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Population health intervention research (PHIR) seeks to develop and evaluate policies, programmes and other types of interventions that may affect population health and health equity. Such interventions are strongly influenced by context – taken to refer to any feature of the circumstances in which an intervention is conceived, developed, implemented and evaluated. Understanding how interventions relate to context is critical to understanding how they work; why they sometimes fail; whether they can be successfully adapted, scaled up or translated from one context to another; why their impacts vary; and how far effects observed in one context can be generalised to others. Concerns that context has been neglected in research to develop and evaluate population health interventions have been expressed for at least 20 years. Over this period, an increasingly comprehensive body of guidance has been developed to help with the design, conduct, reporting and appraisal of PHIR. References to context have become more frequent in recent years, as interest has grown in complex and upstream interventions, systems thinking and realist approaches to evaluation, but there remains a lack of systematic guidance for producers, users and funders of PHIR on how context should be taken into account. This document draws together recent thinking and practical experience of addressing context within PHIR. It provides a broad, working definition of context and explains why and how context is important to PHIR. It identifies the dimensions of context that are likely to shape how interventions are conceptualised, the impacts that they have and how they can be implemented, translated and scaled up. It suggests how context should be taken into account throughout the PHIR process, from priority setting and intervention development to the design and conduct of evaluations and reporting, synthesis and knowledge exchange. It concludes by summarising the key messages for producers, users and funders of PHIR and suggesting priorities for future research. The document is meant to be used alongside existing guidance for the development, evaluation and reporting of population health interventions. We expect the guidance to evolve over time, as practice changes in the light of the guidance and experience accumulates on useful approaches. The work was funded by the Canadian Institutes of Health Research (www.cihr-irsc.gc.ca) – Institute of Population and Public Health (CIHR-IPPH) and the UK National Institute for Health Research (NIHR).

Background The nutrition and physical activity self-assessment for childcare (NAP SACC) intervention has demonstrated effectiveness in the USA. A feasibility randomised controlled trial was conducted in England to adapt the intervention to the UK context. An embedded process evaluation focused on three key questions. 1. Was it feasible and acceptable to implement the intervention as planned? 2. How did the intervention affect staff and parent mediators? 3. Were the trial design and methods acceptable? Methods Twelve nurseries in south-west England were recruited and randomised to intervention or control. The intervention comprised: NAP SACC UK Partner (Health Visitor) support to nurseries to review practice and policies against best practice, and then set goals to improve physical activity, nutrition and oral health; two staff training workshops; and a web-based parent support element. The process evaluation comprised: observations of Partner training (n = 1), Partner/manager meetings (n = 5) and staff workshops (n = 10); semi-structured interviews with Partners (n = 4), managers (n = 12), staff (n = 4) and parents (n = 20); analysis of self-assessment forms, goal setting forms and Partner logbooks; and assessment of staff and parent knowledge, motivation and self-efficacy mediators. Results Overall, NAP SACC UK was feasible to implement and acceptable to nursery staff, managers, Partners and parents. The intervention was implemented as planned in five of the six intervention nurseries. Partners and managers appreciated the opportunity to review and improve nursery practices and valued the relationship forged between them. Staff rated the training workshops highly, despite attending outside of working hours. Most goals set by nurseries were achieved. However, Partners raised concerns about Health Visitors’ capacity to deliver the intervention in any subsequent roll out. Mediator scores improved in all but two areas in intervention staff and parents, with decreases or minimal changes in the control group. The web-based parent element was not well used and should be removed from any subsequent trial. The trial methods were acceptable to managers, staff, Partners and parents. Conclusions Implementing and evaluating a physical activity and nutrition intervention in nursery settings is feasible and acceptable. A full RCT of NAP SACC UK (with appropriate modifications) is warranted. Trial registration ISRCTN16287377 (10 Apr 2015). Electronic supplementary material The online version of this article (10.1186/s12889-019-7102-9) contains supplementary material, which is available to authorized users.

Topic Guide. Guide for qualitative interviews. (DOCX 20 kb)

Additional file 1. The interview guide: What are the lived experiences of conservative treatment for patients with Posterior Tibial Tendon Dysfunction.

Glossary of school terms in England. (DOCX 14 kb)

Stakeholder Engagement Event. Qualitative feedback from initial dissemination of early findings. (DOCX 21 kb)

Table S1. Description of papers included in meta-ethnography. (DOCX 20 kb)

Spirit 2013 checklist. Recommended items to address in a clinical trial protocol and related documents. (DOC 125 kb)

SPIRIT Checklist. (DOC 121 kb)

Mentoring programmes are commonplace, yet little is known about the circumstances in which they operate. This study aimed to gain insight into the context surrounding youth mentoring programmes by asking programme managers and experts in the United Kingdom about their experiences. Telephone interviews with twenty-three programme managers and five experts were undertaken. Interviews were recorded, transcribed verbatim and analysed iteratively using thematic analysis. Contextual influences at the individual-, interpersonal-, organisational-, community-, policy-, and societal-level were identified to impact on programme's development, delivery and maintenance and were summarised in a model. This study further found that youth mentoring programmes operate within a complex context. This context provides challenges and opportunities that impact on programme's sustainability; resulting in many externally-funded programmes to ‘hang by a thread’. It is important for service providers, commissioners and academics to recognise the complexity surrounding mentoring programmes to ensure that programmes are delivered as intended and evaluated appropriately.

Aims: To assess how far motivation to reduce alcohol consumption in increasing and higher-risk drinkers in England predicts self-reported attempts to reduce alcohol consumption and changes in alcohol intake during the following 6 months. Methods: This study used self-reported data from 2928 higher-risk drinkers in the Alcohol Toolkit Study (ATS): a series of monthly cross-sectional household surveys of adults aged 16+ years of age in England. Alcohol consumption was measured in an initial survey and in a 6-month telephone follow-up interview using the Alcohol Use Disorders Identification Test (AUDIT)-C questionnaire. Motivation was measured in the initial survey using the Motivation to Reduce Alcohol Consumption (MRAC) scale. Attempts to reduce alcohol consumption during the past 6 months were recorded at follow-up. Data were analysed using repeated-measures difference-in-differences and logistic regression models. Results: Participants with higher initial motivation to reduce alcohol consumption were more likely to report that they had made an attempt to reduce consumption at follow-up [adjusted odds ratio (ORadj) = 2.39, 95% confidence interval (CI) = 1.75–3.29]. There was an overall reduction in alcohol consumption between initial survey and follow-up (ORadj = 0.72, 95% CI = 0.65–0.79), but there was insufficient evidence of an additional effect of motivation to reduce consumption on subsequent changes in alcohol consumption, with the difference-in-differences effect instead suggesting an average increase (ORadj = 1.37, 95% CI = 1.00–1.88). Conclusions: Increasing and higher-risk drinkers in England who report greater motivation to reduce their consumption are more likely to report making an attempt to reduce during the next 6 months, but this may not be associated with a reduction in alcohol consumption.

Positive youth development (PYD) often aims to prevent tobacco, alcohol, and drugs use and violence. We systematically reviewed PYD interventions, synthesizing process, and outcomes evidence. Synthesis of outcomes, published elsewhere, found no overall evidence of reducing substance use or violence but notable variability of fidelity. Our synthesis of process evaluations examined how implementation varied and was influenced by context.

BACKGROUND: Risk behaviours in adolescence are linked to poor educational attainment and health and other outcomes in young adulthood. We explored whether there are molecular mechanisms associated with the development, or the result, of multiple risk behaviours (MRBs).METHODS: MRBs (antisocial behaviour and delinquency, traffic-related risk behaviour, risky sexual behaviour, lack of exercise) and their sumscore were characterized based on self-reported questions at age 7 and 17 within the ARIES subsample of the ALSPAC birth cohort, and were linked to DNA methylation at over 485,000 CpG sites at ages 0,7 and 17. Associations were determined for participants with complete data (n = 227-575).RESULTS: There was weak evidence of associations between cumulative MRBs and methylation at cg01783492 and cg16720578 at age 17. DNA methylation at age 17 was associated with risky sexual behaviour (cg22883332), lack of exercise (cg03152353, cg20056908, cg20571116) and substance use (cg02188400, cg13906377). No associations between DNA methylation and individual risk behaviours at age 7 were observed. DNA methylation at age 7 might predispose for traffic-related risk behaviour (cg24683561) and substance use (cg08761410) at age 17.LIMITATIONS: Main limitations are absence of information on directly measured blood cell type proportions and tissue specificity, and a modest sample size.CONCLUSIONS: Cumulative MRB in late adolescence was associated with effects on DNA methylation. More specifically, risky sexual behaviour and sedentary behaviour are associated with changes in DNA methylation, while DNA methylation in childhood may predict later traffic-related risky behaviour. For substance use effects in both temporal directions were observed.

Synthesised theories of change for each individual intervention. (DOCX 1841Â kb)

EQ-5D-Y and QALYs results, by treatment arm. Baseline, Time 1 and Time 2 EQ-5D-Y results and corresponding QALY estimates, by treatment arm (DOCX 14 kb)

Example search strategy. (DOCX 123 kb)

Sensitivity analysis of evidence of promise for intervention effects on weekday MVPA at Time 1 and Time 2 using the imputed data set and complete data where accelerometer wear was one or more valid day. Sensitivity analysis of evidence of promise for intervention effects on weekday MVPA at Time 1 and Time 2 using the imputed data set and complete data where accelerometer wear was one or more valid day (DOCX 13 kb)

Consent form for â Positive Choicesâ student questionnaire. (PDF 140Â kb)

Consort 2010 extension for pilot and feasibility trials checklist. Completed CONSORT checklist (version adapted for reporting pilot and feasibility studies). (DOC 225 kb)

PRISMA Checklist. (DOC 412 kb)

Exploratory interaction of the intervention effect on weekday MVPA at Time 1 and Time 2 and peer supporter status. Exploratory interaction of the intervention effect on weekday MVPA at Time 1 and Time 2 and peer supporter status. (DOCX 13 kb)

Baseline descriptive statistics of peer-supporter and non-peer-supporter students. Descriptive data for peer-supporters and non-peer-supporters at baseline. (DOCX 15 kb)