Making integration foundational in population health intervention research: why we need ‘Work Package Zero’

M. Alvarado*, T. L. Penney, C. C. Astbury, H. Forde, M. White, J. Adams

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives: We aimed to identify when and how integration should take place within evaluations of complex population health interventions (PHIs). Study design: Descriptive analytical approach. Methods: We draw on conceptual insights that emerged through (1) a working group on integration and (2) a diverse range of literature on case studies, small-n evaluations and mixed methods evaluation studies. Results: We initially sought techniques to integrate analyses at the end of a complex PHI evaluation. However, this conceptualization of integration proved limiting. Instead, we found value in conceptualizing integration as a process that commences at the beginning of an evaluation and continues throughout. Many methods can be used for this type of integration, including process tracing, realist evaluation, congruence analysis, general elimination methodology/modus operandi, pattern matching and contribution analysis. Clearly signposting when integrative methods should commence within an evaluation should be of value to the PHI evaluation community, as well as to funders and related stakeholders. Conclusions: Rather than being a tool used at the end of an evaluation, we propose that integration is more usefully conceived as a process that commences at the start of an evaluation and continues throughout. To emphasize the importance of this timing, integration can be described as comprising ‘Work Package Zero’ within evaluations of complex PHIs.

Original languageEnglish
Pages (from-to)1-4
Number of pages4
JournalPublic Health
Publication statusPublished - Oct 2022
Externally publishedYes

Bibliographical note

Funding Information:
MA, HF, MW and JA are supported by the Medical Research Council (MRC) Epidemiology Unit, University of Cambridge [grant number MC/UU/00006/7 ]. MW and JA hold grants for evaluations of complex interventions from the National Institute of Health Research (PHR 16/130/01) and Biology and Biotechnology Research Council (BB/V004832/1), which also fund HF. MA is supported by the Wellcome Trust (218629/Z/19/Z), and TP and CA acknowledge research support from York University.

Publisher Copyright:
© 2022 The Author(s)


  • Evaluation
  • Integration
  • Policy
  • Population health interventions
  • Public health


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