Planning Individual and Population-Based Interventions in Global Health: Applying the DEA-A Framework to Promote Behavioral, Emotional, and/or Cognitive Change among Stakeholders

Abstract

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.

Keywords: DEA-A framework; behavior change; chronic disease; cognitive change; emotional change; global health; intervention mapping; program planning.

Figure 1

Step 1 Functional analysis grid of adaptation according to the DEA-A framework.

Figure 2

Articulation between matrices providing a preliminary overview of the ecosystem process of change. BR = Behavioral Regulation; CR = Cognitive Regulation; ER = Emotional Regulation; S = Stress; C = Cognitions; R = Resources; E = Ecosystem. A/O = Actor or Organization. The cross means that the allostasis of an A/O determines its own future regulations and those of other A/Os.