Skill-Mix Changes Targeting Health Promotion and Prevention Interventions and Effects on Outcomes in all Settings (Except Hospitals): Overview of Reviews

Claudia Bettina Maier; Juliane Winkelmann; Laura Pfirter; Gemma A Williams

doi:10.3389/ijph.2023.1605448

Skill-Mix Changes Targeting Health Promotion and Prevention Interventions and Effects on Outcomes in all Settings (Except Hospitals): Overview of Reviews

Int J Public Health. 2023 May 9:68:1605448. doi: 10.3389/ijph.2023.1605448. eCollection 2023.

Authors

Claudia Bettina Maier¹, Juliane Winkelmann², Laura Pfirter¹, Gemma A Williams³

Affiliations

¹ Department of Health Care Management, Faculty of Economics and Management, Technical University Berlin, Berlin, Germany.
² European Observatory on Health Systems and Policies, Brussels, Belgium.
³ European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, United Kingdom.

Abstract

Objectives: Skill-mix changes to step up health promotion and prevention are increasing, but there is limited evidence on their effects. Methods: Overview of reviews, based on a protocol. The search was carried out in six databases, screening was performed ensuring high interrater reliability. All countries, health professions and lay workers in all settings (except hospitals) were included, quality appraisals performed. Results: A total of 31 systematic reviews were included. Expanded roles performing outreach (e.g., home visits) had mostly positive effects on access and health outcomes, primarily for hard-to-reach groups. Task-shifting in colorectal or skin cancer screenings (performed by advanced practice nurses) were suggested effective; supporting roles (by community health workers) increased uptake in screenings, but based on limited evidence. Expanded roles of various professions focusing on lifestyle modification showed promising effects in most reviews, including weight, diet, smoking cessation and physical activity. Reviews on cost-effectiveness were based on limited evidence. Conclusion: Promising skill-mix changes included expanded roles providing lifestyle modifying interventions, task-shifting, and outreach roles for hard-to-reach groups, whereas evidence on costs was limited.

Keywords: health promotion; outcomes; outreach; prevention; role expansion; skill-mix; task-shifting.

Publication types

Review

MeSH terms

Diet*
Exercise
Health Promotion* / methods
Hospitals
Humans
Reproducibility of Results

Grants and funding

This research was financially supported by the UK Health Foundation. The funder had no role in the study design, analysis or write-up of the results. Open Access funding was enabled and organized by the European Observatory on Health Systems and Policies.