TIDieR-PHP: a reporting guideline for population health and policy interventions

We lack guidance on how to describe population health and policy (PHP) interventions in reports of evaluation studies. PHP interventions are legal, fiscal, structural, organisational, environmental, and policy interventions such as the regulation of unhealthy commodities, health service reorganisation, changes in welfare policy, and neighbourhood improvement schemes. Many PHP interventions have characteristics that are important for their implementation and success but are not adequately captured in the original Template for Intervention Description and Replication (TIDieR) checklist. This article describes the development of a revised reporting template for PHP interventions (TIDieR-PHP) and presents the checklist with examples for each item


Supplementary file 2: Population health and policy intervention examples and citation details
Item with examples (citations available in Table 2 below) 1 Brief name Provide the name or a phrase that describes the intervention 1a The Swansea Bureau: A model of diversion from the Youth Justice System 1b Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomised controlled trial

Why
Describe the logic, mechanisms or rationale of the intervention clearly linking intervention elements to the expected effects on immediate or longer term outcomes (or both) 2a "The guiding rationale for UCTs [unconditional cash transfers] is that poor people are rational economic actors but merely lack the resources (money) to realize preferred investment levels. In other words, they possess the knowledge to make the wisest spending decisions that would improve their livelihoods, but they cannot do so because of financial constraints [reference provided]. By providing additional income in the form of cash transfers, households' credit constraints are freed up, allowing them invest in things like education. … Separate from theoretical arguments, an important reason for UCTs in SSA [sub-Saharan Africa] is that there are significant barriers to attaching conditions for both targeted populations and implementers." (page 64) 2b "We have attempted to capture how we think HeLP engages children and families in the HeLP Process Model ( Figure 2). This model attempts to represent the mediating variables related to HeLP within the IMB framework, indicating the feedback loops which appear to strengthen relationships and engagement with HeLP over time in order to create behaviour change." (page 13) 2c "Seguro Popular consists of health policies [reference provided] and priorities, [reference provided] including entitlements for affiliated families, well-defined benefits packages including coverage for 266 unique health interventions, 312 medicines, increased funds to state health ministries proportional to the number of Seguro Popular-affiliated families, federal funds for personal and non-personal health services, and creation of special federal funds for catastrophic medical expenditures associated with certain diseases.6 By linking federal support to medical facility quality, Seguro Popular aims to strengthen an accreditation system for health clinics and hospitals. When rollout is complete, Seguro Popular is intended to increase total health spending in Mexico by a full percentage point of gross domestic product (from 5·6% in 2002)." (page 1447)

Whatmaterials
Describe any materials used in the intervention (including online appendices or URLs for further details), e.g.: • informational materials (may include those provided to recipients of the intervention or in training of intervention providers) • nature and value of any benefit provided (e.g. cash, voucher, meal) • any physical resources or infrastructure provided as part of the intervention 3a "the food demonstration was accompanied by distribution of traditional recipe cards plus health promoting cards, the size of a business card and billed as such with the tienda's name. … The two tiendas also received posters, price tags, shelf tags, streamers (aka papel picado; a traditional Mexican form of art that consists of a long string of paper-cut designs, commonly used at celebrations such as birthdays), nutrient information tables for produce, and other point-of-purchase materials showcasing the fruit or vegetable promoted that week." (page 5) 3b "Voucher incentive payments. Those allocated to the intervention group will be offered financial incentives -Love2Shop vouchers -that can be redeemed in a wide array of UK shops but not used for the purchase of cigarettes or alcohol. The total amount available is £400 if women remain abstinent at each monitoring point" (page 5) 3c "According to JSY's guidelines, after delivery in a government or accredited private health facility, eligible women would receive 600 Indian rupees (US$13·3) in urban areas and 700 rupees ($15·6) in rural areas. In ten high-focus states (Uttar Pradesh, Uttaranchal, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Orissa, and Jammu and Kashmir) with low in-facility birth coverage, all women irrespective of socioeconomic status and parity are eligible for the cash benefit. (page 2009) 3d "In Salvador, construction included the laying of more than 2000 km of sewer pipes, building 86 pumping stations, and connection of more than 300 000 households to the sewerage network." (page 1623)

What and How
Describe how the intervention was planned, established, and intended to be delivered. Depending on the type of intervention, it may be useful to consider: • how sources of funding for the intervention and the service providers were obtained, how users were enrolled and the service delivered • how any payments were made or benefits delivered, how qualifying conditions were implemented • the entity being regulated, the scope of the regulation, permitted level of use; procedures for monitoring or enforcing compliance, and any sanctions for non-compliance • how people were exposed to the intervention, whether it was provided to individuals or larger populations • any underpinning legislation including name, date passed and legislative body 4a "Through competitive tendering, the Department of Health identified 27 existing projects to deliver the YPDP, which received additional funding and support from the National Youth Agency, a non-governmental agency. Tenders were judged on the quality of the proposed work, local deprivation, and teenage pregnancy rates and to ensure geographical spread and ethnic/gender diversity of participants." (page 1) 4b "Salt replacement will be progressively implemented over six months in each village. The intervention will contemplate interactions with families as well as bakeries, community kitchens, food vendors including street vendors, and restaurants. Ideally, replacement will require a complete exchange of ordinary salt." (page 3) 4c "Women will receive incentive payments outlined below: £50 for attending a faceto-face appointment with their NSPS adviser and setting a quit date; £50 if quit 4 weeks after their quit date corroborated by a carbon monoxide breath test result less than 10 ppm collected by a research nurse; £100 if quit after 12 weeks corroborated by a carbon monoxide breath test collected by a research nurse; £200 if they selfreport quit for at least 2 months when contacted for primary outcome assessment by the Helpline at 34 to 38 weeks gestation. This will be corroborated by a carbon monoxide breath test result less than 10 ppm collected by a research nurse." (page 6) 4d "The primary feature of the [Licensing] Act was the removal of fixed closing times that limited the temporal availability of alcohol at licensed outlets. Under the previous system, premises were allowed to serve alcohol between the hours of 11:00 and 23:00 (22:30 on a Sunday) with a standard license, and between 11:00 and 02:00 (03:00 in London) with a 'Special Hours Certificate'. The new legislation allowed greater flexibility in licensing, promoting a system of 'natural staggering', which was believed to be better suited to modern consumers and retailers" (page 2) These regulations limited alcohol promotions within retail stores to a single area and introduced a ban on quantity-based price discounts. This latter aspect of the legislation was considered to be its main component, and prevented off-trade retailers from providing multi-buy promotions such as 'three for the price of two' or 'three bottles for £10'; however, straight discounting of products remained permissible. The intention was to restrict incentives encouraging consumers to purchase more alcohol than they may otherwise have bought, and thereby reduce consumption." (page 2036)

Who provided
Describe the provider of the intervention, including legal status and powers, field organisations and staff responsible for planning, implementation, monitoring and enforcement. Where relevant, describe intervention provider expertise and training (general or specific to the intervention) 5a "The Bureau is intended as a new approach to diversion, utilising inter-agency partnership (in line, in fact, with YJB guidance) between South Wales Police and Swansea Youth Offending Service (YOS), supported by the wider Safer Swansea Partnership. It operates within a formal partnership agreement, which specifies the roles of the respective local agencies, sets out agreed referral eligibility criteria and clarifies decision-making responsibilities." (page 171) 5b "The Well London project is a four-year programme that uses a community development approach to deliver a set of complex health interventions aimed at improving HE, HPA and MH in the most deprived neighbourhoods of 20 London Boroughs. The project is led by The Greater London Authority with the London Health Commission and a consortium of partners including Groundwork London, the London Sustainability Exchange (LSx), the Central YMCA, the University of East London, the South London and Maudsley NHS Foundation Trust (SLaM) and the Arts Council for England. These partners together form the Well London Alliance. The project was launched at the end of 2007 and the interventions, developed in detailed consultation with communities, local authorities (LAs), Primary Care Trusts (PCTs) and London strategic bodies, will be delivered in two phases (covering 9 and 11 Boroughs respectively) with a 6 months gap between them." (page 2) 5c "In alignment with Queensland Health Multicultural Guidelines, all of the MHW's [multicultural health workers] were of Maori or Pacific Islander descent and lived within the communities they serviced, including representatives from seven communities: Cook Islands, Fiji, Fiji Indian, Maori, Samoan, Tongan and Papua New Guinean. … The program activities were implemented in schools with high numbers of children from Maori and Pacific Islander backgrounds (ranging from 10-90% of the total school population)" (page 3) 5d "Five day residential youth-friendly clinic staff training for at least one nurse in each clinic with refresher training after 2 years. On-site training was provided for remaining clinic staff. Monthly support visits by project staff when key features of clinic accessibility were assessed and on-site training tailored to any deficiencies noted. Standards for youth-friendly services provision were developed by clinic nurses, who are independently assessed against these standards at 6 monthly intervals. Prizes are awarded to clinics performing well. Each clinic receives detailed independent feedback on their performance at these standard assessments. The district nursing leadership is an integral part of this process." (page 1238) 6 Where Describe the type of location (e.g. school, community centre) and the geographical scope of the intervention (e.g. national, regional, city-wide). Where relevant, describe the historical, cultural, socioeconomic, or political background to the intervention 6a "Acayucan is one of Mexico's 56 metropolitan areas encompassing three municipalities with a combined population of 105,000 (INEGI, 2007). The city has a central core where most streets have been paved, and outer sections where street pavement is gradually rolled out. Residences are built and inhabited long before streets are paved. … The intervention consists of first-time asphalting of residential nonarterial streets" (page 255) 6b "This study involves inhabitants from Tumbes, a department located in the north coastal region of Peru on the border with Ecuador. The semi-urban area of Tumbes consists of more than 100 villages of varying size with an approximate total population of 80,000. It is comprised of a large 'mestizo' -mixed of European and Amerindian ancestry -population, and the traditional agricultural and fishing landscape has become intermixed with rapidly growing urban sections. Illiteracy rate is around 10%, and 50% of the inhabitants have no health insurance. … [T]here are both challenges and opportunities related to salt substitution in Peru. A previous successful public health measure involved promoting iodine-supplemented salt as a vehicle to prevent iodine deficit disorders, such as goiter, and in commercial spheres, the slogan "Consuma salud… consuma sal", or "Buy health… buy salt", is being promoted. This is a challenge for our intervention because salt has been marketed as a positive health measure, and we now propose to promote the replacement of regular salt with a substitute." (page 6)

Describe when the intervention was implemented, how long it remained in place, and if applicable, the number, duration and scheduling of occasions
7a "The community intervention comprises two modules (eleven 3-h [hour] sessions for each module)" (page 1238) 7b "As part of the 1991 reforms larger general practices were given the option to become fundholders [reference provided]. Fundholding practices were given a budget by their local HA [Health Authority] to purchase certain types of elective secondary care procedures (chargeable electives) from hospitals. … No new fundholders were allowed from the start of the financial year April 1998 and fundholding was abolished in April 1999. After April 1999 no practice had budgetary responsibility for the costs of secondary care for its patients." (page 450)

Planned variation
Describe and provide the reason for any variation or tailoring that was planned or allowed for in the design of the intervention. Examples include differences between locations, geographical areas, population subgroups or over time 8.1a "The key elements of the whole school component were the establishment and support of a school based adolescent health team; the identification of risk and protective factors in each school's social and learning environment from student surveys; and, using these data, the identification of effective strategies to address these issues." (page 998) 8.1b "The researchers asked permission from community leaders and engaged them in discussion of baseline evidence. Facilitators convened and ran intervention design groups-8-10 people, usually separately for men and women-to discuss survey results, cost implications, and specific prevention strategies in each community. The exact process for convening the groups varied from place to place, with some participants suggested by community leaders, some being key figures like school teachers, and some identified by door to door invitation … Communities opted for a range of activities to share basic information on the mosquito life cycle and how to interrupt it (emptying, brushing/scrubbing the interior walls of, or covering receptacles hosting mosquito eggs or larvae); community events to raise awareness, like puppet shows and basketball tournaments; clean up campaigns focused on unoccupied and public premises; introduction of fish into water storage containers (Mexico only); and other activities listed in appendix 2. … Brigadistas also added interventions as their community work advanced (see appendix 2). In Nicaragua, brigadistas received no remuneration; in Mexico, they received allowances for travel, lunch, and child care on the days they worked." (page 3) 8.1c "Because of their local autonomy, SSLPs [Sure Start Local Programmes] do not have a "protocol" to promote adherence to a prescribed model, as do other early interventions that are known to be effective. All SSLPs are expected, nevertheless, to provide core services of outreach or home visiting; family support; support for good quality play, learning, and childcare experiences; primary and community health care; advice about child and family health and development; and support for people with special needs, including help in accessing specialised services. Community participation is central to the mission of these programmes, through local partnerships that bring together all people who are concerned with children in the local community, including health, social, and education services; the private sector; the voluntary sector; and parents" (page 1)

Unplanned variation
Describe and provide the reason for any unplanned variation or modifications in the intervention (e.g. between different locations, geographical areas, population subgroups or over time) that were made after the intervention commenced 8.2a "In one geographically bounded sub-community the builder carrying out the retrofit claimed to have carried out the intervention according to contractual specifications, but failed to do so, until the discrepancies were picked up by the external auditor. This contractor's deception was not detected by the householders. 8.2c "[A]n unexpected result from the interviews with parents was to add a second, parallel intervention for parents. … The original implementation plan was revised to add a modified version of the Families Matter! (FM!) program, adapted for parents of older youth than the original FM! Intervention, which focused on parents of 9-to 12year-olds. In addition, a joint session was added to both programs in which both parents and adolescents came together for guided practice of their newly acquired conversational skills for discussions of sensitive issues within the family." (page 284)

How well
Describe any strategies used or actions taken to maintain fidelity of the intervention (i.e. to ensure that the intervention was delivered as intended) 9.1a "A cornerstone of the intervention is that its facilitators are very carefully selected, trained and supported. The facilitators who implement the intervention with parents go through a similarly rigorous selection process and undergo 2 weeks of residential training on the course materials and facilitation skills. Both groups are supported by the project intervention team who provide ongoing mentoring. Although the initial recruitment and training of facilitators is time consuming (and accounts for the bulk of intervention delivery costs), it is a manageable and easily replicable activity that then forms the backbone of the intervention." (page 1242) 9.1b "To help promote local police department cooperation, a retired state trooper was hired as the project law enforcement liaison midway into the project. Furthermore, additional funds were secured to support project-related enforcement activities. The coordination of the liaison coupled with additional funding significantly enhanced the quantity of project-related enforcement efforts." (page 5)

How welldelivery
Describe fidelity of the intervention (i.e. the extent to which the intervention was delivered as intended) 9.2a "Early compliance with the Scottish legislation was high. Two weeks after implementation of this legislation, the levels of secondhand smoke in bars had decreased by 86%." (page 488) 9.2c "All 32 schools completed the trial. All schools in the intervention group completed or nearly completed the whole programme and the quality of delivery in all schools was at or above the established appropriate level (appendix). 629 (93%) of the 676 children in the intervention group were categorised as compliers (ie, they received at least four of the five drama sessions and the one-to-one goal-setting discussion in phase 3). No notable differences in uptake were seen between the two cohorts (appendix). 353 (52%) of the 676 children had family attending at least one parent event and 652 (96%) children set goals with the HeLP coordinator in phase 3. 411 (63%) of these 652 children had parental support, shown by a parent signature on the goal-setting sheet or written comments about how the parent would support the child in achieving their goals." (page 38)