When and how do ‘effective interventions need to be adapted and/or re-evaluated in new contexts? The need for guidance

Rational models of evidence-informed policy have historically centred on an assumption that it is possible to identify ‘effective’ interventions, before recommending wider implementation. However, for population health interventions (which we define as inclusive of public health and health services), transferability to new contexts is often uncertain.1 Some interventions have demonstrated limited effectiveness, or even harm, when used elsewhere. For example, antenatal corticosteroids have reduced neonatal mortality among pregnant women at risk of preterm birth in high-income countries, but increased mortality and maternal infection in low-income and middle-income countries.2

While definitions are contested, context can be defined as a set of active and unique characteristics and circumstances that interact with, modify, facilitate or constrain intervention delivery and effects. It includes geographical, epidemiological, sociocultural, socioeconomic, ethical, legal and political determinants.3 The argument that every context is unique and interventions cannot translate across them should not be overstated…

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