PSYCHOSOCIAL DOMINANCE

Psychotherapies:

• Cognitive Stimulation Therapy for memory strategies in Alzheimer’s disease in 14 sessions by a psychologist in a healthcare facility, health center, or private practice.
• Mindfulness Based Stress Reduction (MBSR-BC) program against anxiety during cancer treatments in 8 group sessions by a clinical psychologist, psychiatrist, or physician in an oncology department, a patient association, a private practice, a health center, or a healthcare facility.
• Acceptance and Commitment Therapy for chronic pain in 9 group sessions by a clinical psychologist or psychiatrist in a healthcare facility, health center, or private practice.
• Cognitive Behavioral Therapy for Insomnia (CBT-I) in 6-8 individual sessions, either remote or in-person, by a neuropsychologist, clinical psychologist, psychiatrist, or neurologist in a healthcare facility, health center, or private practice.
• Now I Can Do Heights program using virtual reality to treat acrophobia (fear of heights) by a clinical psychologist or psychiatrist in a private practice or health center.

Health Prevention Programs:

• Living Well with COPD therapeutic education program against symptoms and exacerbations of COPD over 2 months with 4 sessions, in-person or remote, by a nurse, physician, or pharmacist in a healthcare facility, health center, or private practice.
• CHESS Method (Chronic Headache Education and Self-management) for migraine self-management by a nurse or physician in a healthcare facility, health center, or private practice.
• MyFriend Youth Program for preventing anxiety and depression among students aged 12 to 15 years, 10 sessions by a school psychologist or school nurse in an educational institution.
• Spiegel Hypnotherapy Method specialized in smoking cessation in 3 sessions by a psychologist, nurse, physician, or hypnotherapist in a private practice, healthcare facility, health center, or private practice.
• Cognitive Behavioral Therapy for Depression (CBT-d) by a clinical psychologist or psychiatrist in a healthcare facility, health center, or private practice.

CORPOREAL DOMINANCE

Physiotherapy Protocols:

• McKenzie Method for back pain by a physiotherapist in a healthcare facility, health center, or private practice.
• Pelvic Floor Muscle Training (PFMT) program by a midwife or physiotherapist in a health center or private practice.
• Rehabilitation program following hip prosthesis in 6 to 10 sessions by a physiotherapist in a healthcare facility, health center, or private practice.

Adapted Physical Activity Programs:

• Dance Therapy for Parkinson’s Disease addressing psychological symptoms of Parkinson’s by a physical activity instructor in a healthcare facility, health center, or private practice.
• Re-exercise program at ventilatory threshold against dyspnea caused by COPD by a physical activity instructor or physiotherapist in a healthcare facility, health center, or private practice.
• Anti-fatigue APA program during treatments for breast, prostate, or colon cancer by a physical activity instructor in a healthcare facility, health center, or private practice.

Thermal Treatments:

• Specialized thermal cure for gonarthrosis by a physiotherapist or thermal agent in a thermal facility.

NUTRITIONAL DOMINANCE

• Gluten-free diet for celiac disease by a dietitian in a healthcare facility, health center, or private practice.
• FODMAP diet for gastrointestinal disorders by a dietitian in a healthcare facility, health center, or private practice.

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.

Accessible Protocols in Consultation

• Enhanced Quality and Safety: Strengthens the quality and safety of existing practices through formalization, harmonization, and securitization.
• Integration with Professional Software: Codified NPI can be integrated into healthcare management software.
• Digital Documentation: Access to documentation from computers, tablets, or smartphones for ease of use.
• Broad Validation: Extends validation to all relevant professionals in the region.
• Quick and Easy Access: Facilitates rapid access to information at critical decision-making moments for prevention and care.
• Simplicity in Tracking: Eases the follow-up and evolutionary process of best implementation practices (e.g., identifying barriers, professional leadership, availability of training and support).

Quality Control and Adherence to Protocols

• Traceability: Utilizes unique coded protocols for tracking.
• Strengthened Care Link: Enhances the relationship between care provision and patient support.
• Monitoring Relevant Indicators: Provides tools for tracking key performance indicators.
• Continuous Education Tool: Serves as a resource for ongoing professional development.
• Regular Updates: Incorporates regular updates based on user feedback.

Means of Valuation

• Response to Identified Multidisciplinary Issues: Addresses problems identified by healthcare teams in a specific territory.
• Extended Roles for Various Professionals: Expands the roles of many professionals, particularly non-physicians.
• Elimination of Ineffective Protocols: Phases out protocols that are ineffective, hazardous, or costly.
• Reduction in Meeting Time: Decreases the need for multiple meetings focused on intervention planning.
• Support for Innovation: Encourages professionals to experiment with new practices, boosting their confidence.
• Financial Valuation: Ensures appropriate financial and resource allocation for effective implementation.

A scientific validation model for medications has existed since the 1960s, with specific regulations recognized worldwide (e.g., FDA, EMA, ANSM). A similar procedure has recently been implemented for medical devices in Europe. However, until now, no consensual model existed for nutritional, bodily, and psychosocial health services due to confusions between approach, protocol, and technique/ingredient. A participatory, pragmatic, and multidisciplinary consensus work followed international scientific health recommendations to address this for NPI (Ninot et al., 2023).

This work took into account the specificities of NPI, health risks, the balance between internal and external validity, the justification of explanatory mechanisms, ethical considerations in health, and respect for contexts of use. The NPIS Model accelerates research through the harmonization of methodological and ethical expectations in NPI. It also enhances the identification, referencing, transferability, and implementation of NPI for the benefit of user health and safety, improving the quality of training.

Ultimately, the NPIS Model distinguishes between individualized, science-based services aimed at addressing known health issues in Western medicine and occupational practices (lifestyle, art of living, work, sociocultural activity, personal development, pursuit of happiness, spiritual practice, etc.). In this sense, the model does not impede individuals' freedom to choose a particular lifestyle. It aims to address a specific health issue for an individual or a group of people within a limited timeframe and a framework regulated by the health sector. The NPIS Model encourages innovations across all other health sectors, particularly in health organizations and early identification actions for health problems.

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.

Moving, eating, drinking, sleeping, talking, reading, writing, painting, listening to music, watching a movie, dancing, laughing, walking, singing, meditating, gardening, socializing, etc., are all activities of daily life. Some of these can generate joy, pleasure, personal growth, and well-being. In a democratic country, everyone is free to interpret and experience these activities in their own way. This relates to life philosophy, lifestyle, the art of living, and personal development. In other words, a daily activity is not an intervention, even if it can occasionally and randomly contribute to the health of certain individuals. Occupational activities and treatments for health problems identified by medicine are different.

The following products are not considered NPI:

• Hygiene and beauty products (shampoo, toothpaste, brush, body cream, etc.)
• Natural products (plants, food, mushrooms, essential oils, etc.)
• Health products (medications, implantable biological materials, dietary supplements, etc.)
• Medical devices (artificial organs, prosthetics, orthotics, digital applications, monitoring systems, etc.)

The following goods and services are not considered NPI:

• Cultural products or services (video games, books, podcasts, artistic practices, museum visits, theater, writing, etc.)
• Everyday consumer products or services (haircuts, aesthetic treatments, dining out, etc.)

The following actions are not considered NPI:

• Public health promotion activities (communication campaigns, videos, posters, booklets, websites, social media posts, etc.)
• Architectural adaptations (creating access ramps, etc.)
• Environmental adaptations (reforestation of a park, creation of a sports workshop, etc.)

The following approaches are not considered NPI:

• Professional disciplines (physiotherapy, psychology, dietetics, public health, etc.)
• Educational approaches (personal development, etc.)
• Esoteric practices (spiritual practices, religious worship, divination, witchcraft, etc.)

The following organizations are not considered NPI :

• Health organizations (networks, platforms, clinics, health centers, healthcare establishments, etc.)
• Health systems (digital platforms, etc.)

The following measures are not considered NPI :

• Health policies (strategies, plans, programs, etc.)
• Regulations (decrees, laws, etc.)
• Judicial decisions (warnings, convictions, etc.)