Background
Methods
Identification and selection of articles
-
articles;
-
published between January 2000 to last searched date (May 2010);
-
in French or English;
-
addressed the concept of transferability defined, even implicitly, as the extent to which the measured effectiveness of an applicable intervention could be achieved in another setting [3];
-
concerned health education interventions [13]
Content analysis
Results
Selected articles
-
did not relate to a health education intervention (indeed, we chose “public health” and “health promotion” as keywords to ensure retrieval of all abstracts addressing health education) (1,139 articles)
-
addressed the transfer of knowledge, skills, and practices, in particular in abstracts retrieved with the keywords “dissemination” and “diffusion” (797 articles).
-
addressed applicability only, in particular in articles retrieved with the keywords “adaptation”, “dissemination”, “translation”, and “generalization” (1,164 articles).
-
22 theoretical and methodological articles presenting analyses of the concept of transferability or related topics, such as the evaluation of interventions, the external validity of studies, or the process of adapting and implementing interventions within an evidence-based perspective;
-
14 describing one intervention, either a primary intervention or an adaptation of an experimental intervention in a different setting;
-
7 literature reviews that mainly addressed transferability in terms of generalizing an intervention.
Authors | Year | Using transferability term | Types of articles | Theme | Detail |
---|---|---|---|---|---|
Zubrick[15] | 2005 | yes | intervention | mental health | provides adaptation modalities |
Belansky[16] | 2006 | yes | intervention | nutrition and physical activity | provides adaptation modalities |
Frijiling[48] | 2003 | no | intervention | cardiovascular diseases | efficacy studies |
Tsey[18] | 2005 | yes | intervention | global health | provides adaptation modalities |
Glasgow[26] | 2004 | no | theoretical and/or methodological | all themes | about REAIM model/tool |
Roush[17] | 2009 | yes | theoretical and/or methodological | all themes | about RCT models and transferability factors |
Rychetnik[19] | 2002 | yes | theoretical and/or methodological | all themes | about transferability factors and quality of evidence |
Wang[3] | 2006 | yes | theoretical and/or methodological | all themes | about limits of RCT model and transferability factors |
Heller[56] | 2008 | yes | theoretical and/or methodological | all themes | about external validity |
Zeicmeister[41] | 2008 | no | theoretical and/or methodological | mental health | about limits of RCT model and need for qualitative evaluation |
Blackstock[49] | 2007 | no | intervention | BPCO | efficacy studies |
Gray[50] | 2000 | no | intervention | alcohol | efficacy studies |
Malterud 2001[20] | 2001 | yes | theoretical and/or methodological | all themes | about qualitative studies |
Elford[21] | 2003 | yes | theoretical and/or methodological | HIV | external validity, limits of RCT models, and transferability factors |
Nielsen[51] | 2008 | no | intervention | nutrition | efficacy studies |
Glasgow[33] | 2003 | no | intervention | diabetes | about process evaluation and use of RE-AIM model |
Hautmann[52] | 2008 | no | intervention | mental health | provides adaptation modalities |
Flowers[22] | 2002 | yes | intervention | HIV | efficacy studies |
Cattan[23] | 2005 | yes | review | loneliness | assesses the transferability of several studies |
Victora[25] | 2004 | no | theoretical and/or methodological | all themes | type of studies, limits of RCT models, dose-intervention and dose response |
Estabrooks[28] | 2003 | no | theoretical and/or methodological | physical activity | focuses on a tool to assess external validity : RE-AIM model/tool |
Baranowski[31] | 2000 | no | review | nutrition | analysis of intervention process, about qualitative evaluation |
Buijs[32] | 2003 | no | intervention | global health and seniors | analysis of intervention process, about qualitative evaluation |
Glasgow[27] | 2003 | no | theoretical and/or methodological | all themes | about RE-AIM model and contextual factors |
Glasgow[55] | 2006 | yes | theoretical and/or methodological | all themes | about RE-AIM model and contextual factors |
Spoth[34] | 2008 | no | theoretical and/or methodological | global health, teenagers | evidence-based public health and translational research |
Klesges[35] | 2008 | no | review | obesity | efficacy studies |
Reinschmidt[40] | 2010 | no | review | diabetes | accounting for adaptations of an experimental study |
Lorig[53] | 2004 | no | intervention | patient education | provides adaptation modalities |
Perrin[45] | 2006 | no | intervention | patient education | providing adaptation modalities |
Kwak[36] | 2005 | no | theoretical and/or methodological | global health | transferability factors, notably focused on participation rate |
Cohen[29] | 2008 | no | theoretical and/or methodological | global health | focuses on the RE-AIM model, types of adaptation, the need to drive evaluation in real settings |
Card[46] | 2009 | no | theoretical and/or methodological | HIV | describes adaptation process in seven steps |
Feldstein[37] | 2008 | no | theoretical and/or methodological | all themes | describes PRISM model to assess external validity |
Bull[38] | 2003 | no | review | all themes | uses RE-AIM model |
Chen[30] | 2009 | no | theoretical and/or methodological | all themes | limits of Campbellian model and RCT model |
Stevens[24] | 2001 | yes | review | mental health | provides adaptation modalities |
Cuijpers[47] | 2005 | no | theoretical and/or methodological | all themes | transferability factors |
Mukoma[44] | 2009 | no | intervention | HIV | process intervention |
Eakin[39] | 2002 | no | review | obesity | uses RE-AIM model |
Rimer[42] | 2001 | no | theoretical and/or methodological | all themes | evidence-based public health, limits of RCT models |
Dzewaltowski[54] | 2004 | no | theoretical and/or methodological | physical activity | describes interest of using REAIM model |
Dzewaltowski[43] | 2004 | no | theoretical and/or methodological | all themes | describes interest of using RE-AIM model |
The terminology used to describe the concept of transferability
Factors influencing transferability
Type of influence | Types of factors |
---|---|
Indirect influence “dose intervention” factors
| · whether the professionals followed the experimental protocol |
· the group size | |
· the existence of incentives for the beneficiaries to facilitate and support their participation | |
· the training and coaching of participants in the protocol’s implementation | |
· the modifications for the new context | |
Direct influence “dose response factors”. | · category 1: Factors present in the target population that reduce the extent to which the intervention affects the outcome, defined as "antagonism." |
· category 2: Factors present in the target population that enhance the extent to which the intervention affects the outcome, defined as "synergism". | |
· category 3: This category determines the beneficiaries’ actual need with respect to the intervention. This concept is based on the theory that the same dose will have less effect if there is less need for it and is defined as a "curvilinear dose–response association." | |
· category 4: The presence or absence of interventions that are antagonistic to the studied intervention, for example, the presence of messages dissonant to that conveyed by the intervention. | |
· category 5: The absence of a necessary cofactor in the causal chain of the intervention. | |
· category 6: The presence or absence of an external intervention that is synergistic with the objective of the intervention studied. |
Indirect influence
Direct influence
Ratings and assessments of transferability
Topic studied | Number of articles |
---|---|
Specifically addressed the question of studies’ validity by emphasizing their internal and external validity | |
Limitations of generalizability of intervention in health education | |
Limitations of experimental frameworks for research in the health education field . | |
The value of qualitative assessments that make it possible to explore and report on possible interactions among populations, interventions, and context and, therefore, to explain the outcomes |
-
Seeking an outcome that would be considered a probability assessment (i.e., did the program have an effect?) calls for a randomized controlled trial.
-
Seeking an outcome that would be considered a plausibility assessment (i.e., did the program seem to have an effect above and beyond other external influences?) calls for observational studies with a control group (quasi-experimental).
-
Seeking an outcome that would be considered an adequacy assessment (i.e., did the expected changes occur?) calls for an observational study.
Tools and criteria available to assess transferability
Transferability factors or types of factors
Categorization of factors | Sub-categories or examples of factors | Source authors |
---|---|---|
Factors related to population
| Factors related to the representativeness and characteristics of the target population (Reach RE-AIM): age, ethnicity, socioeconomic status, income, health status | Glasgow 2004, Estabrooks 2003, Glasgow 2003, Klesges 2008, Bull 2003, Eakin 2002, Dzewaltowski 2004, Elford 2003; Wang, 2006; Cuijpers 2005; Rychetnik, 2002; |
Factors related to participation of the population (Adoption of RE-AIM): perceived benefits, incentive group, a positive atmosphere within the program, the program seen as a priority | Glasgow 2004, Estabrooks 2003, Glasgow 2003, Klesges 2008, Bull 2003, Eakin 2002, Dzewaltowski 2004, Zubrick, 2005; Buijs 2003 | |
Volunteerism and the autonomy of participants | Buijs 2003 | |
Cultural factors related to lifestyles and worldviews | Reinschmidt 2010, Rychetnik, 2002; Elford 2003; | |
Cognitive factors depending on the age of recipients and their language, literacy, educational achievement | Reinschmidt 2010, Wang, 2006; Rychetnik 2002, Elford 2003 | |
Affective - motivational factors related to gender, ethnicity, religion and socioeconomic level | Reinschmidt 2010 | |
Factors related to the implementation
| Factors associated with all the resources and practices required to implement the intervention, including the cost and duration (Implementation of RE-AIM) | Glasgow 2004, Estabrooks 2003, Glasgow 2003, Klesges 2008, Bull 2003, Eakin 2002, Dzewaltowski 2004, Zubrick, 2005; Wang, 2005; Elford 2003 |
Availability of resources for routine application of the intervention | ||
Adaptability to the characteristics of the population | Tsey, 2005 | |
Adaptability of the program to local realities | Buijs 2003, Tsey 2005; Elford 2003 | |
"Comfort,” that is, an optimal intervention environment | Buijs 2003 | |
Mobilization methods that could vary depending on the characteristics of beneficiaries | Perrin 2006 | |
Compensation for the participation of professionals and beneficiaries | Perrin 2006 | |
Language used appropriate to the culture and origin of participants | Perrin 2006 | |
Accessibility of the intervention | Zubrick, 2005; Rychetnick, 2002; Elford 2003 | |
Relevance of the intervention to influence the risk factor and/or problem | Zubrick, 2005 | |
Feasibility of the intervention | Zubrick, 2005 : Elford 2003; | |
Acceptability of the intervention | Zubrick, 2005; Wang, 2005; Elford 2003; | |
Factors related to intervention: its model, its development, its delivery | Rychetnick 2002 | |
Factors related to professionals
| Providing all required instructions and intervention materials | Mukoma 2009, Cuijpers 2005 |
A participatory training that takes into account the professionals’ diverse views and experiences and targets their attitudes, skills and self-efficacy to implement the intervention | Mukoma 2009, Perrin 2006, Cuijpers 2005, | |
Involving professionals in developing and piloting the lessons, and reviewing the research instruments, skills. | Mukoma 2009, Wang, 2006; Rychetnick 2002 | |
Interest earned from the program by professionals in terms of their practice | Cuijpers 2005 | |
Enjoyment of the professionals | Buijs 2003 | |
Factors related to the environment
| Environmental factors related to the systemic dimension of the community | Reinschmidt 2010 |
Recognition of unique institutional settings | Perrin 2006 | |
Factors related to politico-social context (health system, financing, services or existing alternative program, etc.). | Rychetnick 2002, Wang, 2006; Cuijpers 2005, Wang, 2006; | |
Factors associated with interaction between the intervention and context | Rychetnick 2002 | |
Factors related to a specific health problem
| Prevalence of health problem in the population | Zubrick, 2005; Wang, 2005 |
Prevalence of risk factors for the targeted health problem | Zubrick, 2005 | |
Convincing causal link between the risk factor that is the target of the intervention and the health problem | Zubrick, 2005 | |
Relevance of the problem statement to be treated by professionals (expert agreement) | Cuijpers 2005 |
Discussion
-
The promotion and development of more qualitative research, and better understanding of complex phenomena in any kind of health education to allow practitioners to clearly identify what created the outcomes, and whether they depend on the nature of the intervention, the dose intervention, or on the dose response. This process can only be achieved by expanding and recognizing other, complementary methods of research evaluation.
-
The development of tools to evaluate, from the practitioners’ perspective, an intervention’s transferability, given the large number of factors likely to influence it. On this last point, our goal was to clarify the concept in health education and to objectify it. The list contains all factors that may contribute to the development of this type of analysis tool for transferability, including a guide for adapting transferability as needed, depending on the existing factors.