Through decades of research on strategies to best support behavior change, it has become clear that systems- and policy-level interventions can have just as great an influence as individual-level interventions. This fact is particularly true on a population level and especially for situations in which individual behavior change is constrained by structural factors. However, rigorous evaluation of these systems- and policy-level interventions are less frequently found in the health and public health literature. Partly, this limited examination is related to the fact that interventions designed to change systems and policies occur far upstream. It may be challenging to examine in a single study all the links that create a chain from a policy change to a systems change to an individual behavior change and, finally, to an improved health outcome.
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Seligman HK, Hamad R. Moving Upstream: The Importance of Examining Policies to Address Health Disparities. JAMA Pediatr. 2021;175(6):563–564. doi:10.1001/jamapediatrics.2020.6985
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