The research team, led by Gloria Aidoo-Frimpong of the University at Buffalo in collaboration with Ghanaian colleagues from institutions including Ensign Global University and hospitals in Osiem and Offinso, brought together ten adolescent girls and young women and five community interest-holders for an intensive co-creation workshop. The methodological architecture of the study reflected a deliberate commitment to participatory design. Rather than extracting survey responses and departing, the investigators audio-recorded group discussions, captured facilitator field notes, and employed the Nominal Group Technique, a structured consensus method in which participants independently generate and rank ideas before the group deliberates. This ranking procedure allowed the researchers to quantify which barriers participants considered most pressing, while the open discussions and intervention prototypes revealed the texture and reasoning behind those priorities. Transcripts were then subjected to thematic analysis with iterative coding and consensus refinement, a process in which coders repeatedly revisited the data until the interpretive categories stabilized.

What emerged from the analysis was a four-tier map of obstacles operating at distinct but interlocking levels. The first and arguably most pervasive domain involved cultural and religious norms that moralized female sexuality. Participants described how conversations about HIV prevention were frequently framed as evidence of inappropriate behavior, so that a young woman seeking an HIV test or requesting PrEP risked being read as sexually active, and therefore as transgressing expectations of feminine propriety. This moral framing transformed a straightforward health behavior into a social gamble. The second domain concerned knowledge that was real but not actionable. Many participants had heard of HIV self-testing and PrEP, yet they lacked procedural clarity about how the tests worked, how PrEP should be taken, and what to do with a result, leaving them uncertain at precisely the moments when confidence mattered most.

The third barrier domain was emotional and relational. Fear and stigma did not operate only through overt discrimination; they worked through anticipatory distress, the dread of what might happen if a test were discovered, and through relational scrutiny, the sense that partners, family members, or neighbors were constantly evaluating a young woman’s choices. Confidentiality concerns compounded this anxiety, because participants worried that clinic staff or visible service points could expose their prevention activities to their communities. The fourth domain was structural: inconsistent availability of services meant that even motivated women could not count on finding supplies, financial barriers put testing kits and clinic visits out of reach for some, geographic inequities concentrated resources in places easier for urban than rural women to access, and health system practices themselves sometimes deterred rather than welcomed young clients.

The analytical insight of the study lies in how these domains interact. A young woman might possess accurate knowledge about PrEP, for example, but cultural norms that moralize female sexuality could make it socially costly to visit a clinic, while financial constraints and unreliable stock could render the trip futile even if she overcame her hesitation. Conversely, a well-stocked facility in her neighborhood would not help if she feared being seen entering it. The researchers mapped each barrier to the level at which it manifested, individual, interpersonal, socio-cultural, or structural, and then aligned the co-created strategies to those manifestations. This multilevel mapping matters for implementation science because interventions that address only one layer tend to be overwhelmed by the others. A peer education program, however well designed, will struggle if the nearest clinic has no PrEP in stock or if faith leaders publicly condemn its use.

The strategies that participants designed were strikingly concrete and culturally embedded. Storytelling emerged as a central vehicle: narratives grounded in local experience could carry prevention information in forms that felt legitimate rather than clinical, allowing sensitive topics to be discussed without triggering the moral judgments that direct messaging provoked. Participants also proposed deliberate engagement with faith leaders, recognizing that religious authorities shape the very norms that moralize female sexuality, and that their endorsement could either unlock or foreclose community acceptance of HIV prevention services. Rather than treating religion as an obstacle to be circumvented, the young women positioned faith communities as potential allies whose involvement could reframe prevention as responsible and respectable behavior.

Digital tools featured prominently in the co-designed package, but with an attention to developmental nuance that top-down programs often miss. Participants envisioned peer-led education delivered through WhatsApp, the messaging platform that dominates social communication in Ghana, with content tailored to different stages of adolescence and young adulthood. The rationale was that a fourteen-year-old girl navigating school and family supervision has different prevention needs, relationship contexts, and communication preferences than a twenty-two-year-old woman in a partnership or running her own household. A single undifferentiated message, the participants argued, would speak to neither. Alongside the peer-led channels, they proposed anonymous digital support mechanisms that would allow young women to ask questions and seek reassurance without revealing their identities, directly targeting the confidentiality fears that the analysis had identified as a core barrier.

The final strand of the co-designed strategy addressed the structural layer through decentralized, community-based service delivery. By moving HIV self-testing kits and PrEP access out of centralized facilities and into community settings, the participants aimed to reduce the geographic and financial costs of prevention while shrinking the visibility that made clinic visits socially risky. The emphasis on decentralization reflects a broader recognition in health services research that access is not merely a matter of distance but of the total burden, in time, money, and social exposure, that a service imposes on its user. For young women whose mobility and spending money may be controlled by others, a service that requires a long, conspicuous journey is effectively unavailable regardless of its official existence.

The WISE WOMAN findings now set the stage for a pilot phase intended to evaluate the feasibility and acceptability of the co-created strategies and to refine them for broader scale-up. The study’s authors emphasize that grounding intervention design in lived experience and structural reality offers contextually specific guidance that imported models cannot supply, and the ethical architecture of the work, approved by the University at Buffalo’s Institutional Review Board and Ensign Global College’s ethics committee and conducted in accordance with the Declaration of Helsinki and Ghana’s Data Protection Act, underscores the care taken with a vulnerable population. The research was funded through the University at Buffalo’s global research seed funding program, with the funders having no role in the design or interpretation. Whether storytelling circles, faith-leader partnerships, WhatsApp peer networks, and community distribution points can measurably raise testing and PrEP uptake remains to be demonstrated, but the study makes a compelling methodological claim: the young women closest to the problem are also the most precise diagnosticians of it, and interventions that begin with their analysis stand a far better chance of surviving contact with the communities they aim to serve.

Subject of Research: Women-centered co-design of HIV self-testing and PrEP implementation strategies for adolescent girls and young women in Ghana

Article Title: Co-developing women-centered strategies to improve HIV self-testing and PrEP uptake among adolescent girls and young women in Ghana: Findings from the WISE WOMAN study

Article References: Aidoo-Frimpong, G., Mensah, W. K., Anyidoho, D. S., Obeng, Y. A., Abubakar, A. T., & Oduro, M. A. (2026). Co-developing women-centered strategies to improve HIV self-testing and PrEP uptake among adolescent girls and young women in Ghana: Findings from the WISE WOMAN study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15750-1

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15750-1

Keywords: HIV self-testing, PrEP, adolescent girls and young women, Ghana, participatory research, implementation science, human-centered design, nominal group technique, HIV stigma, women's health, community-based services, sub-Saharan Africa

The research team, led by investigators at the Dan L Duncan Comprehensive Cancer Center at Baylor College of Medicine and collaborators at Thomas Jefferson University, set out to solve a problem that has quietly hindered the survivorship field for years. National organizations including the Institute of Medicine, the National Cancer Institute, and the American Society of Clinical Oncology have long called for survivorship care to become a routine component of high-quality cancer care, and the National Standards translated that aspiration into concrete domains: surveillance, symptom management, supportive services, care coordination, and patient-centered follow-up. But the standards describe what should be delivered, not whether an institution has the workflows, staffing models, referral pathways, and data systems to deliver it. Existing quality frameworks, such as Commission on Cancer Standard 4.8 metrics, the LIVESTRONG Center of Excellence indicators, and ASCO’s Quality Oncology Practice Initiative measures, function largely as checklists or compliance metrics rather than as staged assessments of organizational capability.

Maturity models offer a different lens. Borrowed from engineering and business process management, and increasingly applied in healthcare informatics, maturity models characterize progressive stages of organizational capability, from ad hoc improvisation to fully optimized, data-driven operation. Their value lies not merely in identifying strengths and weaknesses but in providing a roadmap: each successive level describes the concrete processes, resources, and governance an organization must build to advance. Until now, such frameworks had been minimally applied in cancer survivorship, a gap the CSMM was explicitly designed to fill. Crucially, the model assesses organizational capability for implementing the National Standards rather than directly measuring the quality of care itself, a distinction the authors emphasize throughout.

Building the model required a careful methodological translation. Because the ten National Standards define clinical services rather than implementation functions, the researchers could not simply map one standard to one maturity domain. Instead, they consolidated conceptually related standards that depend on shared organizational capabilities into seven broader operational domains: survivorship care planning, risk of recurrence, specialty care, financial hardship and toxicity, lifestyle behaviors and supportive services, practical and social impacts, and physical and psychological effects. For example, the standards addressing lifestyle behaviors and supportive health services were merged because both are typically operationalized through similar screening processes, referral pathways, navigation programs, and community partnerships. Each domain was then described across five maturity levels, adapted from established maturity model frameworks, ranging from level one, ad hoc, to level five, optimized, with descriptors reflecting observable institutional characteristics such as role delineation, documentation practices, and use of data.

To refine and test this preliminary strawman model, the team conducted a mixed-methods, participatory study anchored in five multidisciplinary focus groups at the comprehensive cancer center. Fourteen clinicians and supportive care professionals participated, drawn from oncology, primary care, nursing, social work, rehabilitation, and psychosocial services, and practicing across academic, safety-net, and Veterans Affairs settings. The sessions employed consensus-building techniques adapted from the nominal group technique, a structured approach designed to elicit expert perspectives while preventing any single voice from dominating. Participants completed dot-voting prioritization exercises, ranking the seven domains by three distinct criteria: which would have the greatest clinical impact if implemented, which would be easiest to implement, and which patients would prioritize most highly. They then revised maturity level descriptors and rated their own practice settings against the model.

The prioritization results exposed a striking tension at the heart of survivorship care implementation. Risk of recurrence, specialty care, and survivorship care planning ranked highest for both clinical impact and implementation ease, and these two dimensions correlated moderately with each other. But when participants considered what patients would prioritize most, the picture shifted dramatically toward physical and psychological effects, risk of recurrence, and financial hardship. Statistical analysis confirmed the divergence: clinical impact and perceived patient priority showed a weak negative correlation, with a Spearman’s rho of minus 0.252, and overall concordance across the three ranking dimensions was minimal, at a Kendall’s W of just 0.056. In practical terms, the domains clinicians view as most influential for outcomes are not the ones patients experience as most urgent, a mismatch with direct consequences for how institutions allocate scarce resources.

When participants applied the CSMM to their own settings, the results were uniformly humbling. Maturity ratings clustered between levels one and two, indicating that survivorship care processes remain largely ad hoc or, at best, planned rather than standardized and integrated. Risk of recurrence and specialty care scored relatively higher, suggesting that surveillance and referral activities embedded in routine oncology practice are more established, while lifestyle behaviors, supportive services, and practical and social impacts lagged furthest behind. Variation within the institution was substantial: specialty care ratings ranged from a mean of 1.00 in one focus group to 3.67 in another, revealing uneven development of capabilities even within a single cancer center. The model was then distributed to twelve external stakeholders affiliated with the National Cancer Institute Survivorship Supplement Awardees network, institutions that are among the most survivorship-engaged in the country. Their overall mean rating was 1.93, nearly identical to the internal mean of 1.85, a finding the authors describe as striking, since even these focused centers remain at early maturity stages.

Qualitative analysis of the focus group discussions illuminated why implementation stalls. The most frequently cited barrier, mentioned in five of the groups, was a lack of clearly defined processes and responsibilities, captured in one participant’s observation that there is a lack of workflow clarity about the process and roles. Clinician time constraints followed closely, then variation in survivorship needs across cancer types and settings, limited institutional resources, and technical barriers such as fragmented electronic health record integration. Participants noted that practical and social issues bleed into financial issues, complicating domain boundaries, and that survivorship care is resource-intensive yet rarely supported by dedicated funding or protected time. Importantly, they also identified opportunities: embedding patient-reported needs screening into clinic workflows and creating reliable referral triggers could advance maturity without requiring major new investment.

The CSMM is designed as a structured self-assessment rather than a scoring exercise. Organizations compare current practices against domain descriptors, select the level that best reflects their state, and receive a radar plot of their maturity profile overlaid with aggregate community averages. When completed by multiple stakeholders, divergent ratings are treated not as measurement error but as valuable signals of misalignment between clinical, administrative, and operational perspectives. The model can be administered at baseline and repeated over time to track progress, and the online assessment is publicly available for organizations implementing the National Standards. The authors acknowledge limitations, including the single-center origin of the focus groups, the modest external sample, and the absence of survivor and caregiver perspectives in this development phase, all of which they flag as priorities for future refinement.

The broader significance of the study lies in reframing the survivorship challenge. The field has largely succeeded in defining what good survivorship care looks like; what it has lacked is a way to ask whether institutions possess the organizational capability to provide it. By translating national standards into staged, domain-specific maturity levels, the CSMM gives program leaders, administrators, and clinicians a common language for identifying where processes break down and where the next dollar, hire, or workflow redesign will matter most. As the number of cancer survivors continues to grow and the National Standards evolve, tools of this kind may prove essential for converting well-intentioned national guidance into consistent, patient-centered care that reaches every survivor, not just those fortunate enough to land in a mature system.

Subject of Research: Development of the Cancer Survivorship Maturity Model to assess organizational implementation of the National Standards for Cancer Survivorship Care

Article Title: Supporting implementation of the national standards for cancer survivorship care: development of the cancer survivorship maturity model (CSMM)

Article References: Dowst, H., Shirzadi, M., Mims, M., Hilsenbeck, S., Wang, L., & Badr, H. (2026). Supporting implementation of the national standards for cancer survivorship care: development of the cancer survivorship maturity model (CSMM). Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-026-02131-0

Image Credits: AI Generated

DOI: 10.1007/s11764-026-02131-0

Keywords: cancer survivorship, maturity model, National Standards for Cancer Survivorship Care, implementation science, health care management, organizational maturity, oncology, nominal group technique, quality improvement, patient-centered care, health services research, survivorship care planning

Primary health care, anchored internationally in the Declaration of Astana, emphasizes person-centred services across the lifespan, spanning preventive, promotive, curative, rehabilitative and palliative care, alongside intersectoral action on the social determinants of health. Occupational therapy, with its holistic, client-centred and occupation-based approach, would seem a natural fit for this agenda, and the profession worldwide is gradually shifting from hospital rehabilitation toward health promotion and population health. Yet integration remains limited almost everywhere, held back by structural and historical barriers, weak funding mechanisms and the profession’s traditional orientation toward curative rehabilitation. In Cyprus these problems are amplified by an ongoing health system reform and a very young educational infrastructure, since the country’s only occupational therapy programme admitted its first cohort as recently as 2015.

The Cypriot context gives the study its urgency. Since 2019, the General Health System, known as GeSY, has reorganized care around personal doctors acting as gatekeepers, with the Health Insurance Organization purchasing services and an explicit emphasis on prevention and integrated care. Rehabilitation services, including occupational therapy, are nominally part of the GeSY benefits package. In practice, however, most occupational therapists work in hospitals, rehabilitation centres or private practice, and the most recent survey by the Council of Occupational Therapists for the European Countries counted only 43 occupational therapists employed in primary health care in Cyprus. By contrast, countries such as Norway, the Netherlands and the United Kingdom report between 700 and 1,400 occupational therapists working in primary care, supported by clear referral pathways and insurance-based funding. Meanwhile, Cyprus faces rising chronic disease, obesity, smoking and physical inactivity, including among children, trends that demand exactly the community-based preventive workforce the country lacks.

To explore how students experience this disconnect, the researchers ran a two-phase qualitative study with seven undergraduate students, four women and three men, six of them in their fourth year and one in her third, all of whom had completed at least 340 hours of clinical placement. In the first phase, a 70-minute focus group was conducted using a semi-structured guide, with participants given translated stimulus materials including the curriculum itself, the Declaration of Astana, the Cyprus Country Health Profile and the European Tuning Competency Framework for Occupational Therapy. The transcript was analysed using Framework Analysis, a method that combines predefined themes from the literature with participant-driven insights through systematic coding, charting and interpretation. In the second phase, the same students took part in a Nominal Group Technique session, a structured consensus method in which participants silently generate ideas, share them in round-robin fashion, discuss and clarify them, and then rank their top five choices using a weighted point system.

The focus group findings coalesced around five themes, and their content is striking. Students described a curriculum rich in theory but heavily skewed toward paediatric and adult neurological rehabilitation, with minimal exposure to older adults, palliative care, prevention or underserved populations. One participant noted that courses discuss stroke extensively but never what someone can do to avoid having a stroke in the first place. Students felt confident managing conditions after onset but unprepared for proactive and end-of-life interventions, a serious gap in a country with a rapidly ageing population and high rates of chronic disease. They also reported that their skills were concentrated in one-to-one and small-group clinical work, leaving them unsure of their role in public health and population-level empowerment, even as they expressed a clear desire for project-based, community-engaged learning in which they could co-design initiatives with underserved groups.

Two further themes deepened the picture. On multisectoral action, students said they understood interdisciplinary collaboration in theory but felt practically unprepared to function within cross-sectoral systems, attributing this to the absence of shared educational experiences with other health professions. One participant observed that while occupational therapy students understand their own role, other team members cannot understand theirs, partly because the disciplines never train together, and another noted that other degrees in the faculty lack interprofessional education entirely, making collaboration structurally difficult. On autonomy, students reported a persistent gap between knowing and doing: theoretical concepts from occupational science were intellectually valuable but hard to internalize without application, and even laboratory exams remained, in their words, entirely theoretical. This lack of integration undermined their clinical reasoning, professional autonomy and confidence in unfamiliar settings.

The Nominal Group Technique session translated these frustrations into a ranked set of fifteen concrete recommendations, which clustered into three pedagogical categories. Feedback-based teaching received the highest priority, with students demanding specific, meaningful feedback delivered at multiple stages of each course, in both written and verbal form, rather than generic comments. Applied learning came next: case studies integrated across all courses, simulation-based learning incorporating tools such as artificial intelligence and trained actors for realism, and project-based learning involving design-thinking activities in real-world contexts. One participant pointedly invoked medical education’s simulation dolls, where students examine, diagnose and decide on the spot, and asked why occupational therapy students should not train the same way. Collaborative, interprofessional teaching ranked third, reflecting a strong desire to learn alongside nurses, general practitioners and other peers in structured ways that build genuine teamwork capacity. Peer mentoring, in which senior students guide juniors, was also valued as a scaffold for professional development.

The authors situate these findings within a broader international debate. Students in other countries have similarly reported feeling underprepared for community-based roles because curricula remain grounded in biomedical rehabilitation models, and global frameworks, including the World Federation of Occupational Therapists’ workforce strategy and the WHO Rehabilitation Competency Framework, all call for competencies in community engagement, interprofessional collaboration, leadership and advocacy. Examples from the Global South show what transformation can look like: Brazil’s reforms emphasize community-based practice aligned with national health goals, while South Africa’s occupation-based community development framework positions therapists as partners who co-design interventions with communities to address occupational injustice. The study also highlights a pragmatic tension that risks reinforcing the status quo: even when broader learning opportunities exist, students feel compelled to pursue conventional placements because jobs in prevention and health promotion simply do not exist, meaning idealistic curriculum choices carry no labour-market reward.

The study’s limitations are acknowledged candidly. With only seven participants from a single institution, transferability is constrained, and the exclusive reliance on student perspectives, without triangulation with educators or curriculum documents, limits confirmability, while the absence of longitudinal follow-up leaves open how perceptions of readiness might evolve. Nevertheless, the researchers argue the message is clear and consequential: occupational therapy education in Cyprus is theoretically strong but misaligned with evolving societal health priorities, and reform is needed to embed primary health care competencies, experiential and interprofessional learning, and community engagement throughout the curriculum. As one participant put it, if the university does not change how it prepares students to work in prevention and health promotion in areas where the profession is still underdeveloped, then change will never happen. For a profession whose founding values align so closely with primary health care, the students’ verdict amounts to a challenge not just to one small programme, but to occupational therapy education everywhere.

Subject of Research: Occupational therapy students' perceptions of their readiness for primary health care and curriculum reform

Article Title: Student’s views on their education – Are they ready for primary health care?

Article References: Orologas, S., Sakellariou, D., Christensen, J. R., & Björklund Carlstedt, A. (2025). Student’s views on their education – Are they ready for primary health care?. Scandinavian Journal of Occupational Therapy, 32(1), Article 2597208. https://doi.org/10.1080/11038128.2025.2597208

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2597208

Keywords: occupational therapy, primary health care, curriculum development, health professional education, Cyprus, interprofessional education, simulation-based learning, community-based practice, health promotion, professional identity, qualitative research, Nominal Group Technique

The motivation for the project is straightforward: research priority setting determines which uncertainties get resolved before they matter. The authors argue that prioritizing research on epidemic measures can help ensure that studies address genuinely important questions rather than convenient ones, so that future decisions rest on better evidence. The work was carried out by the Centre for Epidemic Interventions Research, CEIR, a research centre embedded within the Norwegian Institute of Public Health that focuses on generating and synthesizing evidence about interventions used to control epidemics. Rather than letting individual researchers choose their own questions, the team built a structured process designed to capture the concerns of a broad range of Norwegian stakeholders and to apply transparent criteria for ranking what matters most.

The first methodological challenge was scope. Public health and social measures encompass a sprawling universe of interventions, from testing, isolation, contact tracing and quarantine to school closures, border restrictions, mask mandates, ventilation improvements and mass gathering limits. To map that landscape, the researchers conducted a literature review and solicited feedback from Norwegian stakeholders, ultimately assembling an exhaustive inventory of 173 distinct interventions. Because that list was far too large to interrogate question by question, they asked stakeholders to identify their top priorities, which narrowed the field to 22 interventions considered most relevant for the Norwegian setting. This filtering step anchored the entire exercise in what practitioners and decision-makers actually care about, rather than in what is easiest to study.

With the shortlist in hand, the team turned to established methods for surfacing research uncertainties. They drew on the nominal group technique, a structured facilitation method designed to elicit and rank ideas from participants in a way that limits the influence of dominant voices, and on approaches developed by the James Lind Alliance, a UK-based initiative known for bringing patients, clinicians and researchers together to agree on research priorities. Using these techniques with Norwegian stakeholders, the researchers collected raw proposals about what remains unknown or contested about the effects of the 22 priority interventions. The process generated 252 distinct questions, a volume that reflects how much legitimate uncertainty persists about measures that many governments deployed at enormous economic and social cost during the COVID-19 pandemic.

Turning 252 raw questions into a workable set required careful analytical work. The researchers applied thematic analysis, a qualitative method that groups similar items into overarching themes, combined with member checking, in which participants verify that the synthesized versions faithfully capture what they originally proposed. Through this process the 252 questions were consolidated into 76 research questions framed to capture the substance of the uncertainties stakeholders had raised. The consolidation was not merely editorial; each retained question needed to be answerable through research while preserving the intent of the people who raised it. The resulting list provides a systematic snapshot of where Norwegian stakeholders see the largest gaps between what is known about epidemic measures and what decision-makers need to know.

Prioritizing those 76 questions demanded explicit criteria rather than intuition. Drawing on a review of the literature and feedback from stakeholders, the team developed a set of twelve criteria against which each question could be judged, reflecting considerations such as the importance of the underlying decision, the size of the uncertainty, and the feasibility and likely impact of answering it. Thirteen members of the research team then independently applied these criteria to score and rank the questions. Using structured scoring by multiple assessors, rather than a single panel discussion, helps reduce the idiosyncrasies of individual judgment and makes the rationale for each ranking visible and auditable.

The scoring was not the final word. The team sought feedback from Norwegian stakeholders on the provisional priorities and incorporated that input into a consensus process within CEIR, which ultimately settled on a final list of sixteen prioritized research questions about the effects of public health and social measures. That iterative design, moving from broad stakeholder input to analytical consolidation to formal scoring and back to stakeholder consultation, reflects a core principle of evidence-informed priority setting: the people who will use or be affected by the research should have a genuine voice in what gets studied. It also mirrors lessons learned during COVID-19, when rapid evidence syntheses sometimes answered questions that were technically tractable but of limited practical value to policymakers.

A distinctive feature of the study is its attention to whether the priorities travel beyond Norway. The researchers presented the final list of sixteen questions to five external experts from Australia, Canada, Chile, the United States and the United Kingdom, using the TRANSFER framework, an approach developed for assessing the transferability of systematic review findings to different settings. This step acknowledges a persistent tension in pandemic research: measures such as school closures or contact tracing operate within specific health systems, legal frameworks and social contexts, so priorities identified in a high-capacity Nordic welfare state may differ from those in low- and middle-income countries. The external review offers an indication of how far the Norwegian list can serve as a starting point internationally, even though the questions were formulated for a national context.

The methodological machinery of the study, documented across nine appendices of supplementary material, is itself a contribution. By combining literature review, stakeholder consultation, nominal group technique, James Lind Alliance methods, thematic analysis, structured scoring against twelve criteria, and transferability assessment, the team produced a reproducible template that other national public health agencies could adapt. The study also navigated the ethical landscape of such work: because it did not constitute medical or health research under the Norwegian Health Research Act, it was exempt from review by the Regional Committees for Medical and Health Research Ethics, but the authors nevertheless followed established research ethics principles, including informed consent, anonymity and minimizing the burden of participation. The article is open access, published under a Creative Commons Attribution license, with no dedicated funding received for the work.

The implications reach well beyond Norway. The COVID-19 pandemic exposed how little rigorous evidence existed about the comparative effectiveness, unintended consequences and equity impacts of non-pharmaceutical interventions, and how quickly decisions must be made when evidence is thin. A pre-agreed list of priority questions can shape funding calls, trial designs, data collection infrastructure and rapid evidence synthesis efforts before the next crisis hits, so that answers are available when they are needed rather than years afterward. The sixteen prioritized questions will now guide the future work of the Centre for Epidemic Interventions Research, and the authors suggest the list may be useful to others in Norway and internationally as a starting point for setting their own research priorities. In effect, the study converts the scattered uncertainties of a global emergency into a disciplined research agenda, offering a concrete answer to a question that has haunted public health since 2020: when the next epidemic comes, what should we be studying right now?

Subject of Research: Research priority setting for public health and social measures to manage epidemics

Article Title: Research priorities for public health and social measures to manage epidemics: a multi-method consensus study in Norway

Article References: Munthe-Kaas, H. M., Elstrøm, P., Bruun, T., Bjørbaek, M., Elgersma, I. H., Flottorp, S., Fretheim, A., Gopinathan, U., Holst, C., Rosenbaum, S., Selstø, A., Solberg, R., & Oxman, A. D. (2026). Research priorities for public health and social measures to manage epidemics: a multi-method consensus study in Norway. BMC Public Health. https://doi.org/10.1186/s12889-026-29391-w

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29391-w

Keywords: public health and social measures, epidemic preparedness, pandemic preparedness, research priority setting, consensus methods, nominal group technique, James Lind Alliance, stakeholder engagement, non-pharmaceutical interventions, evidence-informed decision making, COVID-19, Norway

The problem the researchers set out to solve is deceptively simple to state but difficult to resolve. The term non-pharmacological intervention, or NPI, refers to health prevention and care protocols supervised by healthcare professionals, yet no precise and widely adopted definition currently exists. This definitional vacuum has real consequences. Because NPIs vary enormously in content, delivery, and study design, research findings are difficult to compare, replicate, or synthesize. The authors argue that this heterogeneity limits scientific impact, hinders dissemination and continuous improvement of practices, and contributes to significant mistrust among professionals and the public. Existing reporting guidelines such as CONSORT address only a subset of the study types relevant to NPI assessment, leaving large portions of the evidence base without shared standards.

To build the framework, the team conducted a structured consensus study from 2022 to 2023, collaborating with researchers, healthcare users, healthcare practitioners, health operators, scientific societies, and health authorities. The methodology was hybrid, primarily inspired by the Nominal Group Technique and supplemented with elements of a modified Delphi approach. A multidisciplinary committee of 22 experts guided the process through iterative, open, and documented exchanges across four stages. First, a committee of 70 members created an initial list of ethical and methodological items. Second, a larger committee of 300 members refined that list. Third, 503 voters cast open votes on each individual item. Finally, the draft framework was submitted for consultation to 36 scientific societies and 14 health authorities, whose feedback shaped the final document.

The consensus process yielded a definition that anchors the entire model. An NPI, the stakeholders agreed, is an evidence-based, effective, personalized, non-invasive health prevention or care protocol, registered and supervised by a qualified professional. Each element of this definition carries weight. The requirement of an evidence base excludes practices unsupported by research. The emphasis on personalization acknowledges that non-drug interventions are typically tailored to individual circumstances rather than administered in fixed doses. The non-invasive criterion distinguishes these protocols from surgical or otherwise intrusive procedures. Registration and professional supervision, meanwhile, address concerns about unregulated practitioners and unverified claims that have long shadowed the field.

On top of this definition, the researchers constructed the NPIS Model as a set of 77 recommendations for evaluating NPIs, divided into 14 ethical and 63 methodological items. Every recommendation achieved at least 80 percent agreement among voters, a threshold the authors describe as evidence of genuine consensus rather than mere majority preference. The recommendations are organized around five types of studies that together span the translational pathway of an intervention: mechanistic studies, which probe how an intervention works at biological or psychological levels; observational studies, which document associations in real-world populations; prototypical studies, which establish feasibility and preliminary signals; intervention studies, the controlled trials that test efficacy; and implementation studies, which examine how interventions perform when deployed at scale in routine care.

This five-stage architecture is one of the model’s most distinctive technical contributions. Traditional evaluation frameworks tend to privilege the randomized controlled trial as the gold standard, but the authors argue that NPIs require a broader evidentiary ecosystem. A mindfulness-based stress reduction program, for example, cannot be evaluated in the same way as a small-molecule drug. Its active ingredients are distributed across instructor competence, participant engagement, dose and frequency of practice, and the therapeutic relationship itself. Mechanistic work may be needed to identify which psychological or neurobiological pathways are engaged, while implementation research determines whether the program retains its benefits when delivered by ordinary clinicians in busy clinics rather than by the specialists who designed it.

The ethical recommendations embedded in the model are equally notable. Because NPIs often involve vulnerable populations, behavioral manipulation, and long-term lifestyle change, questions of informed consent, participant burden, data protection, and equitable access take on particular urgency. By codifying 14 ethical requirements alongside the methodological ones, the framework signals that rigor and ethics are inseparable in this field. The authors report that 31 scientific societies and three health authorities have already provided letters of support for the NPIS Model, suggesting substantial institutional appetite for a shared reference. The framework is also accompanied by a registry maintained by the Non-Pharmacological Intervention Society, the non-profit scientific organization that coordinated the consensus process.

The study’s authors are candid about the limitations of their work. Because the framework was developed by francophone contributors, with voting restricted to residents of France, its applicability beyond this setting remains to be established through future international consultation and validation. Health systems differ in financing, professional regulation, and cultural attitudes toward non-drug therapies, and a framework forged in one national context may require adaptation elsewhere. The researchers also disclose a non-financial competing interest: several team members hold founding, leadership, or coordinating roles within the Non-Pharmacological Intervention Society, the organization that created and promotes the model. Transparency about these constraints, they suggest, is itself consistent with the model’s ethos of open, documented consensus-building.

If the NPIS Model gains international traction, its implications could reach far beyond academic methodology. Insurers and health authorities increasingly face pressure to decide which non-drug therapies to reimburse, and the absence of shared evaluation standards has made those decisions contentious. A common framework could help distinguish well-supported interventions from poorly validated ones, protect patients from unproven claims, and give practitioners confidence that the protocols they adopt meet recognized ethical and scientific benchmarks. For researchers, the model offers a roadmap for designing studies that regulators, journals, and funders can readily assess. The authors hope the framework will promote transparency, methodological rigour, ethical standards, and transferability in NPI research, ultimately increasing the value of evaluation for researchers, practitioners, healthcare users, and health authorities alike. Whether the model achieves that ambition will depend on the international validation studies now needed to test its portability across borders and health systems.

Subject of Research: A consensus-based framework for evaluating non-pharmacological interventions in health prevention and care

Article Title: The NPIS model: a consensus-based framework for evaluating non-pharmacological interventions

Article References: Ninot, G., Descamps, E., Achalid, G., Abad, S., Carbonnel, F., Carrieri, P., Dargent-Molina, P., Fiteni, F., Foucaut, A.-M., Guyon, A., Legout, A., Lognos, B., Molinari, N., Nizard, J., Nogues, M., Poisbeau, P., Rochaix, L., & Falissard, B. (2026). The NPIS model: a consensus-based framework for evaluating non-pharmacological interventions. Health Research Policy and Systems. https://doi.org/10.1186/s12961-026-01521-1

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DOI: 10.1186/s12961-026-01521-1

Keywords: non-pharmacological interventions, NPIS Model, consensus study, health research evaluation, research methodology, medical ethics, public health, Nominal Group Technique, Delphi method, clinical guidelines, evidence-based practice, health policy