As of April 2019, there were 46 evaluation models for NPI in the scientific literature (Carbonnel and Ninot, 2019). These models were constructed by researchers for researchers, often from a monodisciplinary perspective and rarely from a patient-centered approach. This led to significant heterogeneity in study protocols and the way NPI were conceived (approach, method, technique, or materials). The results were scattered, debatable, poorly transferable, and rarely reproducible. Consequently, these practices were not widely recognized outside the study context (dependent on the establishment and/or practitioner). This situation raised doubts about their effectiveness (e.g., efficacy, safety, relevance, utility, cost-effectiveness), their content (e.g., heterogeneity in doses, procedures, ingredients, techniques, contexts, target populations), their approval (e.g., ethics committees), their dissemination (e.g., conflicting reviewer opinions), their teaching (e.g., protocols, best practices), and their recognition (e.g., authorization, integration into official classifications, reimbursement). This lack of a consensual evaluation model for NPI suggested that each professional had to reinvent their program for every new patient, given the wide or contradictory recommendations from authorities, agencies, and scientific societies. It also implied that only the patient-provider relationship mattered in the health effects induced (Ninot, 2020). Moreover, it left the door open for pseudoscientific practices and, more broadly, parallel medicine, along with all the obscurantist, health-related, sectarian, political, and judicial issues that are known in France (Miviludes, 2022; CNOI, 2023; CNOM, 2023) and around the world (Ernst and Smith, 2018). This idea was also gaining traction in the United States in the field of oncology, aiming to juxtapose two medical offerings: one based on experimental science, primarily focused on surgery, medication, radiotherapy, and medical devices, and the other described as "complementary, integrative, or traditional," based on individual experience, opinions, and traditions (Mao et al., 2022). This second offering claimed exclusivity in the domains of prevention and care, emphasizing care for the person versus cure for the disease. Thus, the NPIS Model was co-constructed with the idea that experimental science could demonstrate the existence of effective, safe, and reproducible prevention and care protocols. This work was supported by seed funding for participatory research from INSERM and involved over 1,000 participants under the guidance of a committee of 22 multidisciplinary experts, including two user representatives. This transdisciplinary innovation is currently supported by 30 French scientific societies, the National Center for Palliative Care and End of Life, INCa, and the French Platform for Clinical Research Networks.

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).

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.

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.