Assessment of scalability of evidence-based innovations in community-based primary health care: a cross-sectional study

Abstract

Background: In 2013, the Canadian Institutes of Health Research funded 12 community-based primary health care research teams to develop evidence-based innovations. We aimed to explore the scalability of these innovations. Methods: In this cross-sectional study, we invited the 12 teams to rate their evidence-based innovations for scalability. Based on a systematic review, we developed a self-administered questionnaire with 16 scalability assessment criteria grouped into 5 dimensions (theory, impact, coverage, setting and cost). Teams completed a questionnaire for each of their innovations. We analyzed the data using simple frequency counts and hierarchical cluster analysis. We calculated the mean number and standard deviation (SD) of innovations that met criteria within each dimension that included more than 1 criterion. The analysis unit was the innovation. Results: The 11 responding teams evaluated 33 evidence-based innovations (median 3, range 1-8 per team). The innovations focused on access to care and chronic disease prevention and management, and varied from health interventions to methodological innovations. Most of the innovations were health interventions (n = 21), followed by analytical methods (n = 4), conceptual frameworks (n = 4), measures (n = 3) and strategies to build research capacity (n = 1). Most (29) met criteria in the theory dimension, followed by impact (mean 22.3 [SD 5.6] innovations per dimension), setting (mean 21.7 [SD 8.5]), cost (mean 17.5 [SD 2.1]) and coverage (mean 14.0 [SD 4.1]). On average, the innovations met 10 of the 16 criteria. Adoption was the least assessed criterion (n = 9). Most (20) of the innovations were highly ranked for scalability. Interpretation: Scalability varied among innovations, which suggests that readiness for scale up was suboptimal for some innovations. Coverage remained largely unaddressed; further investigation of this critical dimension is necessary.

Intervention Scalability Assessment Tool: A decision support tool for health policy makers and implementers

“…A contributing factor is the lack of pragmatic studies demonstrating how pilot interventions can be disseminated in realworld settings, as research has predominantly focused on describing disease risk patterns [7] or intervention efficacy testing, rather than disseminating interventions across systems [5,8,9]. Other factors include lack of knowledge, skills and capacity among policy-makers and practitioners to determine the suitability of interventions for scale-up [10], and the likelihood that political and resourcing factors are often more powerful influences on scale-up decisions than whether interventions are evidence based [8]. Hence, it is important to provide better support to policy-makers and practitioners to more readily assess the suitability of interventions for scale-up and their scalability within a specific context.…”

The pitfalls of scaling up evidence-based interventions in health

“…Various frameworks have been proposed for guiding researchers and policy-makers in designing the scale-up of an EBI [7,[11][12][13][14][15][16][17][18][19]. Researchers are also proposing methods for evaluating the scalability of interventions, using indicators such as coverage, impact and setting, to prepare researchers to include them in the earliest stages of their study designs [20]. While these frameworks appear convincing and the evolving discourse on scaling-up is enthusiastic, a brief scan of the literature for problems encountered during scale-up revealed a number of potential pitfalls.…”

A Canadian Rural Living Lab Hospital: Implementing solutions for improving rural emergency care

“…Ben Charif et al summarises the steps necessary for successful scale up: assessment of scalability (potential for scale up) of the innovation (eg effectiveness, cost-effectiveness), development of a scale up strategy, strategy implementation, strategy evaluation and assuring sustainability. 26 The Living Lab governance structure will ensure that every innovation deployed goes though the steps of scale up. The scale up strategy will also be supported by the Québec, Canadian and international networks set-up around the Living Lab.…”