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.

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.

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.

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.)

This criterion was established for the scientific validation of medications. It is impossible to think that psychotherapy led by a psychologist or a diet plan supervised by a dietitian can be concealed from a study participant. Every effort has been made to establish the best causal link between the proposal of a practice and its effects on health, taking into account the specificities of NPI without compromising the expected rigor and ethics of health research. Our recommendations aim to minimize biases and enhance validity and reproducibility. However, this will never prevent some individuals or promoters from committing fraud. Given the lower health risks of NPI compared to rapid-action health products (such as surgery, fast-acting medications, or implantable medical devices) and their potential interest in prevention, pragmatic real-world trials or effectiveness studies best address the consideration of risks. Additionally, the evaluation of an NPI has justified conducting an implementation study within the specific country to avoid extrapolating results from one cultural context to another.

The term non-pharmacological intervention (NPI) was not chosen by the scientific society NPIS but has become necessary. It has been used by scientists since 1975. Various authorities and agencies have adopted it, including the World Health Organization since 2003, the French National Authority for Health since 2011, the National Solidarity Fund for Autonomy since 2014, the Ministry of Health since 2018, the High Council for Public Health since 2019, the European Centre for Disease Prevention and Control since 2020, the General Inspectorate of Social Affairs since 2022, the Economic, Social and Environmental Council since 2023, and Health Insurance since 2024. Many national and supranational scientific societies use the term NPI in their recommendations. These health solutions are often "squeezed" between health products and public health measures, despite efforts by professionals to raise awareness and recognition of them. They represent an underestimated area of intangible services situated between goods (e.g., medications, medical devices) and general public health recommendations (e.g., dietary rules, hygiene measures, environmental actions).

They can be lost in compilations of health solutions that mix health promotion actions with targeted programs or confuse methods for identifying a health problem with methods for resolving it. The challenge is to improve the traceability of practices for continuous enhancement of their quality, safety, implementation, and training. These practices can be easily shared from one country to another. The term NPI does not imply "anti-medication" or "alternative medicine" (parallel medicine). Instead, it draws from the rigor of the globally standardized drug validation process to establish good scientific and clinical practices. Over time, we believe that the abbreviation NPI will come to be more widely recognized than its full title, similar to WHO, IBM, SEAT, and many others.

Registers of non-pharmacological practices with imprecise criteria and boundaries.
Catalogs compile various health practices among which NPI may be submerged. Some target the general population, while others are more specific. The selection criteria are heterogeneous, and objectives and practical modalities vary widely. Three examples include two from the United States (EBCCP and Mindtools) and one from France (Capitalisation Santé).