Implementation and scale-up of physical activity and behavioural nutrition interventions: an evaluation roadmap

Abstract

BackgroundInterventions that work must be effectively delivered at scale to achieve population level benefits. Researchers must choose among a vast array of implementation frameworks (> 60) that guide design and evaluation of implementation and scale-up processes. Therefore, we sought to recommend conceptual frameworks that can be used to design, inform, and evaluate implementation of physical activity (PA) and nutrition interventions at different stages of the program life cycle. We also sought to recommend a minimum data set of implementation outcome and determinant variables (indicators) as well as measures and tools deemed most relevant for PA and nutrition researchers.MethodsWe adopted a five-round modified Delphi methodology. For rounds 1, 2, and 3 we administered online surveys to PA and nutrition implementation scientists to generate a rank order list of most commonly used; i) implementation and scale-up frameworks, ii) implementation indicators, and iii) implementation and scale-up measures and tools. Measures and tools were excluded after round 2 as input from participants was very limited. For rounds 4 and 5, we conducted two in-person meetings with an expert group to create a shortlist of implementation and scale-up frameworks, identify a minimum data set of indicators and to discuss application and relevance of frameworks and indicators to the field of PA and nutrition.ResultsThe two most commonly referenced implementation frameworks were the Framework for Effective Implementation and the Consolidated Framework for Implementation Research. We provide the 25 most highly ranked implementation indicators reported by those who participated in rounds 1–3 of the survey. From these, the expert group created a recommended minimum data set of implementation determinants (n = 10) and implementation outcomes (n = 5) and reconciled differences in commonly used terms and definitions.ConclusionsResearchers are confronted with myriad options when conducting implementation and scale-up evaluations. Thus, we identified and prioritized a list of frameworks and a minimum data set of indicators that have potential to improve the quality and consistency of evaluating implementation and scale-up of PA and nutrition interventions. Advancing our science is predicated upon increased efforts to develop a common ‘language’ and adaptable measures and tools.

Evaluating the Implementation of the SWITCH® School Wellness Intervention and Capacity-Building Process through Multiple Methods

“…The study design encompasses an evaluation of implementation and the factors that in uence implementation of SWITCH quality elements and best practices through the lens of the CFIR model (26). We sought to test implementation of SWITCH as a "real world trial," one step prior to full dissemination in the Scale-Up Continuum of evidence-based interventions (20). Consistent with this continuum, the purpose of this implementation evaluation was to "determine the extent to which the intervention is delivered to the target population as planned" (p.3) (20).…”

“…We sought to test implementation of SWITCH as a "real world trial," one step prior to full dissemination in the Scale-Up Continuum of evidence-based interventions (20). Consistent with this continuum, the purpose of this implementation evaluation was to "determine the extent to which the intervention is delivered to the target population as planned" (p.3) (20). The adoption of CFIR and the use of multimethod approach provides advantages for studying the complex relationships in uencing school wellness programming.…”

Choose to Move: A Health Promoting Physical Activity Intervention Can Also Enhance Social Connectedness

“…Elsewhere we described the CTM intervention, implementation and evaluation frameworks that guide our work (28,29,31), the bene ts of CTM on PA and social connectedness (29) and factors that in uenced implementation (30). Brie y, CTM is a 6-month, choice-based health promoting PA program that supports low active older adults to become more physically active and socially connected.…”

“…We describe our study design and implementation approach in detail elsewhere (28)(29)(30)(31). Brie y, we conducted a type 2 hybrid effectiveness-implementation study (32).…”

Evaluation of the Scale-up and Implementation of Mind, Exercise, Nutrition…Do It! (MEND) in British Columbia: A Hybrid Trial Type 3 Evaluation

“…scale-up could be described as a guided expansion of the same program to variety of different sties (or a horizontal scale-up strategy) [14]. The scale-up strategy was centrally driven, phased and involved multiple stakeholders in delivery of a standard intervention package supported by a dissemination approach that could be described as capacity-building [22]. A Provincial Stakeholder Advisory and a Management group were formed to guide dissemination and re ect the B.C.…”