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
2
 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
PART I
3
A QUESTION OF SCOPE: WHAT IS
THE DISTINGUISHING NICHE FOR
HEALTH PROMOTION RESEARCH?
POTVIN, Galway June 2014
OTTAWA CHARTER : AN ACTION-ORENTED
DOCUMENT
4
 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
WHO’S PROPOSITIONS OF THEMES FOR
HEALTH RESEARCH
5
 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
MAPPING THE DOMAIN OF HEALTH
RESEARCH
6
Scaling up solutions
Testing solutions
Level of
analysis
Finding causes
Documenting problem
Research Purpose
POTVIN, Galway June 2014
MAPPING THE DOMAIN OF HEALTH
RESEARCH
7
Scaling up solutions
SCIENCES OF SOLUTIONS
Testing solutions
Level of
analysis
Finding causes
SCIENCES OF PROBLEMS
Documenting problem
Research Objective
POTVIN, Galway June 2014
THE SPACE OF HEALHT PROMOTION
8
Scaling up solutions
SCIENCES OF SOLUTIONS
Testing solutions
Level of
analysis
Finding causes
SCIENCES OF PROBLEMS
Documenting problem
Research Objective
POTVIN, Galway June 2014
PART II
9
POPULATION HEALTH
INTERVENTION RESEARCH
POTVIN, Galway June 2014
POPULATION HEALTH INTERVENTION
RESEARCH
10
“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
POPULATION HEALTH INTERVENTIONS
11
 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
POPULATION HEALTH
INTERVENTIONS
12
 Population health interventions take the form of
programs or policy that (re)distribute health-related
ressources from the health and other sectors. These
interventions aim at affecting the entire the
population
 Population or collective level interventions focus on
social/community factors that affect the
distribution of risk within a population.
 Population health interventions do not focus on
individuals, not even on lots of individuals, they
include politicies and programs that affect socially
defined groups or segments of populations
POTVIN, Galway June 2014
THE SPACE OF POPULATOPM HEALTH
INTERVENTION RESEARCH
13
Scaling up solutions
SCIENCES OF SOLUTIONS
Testing solutions
Level of
analysis
Finding causes
SCIENCES OF PROBLEMS
Documenting problem
Research Objective
POTVIN, Galway June 2014
WHY PHIR AND NOT HEALTH PROMOTION
EVALUATION ?
14
 Positions population health interventions as objects
for scientific enquiry
 Contributes to a project to develop cumulative and
transferable knowledge about HOW TO change the
distribution of risk in a population
 Moves the focus away from project management and
decision-making and emphasises knowledge
production
 Avoids the confusion of « evaluation of » or
« evaluation in » health promotion
POTVIN, Galway June 2014
EVALUATION VS PHIR
PHI research
Evaluation research
Intervention is often initiated by the
researcher, although may be designed in
collaboration with practitioners
Intervention under investigation is usually
designed by practitioners or agencies
Funded by a research grant
Funded by internal resources
Budgeted according to the cost of collecting
information required
Funded as percentage of the cost of the
program, e.g.an arbitrary 10% level
Results are destined for the public domain,
eg., in peer reviewed journals
Results may be restricted to an internal
report by contract agreements
Usually focussed on assessment of
intervention outcomes, may also include
assessment of process and mechanism of
action; bigger budget
Smaller budgets frequently limit enquiry to
secondary data sources in relation to
outcome, or restrict the evaluation
questions to matters of intervention process
Requires ethics approval
Ethics approval not routinely sought
Hawe, P., & Potvin, L. (2009) CJPH, 100 (1) special insert
15 June 2014
POTVIN, Galway
VALID QUESTIONS IN PHIR
16
 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 potential side effects
Is it replicable: observation of an intervention’s capacity to produce
similar chain of effects in various contexts
POTVIN, Galway June 2014
METHODOLOGIES IN PHIR
17
Knowledge synthesis /
simulation / theory
development
Social experimentation
What could work?
Is it the best possible intervention?
Could it work?
Does it work?
Social observation
How does it work?
Is it replicable?
I
M
P
L
E
M
E
N
T
I
O
N
Designed for
research purposes
Designed for
service purposes
POTVIN, Galway June 2014
METHODOLOGIES IN PHIR
18
Aggregate
Knowledge
synthesis and
theorycontext
development
Control for
Social experimentation
context
What could work?
Is it the best possible intervention?
Could it work?
Does it work?
Take context
into account
Social observation
How does it work?
Is it replicable?
I
M
P
L
E
M
E
N
T
I
O
N
Designed for
research purposes
Designed for
service purposes
POTVIN, Galway June 2014
PART III
19
RESEARCH AND IMPLEMENTATION
SYSTEMS FOR POPULATION HEALTH
INTERVENTIONS RESEARCH
POTVIN, Galway June 2014
PHI IMPLEMENTATION SYSTEM: ACTORS
20
Civil
society
Public
administration
(various
sectors)
Private
sector
Foundations
Institut
ions
POTVIN, Galway June 2014
PHI IMPLEMENTATION SYSTEMS
21
SETTING
POPULATION
Activities and services
Civil
society
Found
ations
Public
administration
(various sectors)
Private
sector
Institut
ions
POTVIN, Galway June 2014
CHARACTERISTICS OF PHI
IMPLEMENTATION SYSTEMS
22
 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
PHIR AND IMPLEMENTATION SYSTEMS
23
SETTING
POPULATION
Civil
soci
ety
RESEARCH
APPARATUS
Activities and
Public
administrati
on
(various
sectors)
Priva
te
secto
r
services
Fou
ndat
ions
Instit
ution
s
POTVIN, Galway June 2014
CHARATERISTICS OF PHIR IN RELATION TO
IMPLEMENTATION SYSTEMS
24
 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
 Fourth special collection of papers about PHIR
 11 peer-reviewed papers accross two issues
(Novembre 2013 et février 2014)
 Four conclusions from the Editors




Where are the capacity for PHIR?
Well beyond the RCT a diversity of methods
Diversity of sectors involved in studied interventions
Appetite for this research
POTVIN, Galway June 2014
CONCLUSION
26
1.
2.
3.
4.
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
TO KNOW MORE ABOUT PHIR
27
 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