Narrative review of models and success factors for scaling up public health interventions

Abstract

BackgroundTo maximise the impact of public health research, research interventions found to be effective in improving health need to be scaled up and delivered on a population-wide basis. Theoretical frameworks and approaches are useful for describing and understanding how effective interventions are scaled up from small trials into broader policy and practice and can be used as a tool to facilitate effective scale-up. The purpose of this literature review was to synthesise evidence on scaling up public health interventions into population-wide policy and practice, with a focus on the defining and describing frameworks, processes and methods of scaling up public health initiatives.MethodsThe review involved keyword searches of electronic databases including MEDLINE, CINAHL, PsycINFO, EBM Reviews and Google Scholar between August and December 2013. Keywords included ‘scaling up’ and ‘scalability’, while the search terms ‘intervention research’, ‘translational research’, ‘research dissemination’, ‘health promotion’ and ‘public health’ were used to focus the search on public health approaches. Studies included in the review were published in English from January 1990 to December 2013 and described processes, theories or frameworks associated with scaling up public health and health promotion interventions.ResultsThere is a growing body of literature describing frameworks for scaling health interventions, with the review identifying eight frameworks, the majority of which have an explicit focus on scaling up health action in low and middle income country contexts. Key success factors for scaling up included the importance of establishing monitoring and evaluation systems, costing and economic modelling of intervention approaches, active engagement of a range of implementers and the target community, tailoring the scaled-up approach to the local context, the use of participatory approaches, the systematic use of evidence, infrastructure to support implementation, strong leadership and champions, political will, well defined scale-up strategy and strong advocacy.ConclusionsEffective scaling up requires the systematic use of evidence, and it is essential that data from implementation monitoring is linked to decision making throughout the scaling up process. Conceptual frameworks can assist both policy makers and researchers to determine the type of research that is most useful at different stages of scaling up processes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0301-6) contains supplementary material, which is available to authorized users.

A guide to scaling up population health interventions

“…However, it is clear from the literature and our research that, despite the unpredictable outcomes of scaling up attempts, a good plan can guide the scaling up process in the right direction and make success more likely. 2,3 Moreover, successful scale-up requires systematic use of evidence 2 , and it is particularly important that data from monitoring is linked to decision making throughout the scaling up process. This guide argues that plans for scaling up need to consider a broad range of factors and balance what is desirable with what is feasible.…”

“…1 They have been variously applied in the literature to describe the dissemination of a new technique, prototype product or process innovation; epidemiological and economic forecasting; 'growing' an organisational or system capacity to implement to a new level; and translating a small-scale initiative into a government policy. 2,3 For clarity, specific definitions for 'scalability' and 'scaling up' are needed. In the health sector, scalability is "… the ability of a health intervention shown to be efficacious on a small scale and or under controlled conditions to be expanded under real-world conditions to reach a greater proportion of the eligible population, while retaining effectiveness".…”

County-level outcomes of a rural breast cancer screening outreach strategy: a decentralized hub-and-spoke model (BSPAN2)

“…populations and the capacity to implement outreach and navigation components were trained to implement those program aspects [8]. The hub continued to deliver outreach and navigation in counties with limited capacity.…”

“…Overall, the program expansion was highly successful: the number of women interested in receiving services greatly exceeded program expectations. That resulting rapid increase in demand had consequences that will require further study to help advance the science of scaling up and further rationalize models of preventive service delivery [8]. Previous studies have demonstrated that program designs able to accommodate flexibility during implementation can enhance service uptake among rural-residing women [7,32,33].…”

“…While the hub operations team managed to accommodate increased demand for scheduling and nurse-assisted navigation, documentation and quality monitoring of outreach activities were more inconsistent [8]. Strict adherence to network standards remains a challenge when expanded geography and limited resources restrict the number of organizations with which to partner [33].…”