- Email: [email protected]
Lifestyle interventions: From individuals to communities
Preventive Medicine 49 (2009) 1–2
Contents lists available at ScienceDirect
Preventive Medicine j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / y p m e d
This Month in Preventive Medicine
Lifestyle interventions: From individuals to communities In this month's issue of Preventive Medicine, Rosen et al. propose a model for the development and evaluation of lifestyle interventions that is analogous to the system employed to identify new drugs and to test their efficacy and effectiveness (Rosen et al., 2009). Consider that instead of introducing a new treatment for a specific disease, the objective is to modify a community's lifestyle in a way that is beneficial for its health. It is reasonable to test first whether the intervention is acceptable and feasible in a small number of individuals. If it looks promising, it would be piloted to determine whether it actually can modify people's behavior over the short term. Successfully piloted interventions are candidates for intervention trials, which test their ability to modify the health outcome of interest. These trials can generate the evidence needed to generalize the intervention to the entire community under real-life conditions and to monitor the long-term effects of the intervention. These suggestions make sense. There is still, however, an important difference between prescribing a drug – a medical act – and modifying the behavior of a community. A community is not only a sum of individuals, it also has a collective identity. In an invited commentary on Rosen et al.'s paper, Murray mentions some technical consequences of the influences that individuals in a community can exert upon each other: their responses cannot be viewed as independent from one another (Murray, 2009). There are also important differences in terms of existing knowledge and further knowledge acquisition. Scientific experts are much less familiar with the context of a community's everyday life in which some modification is to occur than the actual community members. The experience of the community, sometimes referred as experiential knowledge (Fazey et al., 2005), can be crucial for harmonizing the intervention within the community context. The active involvement of the community may provide further guarantees of success (Israel et al., 1998). We had mentioned in a previous editorial that “Even though it is a domain that is still in its infancy, finding optimal ways of integrating the perspectives of lay-people and patients themselves into the design and administration of preventive interventions is needed for ensuring that what is delivered by preventive health professionals is actually received and practiced by their target clientele” (Morabia and Costanza, 2008). Thus, in our view, the community should be actively involved in all four phases of a development and evaluation process, such as the one proposed by Rosen et al. (2009). The community can be represented not only by individual citizens, but also by advocacy groups specifically constituted around health promotion goals. Community-involving research has the potential to dramatically improve the way prevention research is currently performed. Designing and implementing community interventions is an essential, even if challenging, role of preventive medicine. We welcome our readers' theoretical as well as empirical contributions on these points in future issues of PM.
References Fazey, I., Fazey, J.A., Fazey, D.M.A., 2005. Learning more effectively from experience. Ecol. Soc. 10, 4 (online). Israel, B.A., Schulz, A.J., Parker, E.A., Becker, A.B., 1998. Review of community-based research: assessing partnership approaches to improve public health. Annu. Rev. Public Health 19, 173–202. Morabia, A., Costanza, 2008. What is this thing called preventive medicine (III)? Prev. Med. 48, 151–153. Murray, D.M., 2009. On developing and evaluating lifestyle interventions. Prev. Med. 49, 19–20. Rosen, L.J., Manor, O., Brody, D., Engelhard, D., Shtarkshall, R., Zucker, D., 2009. From pills to programs: Lessons from medicine for developing effective lifestyle interventions. Prev. Med. 49, 12–18. 0091-7435/$ – see front matter © 2009 Published by Elsevier Inc. doi:10.1016/j.ypmed.2009.06.003
2
This Month in Preventive Medicine
Alfredo Morabia Center for the Biology of Natural Systems, Queens College – CUNY, 163-03 Horace Harding Expressway, Flushing, NY 11365, USA Michael C. Costanza University of Vermont, USA Geneva University Hospitals, Switzerland 6 Newbury Close, Rushden, Northamptonshire, NN10 0EU, UK E-mail address: [email protected].
Contents lists available at ScienceDirect
Preventive Medicine j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / y p m e d
This Month in Preventive Medicine
Lifestyle interventions: From individuals to communities In this month's issue of Preventive Medicine, Rosen et al. propose a model for the development and evaluation of lifestyle interventions that is analogous to the system employed to identify new drugs and to test their efficacy and effectiveness (Rosen et al., 2009). Consider that instead of introducing a new treatment for a specific disease, the objective is to modify a community's lifestyle in a way that is beneficial for its health. It is reasonable to test first whether the intervention is acceptable and feasible in a small number of individuals. If it looks promising, it would be piloted to determine whether it actually can modify people's behavior over the short term. Successfully piloted interventions are candidates for intervention trials, which test their ability to modify the health outcome of interest. These trials can generate the evidence needed to generalize the intervention to the entire community under real-life conditions and to monitor the long-term effects of the intervention. These suggestions make sense. There is still, however, an important difference between prescribing a drug – a medical act – and modifying the behavior of a community. A community is not only a sum of individuals, it also has a collective identity. In an invited commentary on Rosen et al.'s paper, Murray mentions some technical consequences of the influences that individuals in a community can exert upon each other: their responses cannot be viewed as independent from one another (Murray, 2009). There are also important differences in terms of existing knowledge and further knowledge acquisition. Scientific experts are much less familiar with the context of a community's everyday life in which some modification is to occur than the actual community members. The experience of the community, sometimes referred as experiential knowledge (Fazey et al., 2005), can be crucial for harmonizing the intervention within the community context. The active involvement of the community may provide further guarantees of success (Israel et al., 1998). We had mentioned in a previous editorial that “Even though it is a domain that is still in its infancy, finding optimal ways of integrating the perspectives of lay-people and patients themselves into the design and administration of preventive interventions is needed for ensuring that what is delivered by preventive health professionals is actually received and practiced by their target clientele” (Morabia and Costanza, 2008). Thus, in our view, the community should be actively involved in all four phases of a development and evaluation process, such as the one proposed by Rosen et al. (2009). The community can be represented not only by individual citizens, but also by advocacy groups specifically constituted around health promotion goals. Community-involving research has the potential to dramatically improve the way prevention research is currently performed. Designing and implementing community interventions is an essential, even if challenging, role of preventive medicine. We welcome our readers' theoretical as well as empirical contributions on these points in future issues of PM.
References Fazey, I., Fazey, J.A., Fazey, D.M.A., 2005. Learning more effectively from experience. Ecol. Soc. 10, 4 (online). Israel, B.A., Schulz, A.J., Parker, E.A., Becker, A.B., 1998. Review of community-based research: assessing partnership approaches to improve public health. Annu. Rev. Public Health 19, 173–202. Morabia, A., Costanza, 2008. What is this thing called preventive medicine (III)? Prev. Med. 48, 151–153. Murray, D.M., 2009. On developing and evaluating lifestyle interventions. Prev. Med. 49, 19–20. Rosen, L.J., Manor, O., Brody, D., Engelhard, D., Shtarkshall, R., Zucker, D., 2009. From pills to programs: Lessons from medicine for developing effective lifestyle interventions. Prev. Med. 49, 12–18. 0091-7435/$ – see front matter © 2009 Published by Elsevier Inc. doi:10.1016/j.ypmed.2009.06.003
2
This Month in Preventive Medicine
Alfredo Morabia Center for the Biology of Natural Systems, Queens College – CUNY, 163-03 Horace Harding Expressway, Flushing, NY 11365, USA Michael C. Costanza University of Vermont, USA Geneva University Hospitals, Switzerland 6 Newbury Close, Rushden, Northamptonshire, NN10 0EU, UK E-mail address: [email protected].