Each NPI file in the NPI Registry has been submitted by a practitioner or researcher through the dedicated platform hosted by the NPIS. Each file undergoes review by an independent and integrated scientific committee. This committee invites relevant scientific societies and health authorities to validate the NPI files and/or to oversee the decisions made. Each validated file is then reviewed by a committee of users and professionals. Once labeled NPIS©, the file is translated into at least English and French and integrated into the NPI Registry.

The file contains standardized content supported by scientific studies that align with the NPIS definition of NPI, the expected specifications (Table 2), and the consensual evaluation framework for NPI, known as the NPIS Model. It includes a manual for professionals, an information notice for users, a section on funding options, and an area for anonymous user feedback. This ensures the file remains dynamic and part of a virtuous cycle of continuous improvement for the NPI.

A minimum of one prototypical study, one mechanistic study, two interventional studies, and one implementation study published in a peer-reviewed journal is required for an NPI proposal to be accepted by the expert committee tasked with validating the NPI file and awarding the NPIS© label. Specifically, experts must have evidence to anonymously vote on each criterion of the NPI file proposed to the NPIS by a submitter:

• Described (≥ 1 prototypical study)
• Explainable (≥ 1 mechanistic study)
• Effective (≥ 2 interventional studies)
• Safe (≥ 2 interventional studies)
• Implementable (≥ 1 implementation study in the country)

A professional must understand all the specifics of the NPI, the criteria justifying its use, how to implement its protocol, whom to contact, useful tips, required materials, and any prerequisite training needed.

In France, the term "professional" is broader than the term "practitioner," which is limited to the 24 healthcare professionals defined in the Public Health Code (CSP). For example, a clinical psychologist and a teacher in adapted physical activity (APA) are professionals who work for the health of individuals by offering NPI for preventive or therapeutic purposes, but they are not considered "health professionals" in the strict sense of the CSP. Some professions fall under the Social Action and Families Code (e.g., specialized educator) or the Sports Code. In Europe and worldwide, the issue becomes more complex because health-related professions do not share the same designations. For instance, "masseur-kinésithérapeute" in France is referred to as "physiotherapist" in most other countries. NPI can serve as common denominators across countries, as they will have a unique code and specification sheet.

The term NPI has been used by scientists working in the health field since 1975. However, it is not the only term; other similar terms are used synonymously, especially in PubMed. There are ten English terms to describe non-pharmacological processes and twenty-eight to describe methods of operation. An exhaustive inventory of NPI on a scientific article search engine is currently impossible due to the variety of terms researchers use, each with distinct meanings: rehabilitation intervention, psychosocial intervention, mental intervention, cognitive intervention, psychological intervention, behavioral intervention, psychosomatic intervention, nutrition intervention, dietary intervention, food intervention, physical intervention, body intervention, exercise intervention, manual intervention, salutogenic intervention, natural intervention, self-help intervention, nursing intervention, therapy intervention, care intervention, disease management intervention, multimodal intervention...

A search on PubMed from August 15, 2024, indicates 55,689 articles citing the term "non-pharmacological" or its equivalent up to 2023. While these figures do not challenge the trend, they are likely underestimated due to the database's focus on health products rather than services, biological treatments over psychosocial ones, studies on North American populations, and journals published by North American organizations. This aligns with an official U.S. government site managed by the National Center for Biotechnology Information and hosted by the National Library of Medicine, part of the National Institutes of Health (NIH).

A search on PubMed from August 15, 2024, also reveals 11,642 articles citing the term "non-pharmacological intervention" or its equivalent up to 2023. Both curves demonstrate an increase since 2000, with a notable acceleration since 2010.

The French National Authority for Health has been encouraging the use of the term NPI in health since 2011.

NPI are protocols to be implemented with a target population, but they are merely specifications. They must be contextualized and personalized. The NPI Registry offers best practices and tips for optimal implementation. Furthermore, the NPIS recommends interdisciplinary training in health ethics for their application. The scientific society works with its partners to develop and recognize this foundational training, which could be conducted particularly in higher education institutions in collaboration with the Ministry of Health. This ethical training includes all the prerequisites of knowledge, skills, and attitudes necessary for interprofessional practice in health. Health professionals with practical experience, such as doctors, will have equivalencies.

The NPIS has outlined a roadmap from 2021 to 2030 aligned with the strategies of European and international health institutions. To this end, it has initiated discussions with the European Public Health Association (EUPHA), involved in health service innovation, the European Centre for Disease Prevention and Control (ECDC), which is planning to create a registry, the European Commission, which aims to promote "health, nutrition, mental health, and psychosocial support to communities," and WHO Europe, which intends to identify the "most effective health interventions" by 2030. The NPIS submitted several European projects in 2024.

The NPIS is also engaging with WHO, which has advocated for "self-care interventions" since 2022, included NPI in its Global Action Plan for Mental Health published in 2022, and identified "the most effective and feasible interventions in a national context" in a report published in 2021. Additionally, it is collaborating with other international organizations such as UNESCO, which has promoted "specific health and well-being education interventions" since 2016, UNICEF, which has advocated for sharing "effective health interventions" since 2016 and developing "primary healthcare" since 2018, the UN, which has called for "accelerating essential health services" since 2023, and the Coalition of Partnerships for Universal Health Coverage and Global Health, advocating for "people-centered, comprehensive, and integrated services" since 2021.

Thus, an ecosystem for NPI, from research to practice through training and delivery, is being constructed, with NPIS actively participating. It involves all stakeholders, both academic and non-academic, to create a true value chain benefiting personalized and precision medicine based on science, sustainable health, and equitable longevity. With over 2.1 billion people aged over 60 by 2050, multistakeholder collaborations will be the foundation of a sustainable and equitable longevity economy.

This is why forums on NPI have been organized since 2024 in France and Europe, called NPIS Forum. An international summit titled NPIS Summit takes place every year in October, and regional events called NPIS Satellite gather professionals and users around a health theme.

An alliance for NPI is essential today in response to siloed proposals from various disciplines (biology, psychology, public health), professions (medical, paramedical, educational, social), sectors (prevention, care, support for autonomy, social services, education, end-of-life care, disability), and currents (traditional or scientific medicine) at both national and supranational levels. The NPIS brings together these scattered and sometimes divided stakeholders to foster better understanding, practice, and recognition of NPI. The scientific society contributes to developing an NPI ecosystem that is often overlooked. It mobilizes hundreds of professionals and users worldwide to address the public health challenges of the 21st century that are widely recognized.

It highlights essential NPI and best practices to be delivered to the right people at the right time in their journey without criticizing other health solutions. Specifically, the NPIS enables:

• Research stakeholders to develop, evaluate, and promote NPI.
• Care, prevention, and social support professionals to enhance their skills and access best practice recommendations and implementation tools for NPI.
• Health operators to choose, organize, track, consolidate, secure, and sustain investments in NPI.
• National and supranational health agencies to improve their knowledge for designing effective strategies regarding NPI.
• Governments, non-governmental organizations, user associations, and health actor federations to establish a common language within a defined scope to create just, equitable, and sustainable policies.

After establishing a standardized evaluation model, the NPIS contributes to an interprofessional, intersectoral, and bipartisan alliance in favor of NPI. Through an annual global summit, it gathers all stakeholders in the ecosystem during the third week of October, known as the NPIS Summit. This significant event discusses the economic and regulatory structuring of the ecosystem with all parties involved. The 2024 edition will take place in a highly symbolic venue, the Cité Universitaire in Paris, a quintessential humanist space open to the world, science, and peace, created between the two world wars last century. Everyone can participate and contribute to this international dynamic aimed solely at legitimizing NPI within health system offerings without disparaging other solutions. This coalition is called the NPIS Alliance.