Anticipating and Assessing Adverse and Other Unintended Consequences of Public Health Interventions: Development and presentation of the CONSEQUENT Framework

Jan M Stratil; Renke Biallas; Ani Movsisyan; Kathryn Oliver; Eva A Rehfuess

doi:10.1055/s-0044-1794344

Das Gesundheitswesen, Inhaltsverzeichnis

Gesundheitswesen 2024; 86(S 05): S329
DOI: 10.1055/s-0044-1794344

Abstracts │ ÖGPH

Anticipating and Assessing Adverse and Other Unintended Consequences of Public Health Interventions: Development and presentation of the CONSEQUENT Framework

Authors

Jan M Stratil

¹Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall in Tirol, Austria
Renke Biallas

²Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
Ani Movsisyan

³Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich and Pettenkofer School of Public Health, Munich, Germany
Kathryn Oliver

⁴Faculty of Public Health Policy, London School of Hygiene & Tropical Medicine, London, UK
Eva A Rehfuess

³Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich and Pettenkofer School of Public Health, Munich, Germany

Abstract

Volltext

Background Despite best intentions and even when producing beneficial outcomes, public health interventions can cause adverse and other unintended consequences (AUCs). These are usually not systematically examined in the development, evaluation, or implementation of public health interventions. The objective of this research project was to develop a framework intended to guide the anticipation and assessment auf AUCs of public health interventions.

Methods We employed the ‘best-fit’ synthesis approach: an a priori framework was used as a starting point and iteratively revised based on evidence identified through systematic reviews of the scientific literature. The a priori framework was advanced in an iterative process, based on a thematic analysis of systematic reviews of theoretical and conceptual studies as well as systematic reviews focused on AUCs of public health interventions. This preliminary framework coded against four systematic reviews addressing AUCs of four different public health interventions to validate it.

Results The Consequences of Public Health Interventions (CONSEQUENT) framework includes two components: the first focuses on AUCs and serves to categorize them; the second (supplementary) component highlights the mechanisms through which AUCs may arise. The consequences component comprises eight domains of AUCs: (i) health, (ii) health system, (iii) human rights, (iv) acceptability and adherence, (v) equality and equity, (vi) social and institutional, (vii) economic and resource-related, (viii) and the environment. The mechanisms component consists of eight mechanisms, through which AUCs might arise. It also offers structured definitions and examples for each of these domains, as well as of the potential mechanisms leading to them.

Conclusion The CONSEQUENT framework can serve as a tool for researchers to assess and classify adverse and other unintended consequences of a broad range of public health interventions and to explore underlying mechanisms. The framework may facilitate structured reflections on the adverse and other unintended consequences while developing, evaluating, and implementing a broad range of heterogenous public health interventions. In upcoming studies, we aim to evaluate and further refine the framework through practical application.