gms | German Medical Science

Background: Despite best intentions and even when producing beneficial outcomes, public health interventions can cause adverse and other unintended consequences (AUCs). While the COVID-19 pandemic has raised awareness about this issue, AUCs are usually not systematically examined in the development, evaluation, or implementation of such 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: In the development, 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 created using key elements of the WHO-INTEGRATE framework [1] as well as the Behavior Change Wheel [2]. These were chosen to root the future framework in a complexity perspective, global health norms and values, as well as established mechanisms of public health interventions. The a priori framework was advanced based on a systematic review of theoretical and conceptual studies as well as systematic reviews focused on AUCs of public health interventions. This was done in an iterative process, based on thematic analysis of the identified publications and deliberations among the authors. In next step and in order to validate the framework, we coded it against four systematic reviews of AUCs of public health interventions conducted on a variety of topics, including interventions in the fields of public health nutrition, illicit drug use, and infection-control measures during the SARS-CoV-2 pandemic.

Results: The Consequences of Public Health Interventions (CONSEQUENT) framework [3] 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, including: (a) through (re-)action and behavior change, (b) through affecting environments and environmental exposure or (c) through affecting social norms and practices, among others. 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.

The authors declare that they have no competing interests.

The authors declare that a positive ethics committee vote has been obtained.