Population Health Intervention Research Research Articles

2.K. Skills building seminar: Nutrition: A Challenge For The Intervention Research And Health Promotion

Abstract Cancer is the leading cause of death in Europe, the second in North America and it's estimated that 40% of cancers are preventable. Among these cancers, it's estimated that 10,8% are attributable to unbalanced diet (5.4%) and overweight (5,4%), and in addition, a smaller proportion is attributable to lack of physical activity (0,9%). In France, it's estimated that one in two people is overweight and particular attention is paid to young people. It's recognised that the risk of cancer can be reduced when the risk factor is known and acted upon: experience has shown that this knowledge is necessary but insufficient to know how to act. Population health intervention research (PHIR), a “solutions” science, fills this gap. It's concerned with the design, implementation, evaluation, adaptation, transferability and sustainability of interventions aimed at improving the health of populations, in order to produce valid knowledge with high potential for social and health impacts. This scientific approach apprehends interventions as “events in systems” and challenges the methodological hegemony imposed for many years by the biomedical sciences and especially epidemiology approach. Finally, this approach follows to act and intervene with and for the targeted populations, particularly people in vulnerable situations. Today, the development of PHIR in health promotion and in the field of cancer on the topic of nutrition, faces three major challenges: - Political; - Methodology; - Transferability. It's therefore proposed to give three complementary presentations directly addressing these issues on the topic of nutrition, each based on concrete examples of implementation in health promotion and in the field of cancer. The aim of this workshop is to offer a time for exchange and discussion on the challenges to be met in developing PHIR in health promotion - on the topic of nutrition - as an innovative model of research within an innovative paradigm shift. It will enable participants to clarify their conceptions of PHIR for the advancement of health promotion in oncology and to evolve these concepts in relation to these three key issues. An interactive format is proposed, including time for discussion based on participants’ perceptions and time for presentations. Key messages • PHIR: an effective scientific approach and a relevant tool for thinking about and developing health promotion policies on the topic of nutrition. • New research paradigm in health promotion and the fight against cancers, particularly linked to unbalanced diet and overweight, based on intervention with populations to act on the determinants of health.

DECLIC patient education program: assessment through a population health intervention research approach (LE DECLIC EPRI)

DECLIC patient education program: assessment through a population health intervention research approach (LE DECLIC EPRI)

Population Health Intervention Research, Health Technology Assessment, Health Services Research and Intervention Implementation Research:Convergences and Singularities

In public health, intervention is an object of research and evaluation which, over time, has given rise to numerous approaches. The first part of the article proposes to reposition intervention research in population health and intervention evaluation on a continuum. Although the former has a more cognitive objective and the latter a more pragmatic objective, they are not mutually exclusive. The distinction between these two practices is based on the predominance of the following characteristics: the objectives pursued, the scope of the investigations, the regulatory constraints, the financing obtained, the ethical approaches taken, and the deliverables established. The second part of the article offers a glance different fields and approaches within the continuum between these two poles: Health Technology Assessment, Health Services Research and Implementation Research. While all of them have the study of health interventions at their core, but each has developed through specialisation in one or the other type of intervention, in a particular scope or context, in certain evaluation questions, or in specific approaches. all as gateways to the study of public health intervention, these different approaches are by no means mutually exclusive.

Evaluating population health interventions:The contributions of theory-driven evaluations

Population health intervention research has been characterized by the deployment of scientific methods designed to produce knowledge on policy and program interventions directly or indirectly involving the health sector, and potentially affecting population health. The proposed solutions encompass a multitude of interventions of variable types, scale, focus and implementation, rendering them particularly complex and difficult to understand. This complexity raises major conceptual and methodological issues because in reality, we assess not an intervention, but rather a set of interventional elements interacting with those specific to the context in which they appear. It is the interactions that produce effects, to the extent that it makes little sense to speak of an intervention, and more sense to consider an interventional system defined by the interactions. To grasp the numerous elements brought into play, it behooves us to amalgamate evaluation paradigms and approaches. In a precise context, theory-driven evaluations are of pronounced interest. This article presents the main principles of this type of evaluation by focusing on its capacity to shed light on the stakes involved in intervention/context interplay, and by putting forward conclusions transferable to population health research.

Patient navigation for colorectal cancer screening in deprived areas: the COLONAV cluster randomized controlled trial

BackgroundThe objective of this study was to assess the effectiveness of a Patient Navigation Intervention targeting deprived patients for Colo-Rectal Cancer (CRC) screening participation.MethodsA cluster randomized controlled trial was conducted in 5 districts. Peer Lay Patient Navigators were recruited to operate in deprived areas. Eligible participants had to be between 50 and 74 years old, live in these deprived areas and receive an invitation to the nationally organized Colo-Rectal Cancer (CRC) screening during the study period. The theory-driven navigation intervention was deployed for 18 months. A population Health Intervention Research assessment method was used to assess effectiveness and context interaction. The primary criterion was screening participation at 12 months.ResultsTwenty-four thousand two hundred eighty-one individuals were included inside 40 clusters. The increase in participation in the intervention group was estimated at 23%, (ORa = 1.23, CI95% [1.07–1.41], p = 0.003). For the subgroup of individuals who participated, the time delay to participating was reduced by 26% (ORa = 0.74, CI95% [0.57–0.96], p = 0.021). Main factors modulating the effect of the intervention were: closeness of navigator profiles to the targeted population, navigators’ abilities to adapt their modus operandi, and facilitating attachment structure.ConclusionThe ColoNav Intervention succeeded in demonstrating its effectiveness, for CRC screening. Patient Navigation should be disseminate with broader health promotion goals in order to achieve equity in health care.Trial registrationclinicaltrials.gov NCT02369757 24/02/2015.

2.D. Workshop: The challenges of developing population health intervention research in cancer health promotion

Abstract As the leading cause of death in Europe and the second leading cause of death in North America, it is known that about 40% of cancers are preventable. Until recently, it was considered that if we know the risk factor, then we can act on it: experience has shown that this knowledge is necessary but insufficient to know how to act. Population health intervention research (PHIR), a ‘solution’ science, addresses this challenge. It is concerned with the design, implementation, evaluation, adaptation, transferability and durability of interventions aimed at improving the health of populations, in order to produce valid knowledge with a high potential for social and health impacts. This scientific approach apprehends interventions as ‘events in systems’ and challenges the methodological hegemony imposed for many years by the biomedical sciences. Today, the development of PHIR in health promotion in the domain of cancer faces three major challenges: – Policy; – Methodology; – Transferability. Three complementary presentations are proposed, each of which will respond directly to these challenges and each of which will be based on concrete examples of implementation in the domain of cancer. The aim of this workshop is to offer a time for exchange and discussion on the challenges to be met in developing PHIR in health promotion, in the domain of cancer and at all stages of the disease, as an innovative model of research within an innovative paradigm shift. It will enable participants to clarify their conceptions of PHIR for the advancement of health promotion in oncology and to evolve these concepts in relation to these three key issues. An interactive format is proposed, including time for discussion based on participants’ perceptions and time for presentations. Key messages • PHIR: an effective scientific approach and a relevant tool for thinking about and developing health promotion policies in the field of cancer. • a new research paradigm for cancer control based on intervention with populations to act on health determinants.

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

ObjectivesWe aimed to identify when and how integration should take place within evaluations of complex population health interventions (PHIs). Study designDescriptive analytical approach. MethodsWe 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. ResultsWe 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. ConclusionsRather 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.

Evaluation of a mobile mammography unit: concepts and randomized cluster trial protocol of a population health intervention research to reduce breast cancer screening inequalities

BackgroundBreast cancer is the leading cancer in women in France both in incidence and mortality. Organized breast cancer screening (OBCS) has been implemented nationwide since 2004, but the participation rate remains low (48%) and inequalities in participation have been reported. Facilities such as mobile mammography units could be effective to increase participation in OBCS and reduce inequalities, especially areas underserved in screening. Our main objective is to evaluate the impact of a mobile unit and to establish how it could be used to tackle territorial inequalities in OBCS participation.MethodsA collaborative project will be conducted as a randomized controlled cluster trial in 2022–2024 in remote areas of four French departments. Small geographic areas were constructed by clustering women eligible to OBCS, according to distance to the nearest radiology centre, until an expected sample of eligible women was attained, as determined by logistic and financial constraints. Intervention areas were then selected by randomization in parallel groups. The main intervention is to propose an appointment at the mobile unit in addition to current OBCS in these remote areas according to the principle of proportionate universalism. A few weeks before the intervention, OBCS will be promoted with a specific information campaign and corresponding tools, applying the principle of multilevel, intersectoral and community empowerment to tackle inequalities.DiscussionThis randomized controlled trial will provide a high level of evidence in assessing the effects of mobile unit on participation and inequalities. Contextual factors impacting the intervention will be a key focus in this evaluation. Quantitative analyses will be complemented by qualitative analyses to investigate the causal mechanisms affecting the effectiveness of the intervention and to establish how the findings can be applied at national level.Trial registrationRegistered on ClinicalTrials.gov, December 21, 2021: NCT05164874.

Recruiting Participants for Population Health Intervention Research: Effectiveness and Costs of Recruitment Methods for a Cohort Study.

BackgroundPublic health research studies often rely on population-based participation and draw on various recruitment methods to establish samples. Increasingly, researchers are turning to web-based recruitment tools. However, few studies detail traditional and web-based recruitment efforts in terms of costs and potential biases.ObjectiveThis study aims to report on and evaluate the cost-effectiveness, time effectiveness, and sociodemographic representation of diverse recruitment methods used to enroll participants in 3 cities of the Interventions, Research, and Action in Cities Team (INTERACT) study, a cohort study conducted in Canadian cities.MethodsOver 2017 and 2018 in Vancouver, Saskatoon, and Montreal, the INTERACT study used the following recruitment methods: mailed letters, social media (including sponsored Facebook advertisements), news media, partner communications, snowball recruitment, in-person recruitment, and posters. Participation in the study involved answering web-based questionnaires (at minimum), activating a smartphone app to share sensor data, and wearing a device for mobility and physical activity monitoring. We describe sociodemographic characteristics by the recruitment method and analyze performance indicators, including cost, completion rate, and time effectiveness. Effectiveness included calculating cost per completer (ie, a participant who completed at least one questionnaire), the completion rate of a health questionnaire, and the delay between completion of eligibility and health questionnaires. Cost included producing materials (ie, printing costs), transmitting recruitment messages (ie, mailing list rental, postage, and sponsored Facebook posts charges), and staff time. In Montreal, the largest INTERACT sample, we modeled the number of daily recruits through generalized linear models accounting for the distributed lagged effects of recruitment campaigns.ResultsOverall, 1791 participants were recruited from 3 cities and completed at least one questionnaire: 318 in Vancouver, 315 in Saskatoon, and 1158 in Montreal. In all cities, most participants chose to participate fully (questionnaires, apps, and devices). The costs associated with a completed participant varied across recruitment methods and by city. Facebook advertisements generated the most recruits (n=687), at a cost of CAD $15.04 (US $11.57; including staff time) per completer. Mailed letters were the costliest, at CAD $108.30 (US $83.3) per completer but served to reach older participants. All methods resulted in a gender imbalance, with women participating more, specifically with social media. Partner newsletters resulted in the participation of younger adults and were cost-efficient (CAD $5.16 [US $3.97] per completer). A generalized linear model for daily Montreal recruitment identified 2-day lag effects on most recruitment methods, except for the snowball campaign (4 days), letters (15 days), and reminder cards (5 days).ConclusionsThis study presents comprehensive data on the costs, effectiveness, and bias of population recruitment in a cohort study in 3 Canadian cities. More comprehensive documentation and reporting of recruitment efforts across studies are needed to improve our capacity to conduct inclusive intervention research.

The Good Food for Learning Universal Curriculum-Integrated Healthy School Lunch Intervention: Protocol for a Two-Year Matched Control Pre-Post and Case Study.

BackgroundGood nutrition affects children’s health, well-being, and learning, and schools offer an important setting to promote healthy behaviors that can last a lifetime. Once children reach school age, they spend more of their waking hours in school than in any other environment. Children’s eating habits may be easier to influence than those of adults. In Canada, households with children are more likely to experience food insecurity, and school food programs that are universally available to all children can support the development of healthy eating patterns across groups of varying socioeconomic status. There is a significant gap in the rigorous community-engaged academic research on the impact of school meal programs, especially universal ones.ObjectiveThe aim of this population health intervention research is to study the impact of a 2-year universal, curriculum-integrated healthy school lunch program in elementary schools in Saskatoon, Saskatchewan, Canada, on food consumption, dietary quality and food and nutrition-related knowledge, attitudes, and practices.MethodsThis population health intervention study will be conducted in 2 intervention elementary schools matched with 2 control schools. We will collect preintervention data, including objective measurements of food eaten at school and food-related knowledge, attitudes, and behaviors. This will be followed by the intervention itself, along with qualitative case studies of the intervention process in the 2 intervention schools. Then, we will collect postintervention data similar to the preintervention data. Finally, we will finish the data analysis and complete the ongoing sharing of learning from the project.ResultsThis study was funded in April 2020 but because of the COVID-19 pandemic, data collection did not begin until May 2021. The intervention will begin in September 2021 and end in June 2023, with end point data collection occurring in May and June 2023. The case study research will begin in September 2021 and will be ongoing for the duration of the intervention.ConclusionsThe opportunity we have to systematically and comprehensively study a curriculum-integrated school lunch program, as well as the promising practices for school food programs across Canada, is without precedent.International Registered Report Identifier (IRRID)DERR1-10.2196/30899

Core competencies for strategic grantmaking: lessons learned from the Innovation Strategy.

The Public Health Agency of Canada Innovation Strategy (PHAC-IS) was a national strategic funding program designed to test, deliver, scale up and evaluate complex population health interventions to determine how they bring about change, the context in which they worked best and for which populations. The PHAC-IS experience provides an opportunity to reflect on the core competencies (skills, knowledge and attitudes) for strategic grantmakers to meet the goals of a national strategic funding program focused on population health intervention research. A literature review, PHAC-IS content analysis, a document review and semi-structured interviews provided insight into a set of core competencies-organized by specific domains-that fostered a team focused on continuous improvement to apply learning and evidence from the funded projects to advance the goals of the strategic funding program. Given its multiple complexities and based on the experience of the PHAC-IS team, it is proposed that funding programs aimed toward bringing change at individual and systems levels for population health promotion may draw upon a set of competencies incorporating the fields of strategic grantmaking; intervention research and evaluation; and public administration. The authors suggest that competency in the field of cultural safety is also pertinent to the successful management and leadership of public health programs, innovations and knowledge mobilization.

The art and science of a strategic grantmaker: the experience of the Public Health Agency of Canada\u2019s Innovation Strategy

SettingThe Public Health Agency of Canada’s Innovation Strategy (PHAC-IS) was established amid calls for diverse structural funding mechanisms that could support research agendas to inform policy making across multiple levels and jurisdictions. Influenced by a shifting emphasis towards a population health approach and growing interest in social innovation and systems change, the PHAC-IS was created as a national grantmaking program that funded the testing and delivery of promising population health interventions between 2009 and 2020.InterventionDuring its decade-long tenure, the PHAC-IS supported the development of innovative, locally driven programs that emphasized health equity, encouraged iterative learning to respond reflexively to complex public health problems (the art), while at the same time promoting and integrating population health intervention research (the science) for improved health at the individual, community, and systems levels through four program components.OutcomesPHAC-IS projects reached priority audiences in over 1700 communities. Over 1400 partnerships were established by community-led organizations across multiple sectors with more than $30 million of leveraged funds. By the final phase of funding, 90% of the projects and partnership networks had a sustained impact on policy and public health practice. By the end of the program, 82% of the projects were able to continue their intervention beyond PHAC-IS funding. Through a phased approach, projects were able to adapt, reflect, and build partnership networks to impact policy and practice while increasing reach and scale towards sustainability.ImplicationsAnalysis and reflection throughout the course of this initiative showed that strong partnerships that contribute sufficient time to collaboration are critical to achieving meaningful outcomes. Building on evaluation cycles that strengthen project design can ensure both scale and sustainability of project achievements. Furthermore, a flexible, phased approach allows for iterative learning and adjustments across various phases to realize sustained population and systems change. The model and reflexive approach underlying the PHAC-IS has the potential to apply to a broad range of public programs.

Créer une communauté de pratique sur la recherche interventionnelle en santé mondiale

In the French-speaking world, specifically in France, intervention research in global health has yet to be fully developed institutionally. The Institute of Research for Development (IRD) is one of the major public actors in global health research in France. Within this institute, researchers publish and communicate little on intervention research despite the fact that this is part of their daily work. This is why, for the past several years, the health and society department of the IRD has been working towards institutionalizing a network of IRD actors in population health intervention research (PHIR). The objective of this article is to analyze the needs of global health actors and elements that will allow for the construction of a community of practice in order to initiate an institutional anchoring of intervention research in global health through the mobilization of IRD actors. Qualitative research was carried out in 2017 including individual and group interviews. The results yielded several observations: 1) a definition of PHIR that differs according to the participants, 2) a need to strengthen formal and informal interactions to respond to the need for training and sharing experiences, to reinforce encounters and interpersonal bonds, to increase communication and visibility of implemented actions, 3) the participants’ desire to evolve together to overcome certain inherent challenges of global health such as interdisciplinarity, North-South partnerships, or communication with different populations. Conducting population health intervention research requires a certain amount of reflection on the ways in which research is done and implies significant changes in the daily lives and work of researchers. It is essential to have institutional support to develop this, such as a community of practice. However, the absence of this community of practice three years later illustrates the operational challenges of implementing such an initiative.

Is randomized trial design adapted to population health intervention research?

Randomized trials are frequently used in clinical research and considered the gold standard, but they are less common in population health intervention research (PHIR). We discuss issues that are sometimes shared and sometimes distinct between PHIR and clinical research, notably the randomization unit, design, standardization of the intervention, outcome(s) and ethical issues. In the end, both PHIR and clinical research share the common aim of assessing interventions, and randomized trials should be more widely used in PHIR, provided that how they are planned and conducted is adapted to the PHIR context.

Perspectives on the state of progress in population health intervention research: A diachronic reflection on the 2019 conference 'PHIR to tackle social and territorial inequalities in health'.

Perspectives on the state of progress in population health intervention research: A diachronic reflection on the 2019 conference 'PHIR to tackle social and territorial inequalities in health'.

Impact of a community-based intervention on Aedes aegypti and its spatial distribution in Ouagadougou, Burkina Faso

BackgroundSeveral studies highlighted the impact of community-based interventions whose purpose was to reduce the vectors’ breeding sites. These strategies are particularly interesting in low-and-middle-income countries which may find it difficult to sustainably assume the cost of insecticide-based interventions. In this case study we determine the spatial distribution of a community-based intervention for dengue vector control using different entomological indices. The objective was to evaluate locally where the intervention was most effective, using spatial analysis methods that are too often neglected in impact assessments.MethodsTwo neighbourhoods, Tampouy and Juvenat in Ouagadougou, Burkina Faso, were chosen among five after a survey was conducted, as part of an assessment related to the burden of dengue. As part of the community-based intervention conducted in Tampouy between August and early October 2016, an entomological survey was implemented in two phases. The first phase consisted of a baseline entomological characterization of potential breeding sites in the neighbourhood of Tampouy as well as in Juvenat, the control area. This phase was conducted in October 2015 at the end of the rainy season. The mosquito breeding sites were screened in randomly selected houses: 206 in Tampouy and 203 in Juvenat. A second phase took place after the intervention, in October 2016. The mosquito breeding sites were investigated in the same yards as during the baseline phase. We performed several entomological analyses to measure site productivity as well as before and after analysis using multilevel linear regression. We used Local Indicators of Spatial Association (LISAs) to analyse spatial concentrations of larvae.ResultsAfter the intervention, it is noted that LISAs at Tampouy reveal few aggregates of all types and the suppression of those existing before the intervention. The analysis therefore reveals that the intervention made it possible to reduce the number of concentration areas of high and low values of pupae.ConclusionsThe contribution of spatial methods for assessing community-based intervention are relevant for monitoring at local levels as a complement to epidemiological analyses conducted within neighbourhoods. They are useful, therefore, not only for assessment but also for establishing interventions. This study shows that spatial analyses also have their place in population health intervention research.

Developing the culture of ethics in population health intervention research in Canada.

Population health intervention research (PHIR) is a particular field of health research that aims to generate knowledge that contributes to the sustainable improvement of population health by enabling the implementation of cross-sectoral solutions adapted to social realities. Despite the ethical issues that necessarily raise its social agenda, the ethics of PHIR is still not very formalized. Unresolved ethical challenges may limit its focus on health equity. This contribution aims to highlight some of these issues and calls on researchers to develop a culture of ethics in PHIR. Three complementary ways are proposed: to build an ethical concept specific to this field, to promote a shared space for critical reflection on PHIR ethics, and to develop the ethical competence in PHIR for which a preliminary framework is proposed.

The benefits of a historical-dialectical ontology to critical mental health promotion research.

In this article, we explore challenges and opportunities in research oriented to understanding the relations among elements of socio-economic life and mental health (MH) and the development and evaluation of mental health promotion (HP) initiatives. We review the population health intervention research (PHIR) literature and respond to recommendations regarding social determinants of health and health inequities-focused research. We discuss three inter-related issue areas: first, the continued dominance of linear and individually oriented theories within predominantly quantitative research approaches and the underdevelopment of ontological and theoretical perspectives that capture complexity; second, the inconsistent use of measures of socio-economic status and health with a lack of attention to taken for granted assumptions; and third, the continued focus on measuring MH challenges to the neglect of exploring the meaning of MH in a positive sense. We extend recommendations within the PHIR literature by sharing our application of a historical-dialectical ontological perspective within a process of social praxis with diverse Canadian young people with varying degrees of access to socio-economic resources. Young people were engaged to explore the relations among socio-economic processes, young people's MH and implications for mental HP. We argue that this ontological perspective can support the development of structurally oriented critical qualitative research approaches in PHIR.

How to Educate Pregnant Women about Endocrine Disruptors?

Background: Despite mediatization, only half of pregnant women are informed about endocrine disruptors (EDs). We wished to inquire about appropriate environmental health education procedures during pregnancy: Who, when, and how? Methods: The question stems from a comprehensive population health intervention research project. It includes qualitative studies aimed at constructing an educational program in environmental health and an accompanying assessment tool. The validation of a customized questionnaire (PREVED© for Pregnancy Prevention Endocrine Disruptors) about the knowledge, attitudes, and practices (KAP) of pregnant women regarding exposure to EDs was carried out in a quantitative study. Results: Health education by a prenatal professional with communication skills should take place as early as possible, during the preconception period or early pregnancy, as part of individual consultation or group workshops. In order to customize the discourse and to develop women’s empowerment, concomitant presentation of the risks by the products used in each room and of previous solutions is recommended. Conclusion: Appropriate health education procedures on EDs should be done at every contact but taking the KAP of pregnant women into account first. We propose all educational actions should be accompanied by questioning of the KAP of pregnant women; for example, with questions from the PREVED© questionnaire.

The AAPRISS Platform: Learning and Taking Action to Reduce Social Inequalities in Health to help PHIR

Abstract Today, the reduction of social inequalities in health is on the political agenda in public health. The complex reality of the determinants of these health inequalities remains difficult to understand and translate into practical actions. One of the reasons is that the circulation of expertise amongst researchers, actors in the field, and public decision is not systematic and still too rare. In 2013, the Federative Institute of Interdisciplinary Research and Studies Health Society (IFERISS) of Toulouse has an interdisciplinary platform (health, the humanities, and the social sciences) that directly offers expertise to public health actors, institutions, and local communities in order to respond to public health issues. At the request of the actors, AAPRISS can intervene at all stages of a study or an intervention, from conceptual and methodological construction to implementation support, and data analysis and use. In particular, the team has expertise in public policy evaluation, support for transferability according to the key functions/implementation/context (FIC) model, and awareness-raising at the intersection of urban planning and health. The platform is in a multi-year partnership with local authorities, the regional health agency of Occitanie, the primary health insurance funds of Occitanie, and various partners in civil society. Six years after the establishment of the AAPRISS platform, there is a strong demand for support and research from the actors and institutions. However, funding for activities remains uncertain despite the support of the National Cancer League and an increasingly strong network of partners. Mixed structures housing spaces for both research and action, which create a dynamic of Population Health Intervention Research, are showing themselves to be effective and seem to meet a need, but their financial stability is insufficient to sustain their activities and promote sustainable reduction of social inequalities in health. Key messages Mixed structures housing spaces for both research and action, which create a dynamic of Population Health Intervention Research, are showing themselves to be effective and seem to meet a need. But the financial stability of this mixed structures is insufficient to sustain their activities and promote sustainable reduction of social inequalities in health.