Hoddinott et al. BMC Public Health 2010, 10:800 http://www.biomedcentral.com/1471-2458/10/800 C O R R E S P O N D E N C E Open Access Group interventions to improve health outcomes: a framework for their design and delivery Pat Hoddinott1*, Karen Allan2†, Alison Avenell1†, Jane Britten3† Abstract Background: Delivering an intervention to a group of patients to improve health outcomes is increasingly popular in public health and primary care, yet “group” is an umbrella term which encompasses a complex range of aims, theories, implementation processes and evaluation methods. We propose a framework for the design and process evaluation of health improvement interventions occurring in a group setting, which will assist practitioners, researchers and policy makers. Methods: We reviewed the wider literature on health improvement interventions delivered to patient groups and identified a gap in the literature for designing, evaluating and reporting these interventions. We drew on our experiences conducting systematic reviews, intervention, mixed method and ethnographic studies of groups for breastfeeding and weight management. A framework for health improvement group design and delivery evolved through an iterative process of primary research, reference to the literature and research team discussion. Results: Although there is an extensive literature on group processes in education, work, politics and psychological therapies, far less is known about groups where the aim is health improvement. Theories of behaviour change which are validated for individual use are often assumed to be generalisable to group settings, without being rigorously tested. Health improvement or behaviour change interventions delivered in a group setting are complex adaptive social processes with interactions between the group leader, participants, and the wider community and environment. Ecological models of health improvement, which embrace the complex relationship between behaviour, systems and the environment may be more relevant than an individual approach to behaviour change. Conclusion: The evidence for effectiveness and cost-effectiveness of group compared with one-to-one interventions for many areas of health improvement in public health and primary care is weak or unknown. Our proposed framework is the first step towards advocating a more systematic approach to designing, evaluating and reporting interventions in group settings, which is necessary to improve this currently weak evidence base. This framework will enable policy makers and practitioners to be better informed about what works, how it works and in which contexts when aiming to improve health in a group setting. Background Groups are an alternative to individual encounters for health improvement, social support and changing beha- viour, for example: smoking cessation [1]; weight loss [2]; parentcraft [3]; and self care for chronic conditions like diabetes [4] and osteoarthritis [5]. Such groups are evol- ving rapidly in response to cultural, epidemiological and environmental change, for example recent increases in * Correspondence: p.hoddinott@abdn.ac.uk † Contributed equally 1Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK Full list of author information is available at the end of the article cardiac rehabilitation groups [6], the expert patient pro- gramme led by trained patients with personal experience of a condition [7] and virtual internet self-help groups [8]. However the evidence for health improvement inter- ventions delivered in group settings is dispersed through several systematic reviews of specific lifestyle behaviours, most of which focus on individual behaviour change interventions and theory. In our experience researching breastfeeding support and weight management groups since 2000 and 2002 respectively, we were surprised by the lack of guidelines for designing, evaluating or report- ing health improvement interventions in group settings. © 2010 Hoddinott et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.