Table 1.

Definition of Key Constructs in Conceptual Framework for Analyzing Integration of Targeted Health Interventions Into Health Systems^a

Conceptual Definition	Operational Definition
The problem is the disease or precursor of disease at which the intervention (see below) is targeted.	Reducing health inequalities through a focus on lifestyle and health-related behaviors (including smoking, diet, exercise, alcohol, and drug use), seen as precursors of the development and exacerbation of chronic diseases like diabetes, heart disease, and cancer.
The intervention is a novel set of technologies, behaviors, routines, and ways of working and delivering services that is directed at improving health outcomes and is implemented by planned action.	The Health Trainer Services (HTSs), in which accredited peer workers (the health trainers, HTs) engage with “hard-to-reach” (and other) individuals and communities to provide one-to-one motivational support and advice directed to achieving healthier lifestyles and less risky health-related behavior.
The adoption system is the key actors and institutions of the local health system and, beyond this, nonhealth organizations and others with a stake in both the problem and the intervention.	Individuals working in the local NHS (PCTs, GPs, and trusts) and third-sector organizations subcontracted to deliver the HTSs. They also include individuals in local authorities and other organizations offering other lifestyle services (eg, commercial weight-loss programs), as well as the service users themselves and their wider communities.
The health system characteristics are those critical functions the health system must undertake to achieve its objectives in regard to improving users’ health. These functions include stewardship and governance, financing, planning, service	Governance: Peer workers (the health trainers) are safe and competent to work with service users. Financing: HTSs have clearly demarcated and sustained funding. Planning: HTS's activities are aligned with the attainment of the health services' priorities and goals. Service Delivery: HTs meet the service standards and expectations of equivalent NHS services.
delivery, monitoring and evaluation, and demand generation.	Monitoring and Evaluation: HTs are able to demonstrate their activities and impacts clearly and consistently. Demand Generation: HTS's are able to generate and capture “sufficient” demand from targeted communities to deliver a cost-effective service.
The context is the wider political-economic, legal, and sociocultural environment in which the health system resides.	These include (1) the changing NHS structures, especially the split between the commissioner and the provider and subsequent reorganizations; (2) the political focus on individual rather than societal determinants of health and on the ring-fencing of health budgets; and (3) the broader context for health-related lifestyles and behaviors for many targeted individuals, including the direct effects and prioritization of social determinants of health.

^aDerived from Atun et al.10