EPSYLON EA 4556, Paul Valéry Montpellier 3, University of Montpellier, 34090 Montpellier, France.
UMRESTTE UMR T 9405, Université Lyon, Université Claude Bernard Lyon 1, 69002 Lyon, France.
Int J Environ Res Public Health. 2024 Mar 21;21(3):378. doi: 10.3390/ijerph21030378.
Addressing health challenges that impact human well-being requires a comprehensive, interdisciplinary approach that would be at the crossroad of population-based prevention and individual-level clinical care, which is in line with a Global Health perspective. In the absence of a unifying theoretical framework to guide such interventions, a Dynamic Ecosystem Adaptation through the Allostasis (DEA-A) framework has been proposed, emphasizing the functional adaptation of individuals and organizations in symbiosis with their living ecosystem. While a conceptual model has been presented, this methodological contribution aims at illustrating the practical application of the DEA-A framework for planning Global Health interventions. The methodology combines Intervention Mapping and Cognitive and Behavioral Theory, extended to the ecosystem. Practical guidelines and supporting tools are provided to help public health providers and clinicians in establishing a functional ecosystem diagnosis of the issue; defining not only behavioral, but also emotional and cognitive change objectives (allostasis targets) expected for each stakeholder; and designing intervention plans targeting determinants of these allostasis. The discussion addresses implementation and evaluation perspectives of interventions based on the DEA-A framework, emphasizing the importance of considering change in its processual and ecosystem complexity. Lastly, encouragements for a deeper understanding of individual and ecosystem homeostasis/allostasis processes are made in order to promote more functional interventions.
解决影响人类福祉的健康挑战需要一种综合的、跨学科的方法,这种方法将处于基于人群的预防和个体层面的临床护理的交叉点,这符合全球卫生的观点。由于缺乏统一的理论框架来指导此类干预措施,因此提出了通过适应(DEA-A)框架的动态生态系统适应,强调了个体和组织与其生存生态系统共生时的功能适应。虽然已经提出了概念模型,但本方法学贡献旨在说明 DEA-A 框架在规划全球卫生干预措施中的实际应用。该方法结合了干预映射和认知与行为理论,并将其扩展到生态系统。提供了实用的指南和支持工具,以帮助公共卫生提供者和临床医生对问题进行功能性生态系统诊断;不仅定义行为改变目标,还定义每个利益相关者预期的情感和认知改变目标(适应目标);并设计针对这些适应目标的决定因素的干预计划。讨论了基于 DEA-A 框架的干预措施的实施和评估观点,强调了考虑其过程和生态系统复杂性变化的重要性。最后,鼓励更深入地了解个体和生态系统的体内平衡/适应过程,以促进更具功能性的干预措施。