Increasing the scale and adoption of population health interventions: experiences and perspectives of policy makers, practitioners, and researchers

Abstract

BackgroundDecisions to scale up population health interventions from small projects to wider state or national implementation is fundamental to maximising population-wide health improvements. The objectives of this study were to examine: i) how decisions to scale up interventions are currently made in practice; ii) the role that evidence plays in informing decisions to scale up interventions; and iii) the role policy makers, practitioners, and researchers play in this process.MethodsInterviews with an expert panel of senior Australian and international public health policy-makers (n = 7), practitioners (n = 7), and researchers (n = 7) were conducted in May 2013 with a participation rate of 84%.ResultsScaling up decisions were generally made through iterative processes and led by policy makers and/or practitioners, but ultimately approved by political leaders and/or senior executives of funding agencies. Research evidence formed a component of the overall set of information used in decision-making, but its contribution was limited by the paucity of relevant intervention effectiveness research, and data on costs and cost effectiveness. Policy makers, practitioners/service managers, and researchers had different, but complementary roles to play in the process of scaling up interventions.ConclusionsThis analysis articulates the processes of how decisions to scale up interventions are made, the roles of evidence, and contribution of different professional groups. More intervention research that includes data on the effectiveness, reach, and costs of operating at scale and key service delivery issues (including acceptability and fit of interventions and delivery models) should be sought as this has the potential to substantially advance the relevance and ultimately usability of research evidence for scaling up population health action.

Process Evaluation of the Nationwide Implementation of a Lifestyle Intervention in the Construction Industry

“…17,18 The intervention needs to be proven effective and effect sizes should be relatively large, because a reduction in effectiveness should be expected after implementation in a less-controlled setting. Furthermore, the intervention should be adaptable and generalizable to various settings without compromising the fidelity of the program.…”

A guide to scaling up population health interventions

“…It is rare for interventions to remain unchanged as they are scaled up, because of the need to adapt them to suit the local context and the organisational, financial and human resources available for scaling up. 4,6,10 These adaptations may reduce effectiveness, but they can improve acceptability and efficiency, highlighting the importance of measuring intervention effectiveness throughout the scaling up process. Reach and adoption are at the heart of scalability.…”

“…9 The guide was developed using a systematic review of scaling up models and methods 3 , and a two-round Delphi process with a sample of senior policy makers, practitioners and researchers actively involved in scaling up processes. 2,10 It was developed as a practical guide to assist health policy makers, health practitioners, and others with responsibility for scaling up effective population health interventions. 9 The guide is divided into four steps: scalability assessment, developing a scaling up plan, preparing for scaling up, and scaling up the intervention.…”

Adjustment for Variable Adherence Under Hierarchical Structure

“…Despite recent interest with “population health” [25], population average estimates are off-purpose for most RCTs, where the goal is to understand how individual patients respond to treatment (e.g., [26]). In contrast to GEE and GLS, random-coefficients models [24] are well-suited for characterizing individual patient response, because they offer estimates of longitudinal response trajectories of individual patients and of the average patient.…”