capacités d'accroître la quantité, la qualité et l'utilisation de la recherche interventionnelle en santé des populations. Mais quelles sont les capacités requises, et comment les développer? Il pourrait y avoir des leçons intéressantes à tirer de l'Initiative canadienne en santé cardiovasculaire (ICSC), qui s'est échelonnée sur 20 ans (1986-2006) et a été la première à rassembler des chercheurs et des responsables de la santé publique (issus des gouvernements et des organisations non gouvernementales) afin de planifier et d'exécuter de la recherche pertinente et d'en mettre les résultats en pratique. La présente étude porte sur les facteurs qui ont habilité ou limité le financement, la conduite et l'utilisation de la recherche scientifique dans le cadre de l'ICSC. Méthode : En nous guidant sur un cadre provisoire de renforcement des capacités, nous avons opté pour une méthode en deux temps : nous avons analysé les documents de l'ICSC, puis consulté les dirigeants de l'ICSC pour peaufiner et confirmer les résultats de l'analyse. Résultats : L'ICSC est le fruit du travail de quelques visionnaires idéalement placés, qui envisageaient une initiative influente, cohérente et de longue durée et qui ont créé l'environnement nécessaire pour la concrétiser. Pour cela, il fallait développer a) la capacité de faire concorder la science (la recherche et l'évaluation) avec les priorités des politiques et des programmes de santé publique, notamment la capacité de mener des « expériences dans des conditions naturelles » et b) la capacité de créer des partenariats constructifs entre différents secteurs d'activité et au sein de ces secteurs. Conclusion : Il est maintenant possible d'appliquer les leçons de l'ICSC à la planification de l'IRISPC.

Abstract Population health interventions tend to lack links to the emerging discourse on interactive knowledge production and exchange. This situation may limit both a better understanding of mechanisms that impact health lifestyles and the development of strategies for population level change. This paper introduces an integrated approach based on structure-agency theory in the context of ‘social practice’. It investigates the mechanisms of co-production of active lifestyles by population groups, professionals, policymakers and researchers. It combines a whole system approach with an interactive knowledge-to-action strategy for developing and implementing active lifestyle interventions. A system model is outlined to describe and explain how social practices of selected groups co-produce active lifestyles. Four intervention models for promoting the co-production of active lifestyles through an interactive-knowledge-to-action approach are discussed. Examples from case studies of the German research network Capital4Health are used to illustrate, how intervention models might be operationalized in a real-world intervention. Five subprojects develop, implement and evaluate interventions across the life-course. Although subprojects differ with regard to settings and population groups involved, they all focus on the four key components of the system model. The paper contributes new strategies to address the intervention research challenge of sustainable change of inactive lifestyles. The interactive approach presented allows consideration of the specificities of settings and scientific contexts for manifold purposes. Further research remains needed on what a co-produced knowledge-to-action agenda would look like and what impact it might have for whole system change.

Background Determining the success of population health interventions often involves assessing multiple, multidimensional outcomes rather than a single one, which presents significant methodological challenges under the evidence-based medicine paradigm. This scoping review examines outcome selection, analysis, and interpretation, and the accuracy of conclusions in complex digital health interventions promoting health among adolescents and young adults (DHI-AYA). Methods A comprehensive search of PubMed, EMBASE, ClinicalTrials.gov, PsycINFO, and CINAHL identified DHI-AYA implemented between 2017 and 2023. Studies were categorised by methodological choice regarding outcome hierarchical position: unique primary, multiple primary, or non-hierarchised outcomes. Outcomes were further classified into effectiveness, process, or economic categories. The authors’ conclusions on intervention success were compared with conclusions drawn by the research team based on the reported outcome analysis strategy. Secondly, four analytical strategies were applied to a subset of selected interventions to illustrate the impact of outcome hierarchical position and number on conclusions about intervention success. Results Analysis of 100 studies linked to 26 DHI-AYA identified 251 distinct outcomes: 164 effectiveness, 78 process, and 9 economic outcomes. Seven interventions were evaluated using a unique primary outcome, 10 using multiple primary outcomes, and 9 using multiple non-hierarchised outcomes. Primary and secondary outcomes were predominantly effectiveness endpoints. The research team reclassified nine interventions (35%) deemed successful by authors as non-conclusive due to statistically conflicting results across outcomes. Most interventions deemed non-conclusive by the research team were evaluated using non-hierarchised outcomes (7/10, 70%). The choice of outcome analysis strategy substantially affected conclusions on intervention success. Conclusions Discrepancies in intervention success assessments highlight the need for enhanced transparency, robustness, and trustworthiness in conclusion-drawing processes. In response, five methodological proposals are formulated: (1) developing core outcome sets specific to population health intervention research (PHIR), (2) collaboratively selecting multidimensional outcomes through a steering committee that accounts for stakeholder preferences and existing theoretical models, (3) exploring multi-criteria decision analysis and consensus-driven methods to transparently combine outcomes, (4) enhancing methodological reporting through intervention development and evaluation to improve scientific integrity and reproducibility, and (5) increasing PHIR expert involvement in ethics, funding, and evaluation committees to improve recognition of evidence produced in this field. PROSPERO Registration number CRD42023401979.

Intervention Street reallocation interventions in three Canadian mid-sized cities: Victoria (British Columbia), Kelowna (British Columbia), and Halifax (Nova Scotia) related to the COVID-19 pandemic. Research question What street reallocation interventions were implemented, and what were the socio-spatial equity patterns? Methods We collected data on street reallocations (interventions that expand street space for active transportation or physical distancing) from April 1 to August 15, 2020 from websites and media. For each city, we summarized length of street reallocations (km) and described implementation strategies and communications. We assessed socio-spatial patterning of interventions by comparing differences in where interventions were implemented by area-level mobility, accessibility, and socio-demographic characteristics. Results Two themes motivated street reallocations: supporting mobility, recreation, and physical distancing in populous areas, and bolstering COVID-19 recovery for businesses. The scale of responses ranged across cities, from Halifax adding an additional 20% distance to their bicycle network to Kelowna closing only one main street section. Interventions were located in downtown cores, areas with high population density, higher use of active transportation, and close proximity to essential destinations. With respect to socio-demographics, interventions tended to be implemented in areas with fewer children and areas with fewer visible minority populations. In Victoria, the interventions were in areas with lower income populations and higher proportions of Indigenous people. Conclusion In this early response phase, some cities acted swiftly even in the context of massive uncertainties. As cities move toward recovery and resilience, they should leverage early learnings as they act to create more permanent solutions that support safe and equitable mobility.

•43 % of WHO member states have school vaccine mandates, but policy details vary.•Some mandates have begun to include education components for non-vaccinating parents/guardians.•Currently, education components are used only in Canada and the U.S.; most are online modules.•Evidence suggests in-person counseling is associated with decreased non-medical exemptions.•Additional research, especially on online module education components, is required. School 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. This 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. We 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. SVMs 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.

Background Breast cancer is the leading cancer in women in France both in incidence and mortality. Organized breast cancer screening (OBCS) has been implemented nationwide since 2004, but the participation rate remains low (48%) and inequalities in participation have been reported. Facilities such as mobile mammography units could be effective to increase participation in OBCS and reduce inequalities, especially areas underserved in screening. Our main objective is to evaluate the impact of a mobile unit and to establish how it could be used to tackle territorial inequalities in OBCS participation. Methods A collaborative project will be conducted as a randomized controlled cluster trial in 2022–2024 in remote areas of four French departments. Small geographic areas were constructed by clustering women eligible to OBCS, according to distance to the nearest radiology centre, until an expected sample of eligible women was attained, as determined by logistic and financial constraints. Intervention areas were then selected by randomization in parallel groups. The main intervention is to propose an appointment at the mobile unit in addition to current OBCS in these remote areas according to the principle of proportionate universalism. A few weeks before the intervention, OBCS will be promoted with a specific information campaign and corresponding tools, applying the principle of multilevel, intersectoral and community empowerment to tackle inequalities. Discussion This randomized controlled trial will provide a high level of evidence in assessing the effects of mobile unit on participation and inequalities. Contextual factors impacting the intervention will be a key focus in this evaluation. Quantitative analyses will be complemented by qualitative analyses to investigate the causal mechanisms affecting the effectiveness of the intervention and to establish how the findings can be applied at national level. Trial registration Registered on ClinicalTrials.gov, December 21, 2021: NCT05164874 .

ObjectivesThe public health impact of nicotine vaping products (NVPs) is subject to complex transitions between NVP and cigarette use. To circumvent the data limitations and parameter instability challenges in modeling transitions, we indirectly estimate NVPs’ impact on smoking prevalence and resulting smoking-attributable deaths using the SimSmoke simulation model.MethodsCanada SimSmoke uses age- and sex-specific data on Canadian population, smoking prevalence and tobacco control policies. The model incorporates the impact of cigarette-oriented policies on smoking prevalence but not the explicit contribution of NVPs. The model was calibrated from 1999 to 2012, thereby projecting smoking prevalence before NVPs were widely used in Canada. The NVP impact on smoking prevalence is inferred by comparing projected 2012–2020 smoking trends absent NVPs to corresponding trends from two Canadian national surveys. We further distinguish impacts before and after NVPs became regulated in 2018 and more available.ResultsComparing 2012–2020 survey data of post-NVP to SimSmoke projected smoking prevalence trends, one survey indicated an NVP-related relative reduction of 15% (15%) for males (females) age 15+, but 32% (52%) for those ages 15–24. The other survey indicated a 14% (19%) NVP-related smoking reduction for ages 18+, but 42% (53%) for persons ages 18–24. Much of the gain occurred since Canada relaxed NVP restrictions. NVP-related 2012–2020 smoking reductions yielded 100,000 smoking-attributable deaths averted from 2012 to 2060.ConclusionSmoking prevalence in Canada, especially among younger adults, declined more rapidly once NVPs became readily available. The emergence of NVPs into the Canadian marketplace has not slowed the decline in smoking.

Setting The Public Health Agency of Canada’s Innovation Strategy (PHAC-IS) was established amid calls for diverse structural funding mechanisms that could support research agendas to inform policy making across multiple levels and jurisdictions. Influenced by a shifting emphasis towards a population health approach and growing interest in social innovation and systems change, the PHAC-IS was created as a national grantmaking program that funded the testing and delivery of promising population health interventions between 2009 and 2020. Intervention During its decade-long tenure, the PHAC-IS supported the development of innovative, locally driven programs that emphasized health equity, encouraged iterative learning to respond reflexively to complex public health problems (the art), while at the same time promoting and integrating population health intervention research (the science) for improved health at the individual, community, and systems levels through four program components. Outcomes PHAC-IS projects reached priority audiences in over 1700 communities. Over 1400 partnerships were established by community-led organizations across multiple sectors with more than $30 million of leveraged funds. By the final phase of funding, 90% of the projects and partnership networks had a sustained impact on policy and public health practice. By the end of the program, 82% of the projects were able to continue their intervention beyond PHAC-IS funding. Through a phased approach, projects were able to adapt, reflect, and build partnership networks to impact policy and practice while increasing reach and scale towards sustainability. Implications Analysis and reflection throughout the course of this initiative showed that strong partnerships that contribute sufficient time to collaboration are critical to achieving meaningful outcomes. Building on evaluation cycles that strengthen project design can ensure both scale and sustainability of project achievements. Furthermore, a flexible, phased approach allows for iterative learning and adjustments across various phases to realize sustained population and systems change. The model and reflexive approach underlying the PHAC-IS has the potential to apply to a broad range of public programs.