Implementation of evidence-based health promotion and disease prevention interventions: theoretical and practical implications of the concept of transferability for decision-making and the transfer process

Abstract

Evidence-based health promotion and disease prevention require incorporating evidence of the effectiveness of interventions into policy and practice. With the entry into force of the German Act to Strengthen Health Promotion and Prevention (PrävG), interventions that take place in people’s everyday living environments have gained in importance. Decision-makers need to assess whether an evidence-based intervention is transferable to their specific target context. The Federal Centre for Health Education (BZgA) recommends that transferability of an intervention should be clarified before any decision to implement it. Furthermore, transferability needs to be finally determined after an evaluation in the target context. In this article, we elaborate on theoretical and practical implications of the concept of transferability for health promotion and disease prevention based on the Population–Intervention–Environment–Transfer Models of Transferability (PIET-T). We discuss how decision-makers can anticipate transferability prior to the intervention transfer with the help of transferability criteria and how they can take transferability into account in the further process. This includes the steps of the analysis of a health problem and identification of effective interventions, the steps of the initial transferability assessment and identification of the need for adaptation, and the steps of the implementation and evaluation. Considering transferability is a complex task that comes with challenges. But it offers opportunities to select a suitable intervention for a target context and, in the transfer process, to understand the conditions under which the intervention works in this context. This knowledge helps to establish an evidence base, which is practically relevant.

Javno zdravstvo i primarna zdravstvena zaštita

“…It will help create a seamless continuum of services, enabling individuals to access preventive measures, screenings, and follow-up treatment as needed, ultimately reducing the disease burden 47 erage. This integrated approach can improve the population's overall health and reduce health inequalities by targeting the social determinants of health, promoting healthy behaviours and enhancing healthcare system services delivery 48 . Disease prevention, as the primordial function of public health and primary health care, represents the convergence of these two fields, which are crucial to maintaining and establishing human health 49 .…”

Contemporary Health Policy and Management: Challenges Remaining

“…The capacity of State actors and organizations that create the drivers of change processes in health systems to respond to the and diversity of the population, do not always have experience in selecting and implementing appropriate interventions related to the social determinants of health, and have therefore had difficulties in meeting commitments to collaborate and work together to promote health [14]. This creates a third barrier: government messages in public health remain ambiguous at best, and lack evidence of real, felt needs for organised communities [15], so it is unlikely that the professionals who manage them will feel sufficiently empowered to seize any opportunities for change towards participatory approaches, and spend more time on increasing medical care coverage and reducing the financial deficits that lead to interventions.…”

Program adaptation by health departments

“…Although the framework is not specific to adapting EBIs, it could be of practical use in that process. Other authors addressed the decision-making process related to transferability in health promotion and disease prevention interventions ( 19 ). The PIET-T process model is meant as a decision-making and planning aid.…”