Friday, August 7, 2009

Accreditation and certification of theory and evidence-based health promotion interventions

The Center for Healthful Living (Centrum Gezond Leven) and the Netherlands Youth Institute of the Netherlands National Institute for Public Health and the Environment are coordinating and leading an effort to come to better evidence-based practice in health promotion interventions in the Netherlands. The Center has developed an accreditation and certification procedure to distinguish between health promotion efforts that have no empirical basis from interventions for which different levels of evidence is available. For this purpose the Certification Commission for Interventions was started. The commission has four sub commissions, one on health promotion interventions for adults, which I will chair.
In health promotion, most often developed to promote healthy life styles for primary prevention of chronic disease, a lot is going on, but most interventions have no or an insufficient evidence-base. Such a situation is regarded as unacceptable in secondary prevention, cure or care, where evidence-based medicine is key. No one would accept, for example, that a new vaccine for Swine Flu was distributed to the population at large without careful stepwise testing in well-designed and controlled studies (see attached figure). In health promotion this is, however, common practice (the second figure shows this): mass-media or more tailored health education and health promotion interventions are designed, maybe pretested in some form of formative research, but often disseminated without any proof of effects.
The efforts of the Center for Healthy Living are aiming to help professionals and policy makers to select the available more promising and more evidence-based interventions for their health promotion purposes. The establishment of the certification procedure should also encourage organisations that develop interventions to improve their quality control and evaluation efforts.
Four levels of evidence will be distinguished (between brackets a very brief summary of the true, much better described and more detailed criteria are provided, click here for a list of criteria in Dutch):
1. Theoretically sound: The intervention’s goals, strategy and methods are well described and based established theoretical models
2. Probably effective: a series (>2) of studies of medium level design strength should suggest effectiveness
3. Proven effective: at least 2 studies with a strong research design show effectiveness
4. Proven cost-effectiveness: additional economic evaluations are available.
In the coming years it will become clear if the system will indeed lead to better evidence-based practice in health promotion.

Sunday, August 2, 2009

In memoriam: Prof Herman Schaalma

Professor Herman Schaalma died suddenly of a heart attack on 25 July 2009 while riding his road bike in the Limburg hills. Last Friday I joined a crowd of 400-500 people in Eijsden near Maastricht, the Netherlands, to say goodbye during an emotional, heart breaking, but sometimes also hilariously funny ceremony.

Herman was a social psychologist and health scientist working at the Faculty of Psychology and Neuroscience of Maastricht University in the field of planned development, implementation and evaluation of theory- and evidence-based health promotion programs, with a focus on HIV/Aids. His research focused on applying (social) psychology in understanding and changing health behaviors. His recent research interests included risk perception and communication; stigma; adherence; culture, psychology and health education; and web-based health education.

I worked with Herman during the time I was at Maastricht University and occasionally after I left Maastricht to work first in Rotterdam, and now at the EMGO Institute for Health and Care Research at the VU University Medical Center in Amsterdam. In fact when in Maastricht I lived for a few years under the same roof as Herman; I lived in an apartment one floor above Herman and his family. Herman was a great colleague and a great neighbour.

The most intensive collaboration we had was when the two of us, together with Prof. Gerjo Kok edited the first edition of the Dutch handbook on health education and behaviour change. Working with Herman in this way was fun, rewarding and challenging. Fun because of his great sense of humour, rewarding because he certainly made sure that we got the job done and his input improved the book in a great way, and challenging because his razor sharp feedback and comments, no beating around the bush, made sure that you wanted to do your best before asking Herman to take a look at your output.

The field of planned, evidence-based health promotion has lost a great colleague and a great character.