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Introduction

p. 7-9


Texte intégral

1The Covid-19 pandemic has revealed an ambivalence in the design and implementation of health interventions (policies, strategies, actions). Indeed, despite a recognition that these must go beyond the framework of the healthcare system to involve all sectors and all people concerned, the crisis has highlighted the entrenchment of public health in an inappropriate biomedical approach (waging “war” on a virus without thinking about the social impacts, imposing measures on the entire population without modulating them according to needs and risks, prioritizing those most biologically vulnerable without deploying actions to reach the most disadvantaged people, etc.).

2Moreover, there have been real difficulties in supporting the development of these interventions and studying them using a multidisciplinary, evidence-based approach anchored in the diversity of territorial and population realities. The crisis thus mobilised decision-making processes that did not involve the populations and too rarely interdisciplinary expertise. It was driven by resources, for once unlimited, rather than by scientifically supported objectives oriented towards equity in addition to effectiveness. In particular, these processes did not incorporate the vulnerabilities of individuals and populations, apart from biomedical vulnerabilities, and often contributed to maintaining, if not reinforcing, pre-existing social inequalities in health.

3Yet the field of research on population health interventions is well established internationally and could have contributed to public health thinking and decision-making. However, this research and its use in decision-making remain marginal in the French-speaking world, from North to South and from East to West. The crisis we have just experienced shows how essential it is to explain more clearly what population health intervention research (PHIR) is and how, through its interdisciplinary approach and rigour, it can support policy decisions and practices to improve population health and reduce social inequalities in health, both locally and internationally.

4Population health intervention research is an emerging field. There is a very strong demand from the research, decision-making, practitioner, and student communities for training and support to design, implement, and evaluate this type of intervention in the international francophone context.

5To respond to this need, we present this guide that is both theoretical and practical for all parties concerned. We define PHIR as a multidisciplinary scientific process for producing cumulative and iterative knowledge on population health interventions. It combines complementary methods to answer an array of questions in order to comprehend the complexity of interventions, their contextual grounding, and the social utility of their conclusions, while taking into consideration the reduction of social inequalities in health. This book makes an original contribution to the analysis of health interventions. It is presented as a counterbalance to the proliferation of books and scientific publications in the field of health that have, until now, focused on experimental approaches derived from clinical research, which are not well suited to this type of intervention.

6This book is based on 20 years of research practice by the three authors on several continents, in several health fields, and with a myriad of different approaches: actions within the healthcare system (the mobilisation of primary care services) and outside it (the distribution of green spaces in a city); individual (vaccination, smoking) or collective approaches (working conditions); the development by researchers of organizational or technical innovations; or the analysis of interventions implemented in the context of public policies. It presents, in an accessible manner, the foundations and concepts of PHIR using numerous examples of their application in several countries.

7Our aim in this book is to show that this approach applies to all interventions, whether implemented in Bordeaux, Paris, Bamako, or Ouagadougou. While the contexts may change, the methodological approaches must be adaptable and provide optimal solutions for obtaining empirical data to answer the original research questions. The examples in this book explain how these approaches are mobilised to study vaccination against Covid-19 in France, dengue or malaria and their vectors in Burkina Faso, or access to healthcare in Mali and Niger.

8The text is supported by some 20 tables and figures and more than 25 boxes to highlight the specific issues related to PHIR in various contexts. Finally, our aim in this book is to identify and explain the particular features of this research and its requirements in terms of openness, contextual grounding, population participation, multidisciplinarity, and knowledge sharing for informed decision-making. It is extensively referenced and structured in six chapters addressing the conceptual and methodological aspects of PHIR.

9The first chapter defines PHIR and describes it in relation to other research approaches in the field of health with regard to its specific objects, approaches, and methods, as well as its dual purpose, cognitive (like all research) and conative (social utility). This social utility purpose questions not only perspectives, objectives, and methods, but also the approach itself, which can only be contextually anchored (often local) and participatory. The second chapter discusses research questions and how to formulate them in a PHIR context. The third chapter presents the main associated methods that should make it possible to answer these questions. The diversity of methods used in PHIR and coming from various research traditions reflects not only this multidisciplinary cross-fertilization, but also the diversity of research objects and questions. The issue of effectiveness, central to biomedical research in a controlled context, is one research question among others that are equally fundamental to PHIR, such as processes, relevance, or the scaling up of interventions and their impacts. The fourth chapter explains the approaches to data production and analysis, whether from a qualitative, quantitative, or mixed methods perspective. Finally, PHIR is not just a technical process and not focused only on methodological issues. Thus, the fifth chapter shows how it is embedded in power issues among a myriad of actors who must be taken into account and involved, while paying attention to inclusion and diversity. Finally, the sixth chapter highlights the ultimate goal of PHIR, which is that the results must be not only rigorous and useful, but at the very least, used. However, this is not achieved through magic; specific activities conducive to knowledge transfer must be planned and organized. Actors and knowledge transfer go hand-in-hand, because the use of results is not an “after-sales service” of research, but a rigorous, continuous, and inclusive process that also depends on how the research is conducted and, in particular, on the ways in which partners are mobilised.

10Thus, we hope this book will contribute to its readers’ current thinking on how to produce scientific knowledge on public health interventions, which are by nature complex and therefore cannot be reduced to studies anchored in a necessarily reductive biomedical approach. It is becoming urgent that the international francophone community, from Dakar to Quebec City, via Marseille and Tangiers, be able to better adopt, fund, organize, and publish on the PHIR approach. This is the ambition of this introductory book.

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Le texte seul est utilisable sous licence Creative Commons - Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International - CC BY-NC-ND 4.0. Les autres éléments (illustrations, fichiers annexes importés) sont « Tous droits réservés », sauf mention contraire.