Evaluation procedures for heat-health action plans in Germany are rarely systematically realized in practice, according to a qualitative study of professionals working in heat and health protection. Researchers interviewed 23 experts with leadership or specialist responsibility in public administration at district, federal state and national level, and in nongovernmental organizations, and found that although every interviewee considered evaluation important, formal evaluation procedures were rarely realized in practice. The study, published in BMC Health Services Research, used the COM-B model of behaviour to organize what helps and what blocks evaluation, and grouped those factors into individual, organizational and policy levels.
Extreme heat and heat waves are increasing in intensity, duration and frequency, and the World Health Organization recommends heat-health action plans as a tool for public health protection. Districts and federal states in Germany have begun implementing such plans. Yet reports on ongoing evaluations, and evidence on the effectiveness and efficiency of planned or implemented measures, remain scarce.
To understand why, the research team conducted thematic analysis with a hybrid combination of deductive and inductive coding within the COM-B model. They then clustered the resulting facilitators and barriers using the Socioecological Model. The analysis showed that barriers to evaluating heat-health action plans are not primarily related to individual- or district-level motivation.
Individual motivation was not reported as a reason for failing to evaluate. Instead, evaluation is limited by opportunity and capability that are shaped within political and institutional conditions. Interviewees emphasized the importance of political support, as well as a clear mandate and assignment for evaluation.
Structural conditions were reported to often hinder evaluation. The absence of guidelines and standards for evaluation, inadequate data infrastructure, insufficient personnel and limited funding were all reported to hinder evaluation efforts. This was reported to result in limited experience and knowledge in evaluating complex interventions such as heat-health action plans.
The researchers report that a combination of identified barriers, rather than any single deficiency, often contributed to professionals feeling overwhelmed with the task of evaluation.
The findings suggest that evaluation is not consistently institutionalized in German heat-health action planning. To institutionalize evaluation within German heat-health action planning, the authors identify a need for greater political commitment, supportive structures, data infrastructures and guidance for evaluation, as well as targeted funding and personnel.
The study is qualitative and based on interviews with 23 professionals throughout Germany, so it captures perceived facilitators and barriers rather than measured evaluation outcomes.
Subject of Research: Barriers to and facilitators of evaluating heat-health action plans in Germany
Article Title: Bridging the evidence gap: a qualitative COM-B analysis of facilitators and barriers to evaluating heat-health action plans in Germany
Article References: Lintener, H., Hoeppe, A., Andreas, M., Kellermann, L., Busalt, S., Schäfer, P., & Sniehotta, F. F. (2026). Bridging the evidence gap: a qualitative COM-B analysis of facilitators and barriers to evaluating heat-health action plans in Germany. BMC Health Services Research, 26(1), Article 1513. https://doi.org/10.1186/s12913-026-15869-1
Image Credits: AI Generated
DOI: 10.1186/s12913-026-15869-1
Keywords: heat-health action plans, Germany, evaluation, COM-B model, public health, extreme heat, qualitative interviews, health services research, political support, data infrastructure, funding, Socioecological Model
Tags: COM-B modeldata infrastructureevaluationExtreme HeatfundingGermanyhealth services researchheat-health action planspolitical supportPublic Healthqualitative interviewsSocioecological Model
