Development and application of the DePtH framework for categorising the agentic demands of population health interventions

The ‘agentic demand’ of population health interventions may influence intervention effectiveness and equity, yet the absence of an adequate framework to classify agentic demands limits the fields’ advancement. We systematically developed the DEmands for PopulaTion Health Interventions (DePtH) framework identifying three constructs influencing agentic demand - exposure (initial contact with intervention), mechanism of action (how the intervention enables or discourages behaviour), and engagement (recipient response), combined into twenty classifications. We conducted expert qualitative feedback and reliability testing, revised the framework and applied it in a proof-of-concept review, combining it with data on overall effectiveness and equity of dietary and physical activity interventions. Intervention components were concentrated in a small number of classifications; DePtH classification appeared to be related to intervention equity but not effectiveness. This framework holds potential for future research, policy and practice, facilitating the design, selection, evaluation and synthesis of evidence.