title: Intervention dose estimation in health promotion programmes: a framework and a tool. Application to the diet and physical activity promotion PRALIMAP trial.
abstract: BACKGROUND
  Although the outcomes of health promotion and prevention programmes may depend on the level of intervention, studies and trials often fail to take it into account. The objective of this work was to develop a framework within which to consider the implementation of interventions, and to propose a tool with which to measure the quantity and the quality of activities, whether planned or not, relevant to the intervention under investigation. The framework and the tool were applied to data from the diet and physical activity promotion PRALIMAP trial.
  
  
  METHODS
  A framework allowing for calculation of an intervention dose in any health promotion programme was developed. A literature reviews revealed several relevant concepts that were considered in greater detail by a multidisciplinary working group. A method was devised with which to calculate the dose of intervention planned and that is actually received (programme-driven activities dose), as well as the amount of non-planned intervention (non-programme-driven activities dose).
  
  
  RESULTS
  Indicators cover the roles of all those involved (supervisors, anchor personnel as receivers and providers, targets), in each intervention-related groups (IRG: basic setting in which a given intervention is planned by the programme and may differ in implementation level) and for every intervention period. All indicators are described according to two domains (delivery, participation) in two declensions (quantity and quality). Application to PRALIMAP data revealed important inter- and intra-IRG variability in intervention dose.
  
  
  CONCLUSIONS
  A literature analysis shows that the terminology in this area is not yet consolidated and that research is ongoing. The present work provides a methodological framework by specifying concepts, by defining new constructs and by developing multiple information synthesis methods which must be introduced from the programme's conception. Application to PRALIMAP underlined the feasibility of measuring the implementation level. The framework and the tool can be used in any complex programme evaluation. The intervention doses obtained could be particularly useful in comparative trials.
  
  
  BACKGROUND
  PRALIMAP is registered at ClinicalTrials.gov under NCT00814554.
authors.affiliation: INSERM, CIC-EC CIE6, Nancy, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Legrand
authors.forename: Emilie
authors.initials: E
authors.lastname: Bonsergent
authors.forename: Clotilde
authors.initials: C
authors.lastname: Latarche
authors.forename: Fabienne
authors.initials: F
authors.lastname: Empereur
authors.forename: Jean François
authors.initials: JF
authors.lastname: Collin
authors.forename: Edith
authors.initials: E
authors.lastname: Lecomte
authors.forename: Evelyne
authors.initials: E
authors.lastname: Aptel
authors.forename: Nathalie
authors.initials: N
authors.lastname: Thilly
authors.forename: Serge
authors.initials: S
authors.lastname: Briançon
mesh_terms: D016000:Cluster Analysis; D003625:Data Collection / Q000379:methods; D004032:Diet; D015444:Exercise; D006266:Health Education; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D009765:Obesity / Q000517:prevention & control; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance; D016730:Program Development; D019984:Quality Indicators, Health Care / Q000458:organization & administration / Q000592:standards; D012572:School Health Services / Q000592:standards; D011795:Surveys and Questionnaires; D000078329:Workforce