AUTHOR=Maier Claudia Bettina , Winkelmann Juliane , Pfirter Laura , Williams Gemma A. 

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

JOURNAL=International Journal of Public Health

VOLUME=Volume 68 - 2023

YEAR=2023

URL=https://www.ssph-journal.org/journals/international-journal-of-public-health/articles/10.3389/ijph.2023.1605448

DOI=10.3389/ijph.2023.1605448

ISSN=1661-8564

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. Systematic reviews covering all professions or lay workers in all settings were included (except hospitals) and quality appraisals performed. 
Findings. 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, in particular for hard-to-reach groups. Advanced practice nurses performing colorectal and skin cancer screenings were suggested to be safe and effective if adequately educated, but based on limited evidence. Expanded roles of various professions focusing on behaviour change showed promising effects on several outcomes in the majority of the reviews, including weight, diet, smoking cessation and physical activity. Reviews on cost-effectiveness were based on limited evidence. 
Conclusion. Promising skill-mix innovations included expanded roles providing lifestyle modifying interventions, and outreach roles for at-risk or vulnerable groups, whereas evidence on costs was limited.