1932

Abstract

Advancing the science of intervention scale-up is essential to increasing the impact of effective interventions at the regional and national levels. In contrast with work in high-income countries (HICs), where scale-up research has been limited, researchers in low- and middle-income countries (LMICs) have conducted numerous studies on the regional and national scale-up of interventions. In this article, we review the state of the science on intervention scale-up in both HICs and LMICs. We provide an introduction to the elements of scale-up followed by a description of the scale-up process, with an illustrative case study from our own research. We then present findings from a scoping review comparing scale-up studies in LMIC and HIC settings. We conclude with lessons learned and recommendations for improving scale-up research.

Loading

Article metrics loading...

/content/journals/10.1146/annurev-publhealth-052020-113438
2022-04-05
2024-12-06
Loading full text...

Full text loading...

/deliver/fulltext/publhealth/43/1/annurev-publhealth-052020-113438.html?itemId=/content/journals/10.1146/annurev-publhealth-052020-113438&mimeType=html&fmt=ahah

Literature Cited

  1. 1. 
    Ansbro ÉM, Gill MM, Reynolds J, Shelley KD, Strasser S et al. 2015. Introduction of syphilis point-of-care tests, from pilot study to national programme implementation in Zambia: a qualitative study of healthcare workers’ perspectives on testing, training and quality assurance. PLOS ONE 10:e0127728
    [Google Scholar]
  2. 2. 
    Araya R, Alvarado R, Sepúlveda R, Rojas G. 2012. Lessons from scaling up a depression treatment program in primary care in Chile. Rev. Panam. Salud Publ. 32:234–40
    [Google Scholar]
  3. 3. 
    Bambra C, Smith KE, Pearce J. 2019. Scaling up: the politics of health and place. Soc. Sci. Med. 232:36–42
    [Google Scholar]
  4. 4. 
    Barker PM, Reid A, Schall MW 2016. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implement. Sci. 11:12
    [Google Scholar]
  5. 5. 
    Blauvelt C, West M, Maxim L, Kasiya A, Dambula I et al. 2018. Scaling up a health and nutrition hotline in Malawi: the benefits of multisectoral collaboration. BMJ 363:k4590
    [Google Scholar]
  6. 6. 
    Bullock HL, Lavis JN. 2019. Understanding the supports needed for policy implementation: a comparative analysis of the placement of intermediaries across three mental health systems. Health Res. Policy Syst. 17:82
    [Google Scholar]
  7. 7. 
    Bulthuis SE, Kok MC, Raven J, Dieleman MA 2020. Factors influencing the scale-up of public health interventions in low- and middle-income countries: a qualitative systematic literature review. Health Policy Plan 35:219–34
    [Google Scholar]
  8. 8. 
    Callaghan-Koru JA, Islam M, Khan M, Sowe A, Islam J et al. 2020. Factors that influence the scale up of new interventions in low-income settings: a qualitative case study of the introduction of chlorhexidine cleansing of the umbilical cord in Bangladesh. Health Policy Plan 35:440–51
    [Google Scholar]
  9. 9. 
    Charif AB, Zomahoun HTV, LeBlanc A, Langlois L, Wolfenden L et al. 2017. Effective strategies for scaling up evidence-based practices in primary care: a systematic review. Implement. Sci. 12:139
    [Google Scholar]
  10. 10. 
    Côté-Boileau E, Denis J-L, Callery B, Sabean M 2019. The unpredictable journeys of spreading, sustaining and scaling healthcare innovations: a scoping review. . Health Res. Policy Syst. 17:84
    [Google Scholar]
  11. 11. 
    Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC 2009. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement. Sci. 4:50
    [Google Scholar]
  12. 12. 
    Davis MM, Nambiar S, Mayorga ME, Sullivan E, Hicklin K et al. 2019. Mailed FIT (fecal immunochemical test), navigation or patient reminders? Using microsimulation to inform selection of interventions to increase colorectal cancer screening in Medicaid enrollees. Prev. Med. 129:105836
    [Google Scholar]
  13. 13. 
    Dopp AR, Narcisse M-R, Mundey P, Silovsky JF, Smith AB et al. 2020. A scoping review of strategies for financing the implementation of evidence-based practices in behavioral health systems: state of the literature and future directions. Implement. Res. Pract. 1:2633489520939980
    [Google Scholar]
  14. 14. 
    Dunbar J, Hernan A, Janus E, Davis-Lameloise N, Asproloupos D et al. 2012. Implementation salvage experiences from the Melbourne diabetes prevention study. BMC Public Health 12:806
    [Google Scholar]
  15. 15. 
    ExpandNet, WHO (World Health Organ.) 2009. Practical guidance for scaling up health service innovations Rep. WHO Geneva: https://www.who.int/reproductivehealth/publications/strategic_approach/9789241598521/en/
    [Google Scholar]
  16. 16. 
    ExpandNet, WHO (World Health Organ.) 2010. Nine steps for developing a scaling-up strategy Rep. WHO Geneva: https://www.who.int/immunization/hpv/deliver/nine_steps_for_developing_a_scalingup_strategy_who_2010.pdf
    [Google Scholar]
  17. 17. 
    ExpandNet, WHO (World Health Organ.) 2011. Beginning with the end in mind: planning pilot projects and other programmatic research for successful scaling up Rep. WHO Geneva: https://www.who.int/reproductivehealth/publications/strategic_approach/9789241502320/en/
    [Google Scholar]
  18. 18. 
    Fagan AA, Bumbarger BK, Barth RP, Bradshaw CP, Cooper BR et al. 2019. Scaling up evidence-based interventions in US public systems to prevent behavioral health problems: challenges and opportunities. Prev. Sci. 20:1147–68
    [Google Scholar]
  19. 19. 
    Fitzgerald L, Benzerga W, Mirira M, Adamu T, Shissler T et al. 2016. Scaling up early infant male circumcision: lessons from the Kingdom of Swaziland. Glob. Health Sci. Pract. 4:Suppl. 1S76–86
    [Google Scholar]
  20. 20. 
    Franks RP, Bory CT. 2015. Who supports the successful implementation and sustainability of evidence-based practices? Defining and understanding the roles of intermediary and purveyor organizations. New Dir. Child Adolesc. Dev. 2015:41–56
    [Google Scholar]
  21. 21. 
    Greenhalgh T, Papoutsi C. 2019. Spreading and scaling up innovation and improvement. BMJ 365:I2068
    [Google Scholar]
  22. 22. 
    Gupta A, Thorpe C, Bhattacharyya O, Zwarenstein M. 2016. Promoting development and uptake of health innovations: the Nose to Tail Tool. F1000Research 5:361
    [Google Scholar]
  23. 23. 
    Hainsworth G, Engel DM, Simon C, Rahimtoola M, Ghiron LJ. 2014. Scale-up of adolescent contraceptive services: lessons from a 5-country comparative analysis. J. Acquir. Immune Defic. Syndr. 66:Suppl. 2S200–8
    [Google Scholar]
  24. 24. 
    Harris MF, Parker SM, Litt J, van Driel M, Russell G et al. 2017. An Australian general practice based strategy to improve chronic disease prevention, and its impact on patient reported outcomes: evaluation of the preventive evidence into practice cluster randomised controlled trial. BMC Health Serv. Res. 17:637
    [Google Scholar]
  25. 25. 
    Herbst JH, Raiford JL, Carry MG, Wilkes AL, Ellington RD, Whittier DK. 2016. Adaptation and national dissemination of a brief, evidence-based, HIV prevention intervention for high-risk men who have sex with men. MMWR 65:42–50
    [Google Scholar]
  26. 26. 
    Holland-Carter L, Tuerk PW, Wadden TA, Fujioka KN, Becker LE et al. 2017. Impact on psychosocial outcomes of a nationally available weight management program tailored for individuals with type 2 diabetes: results of a randomized controlled trial. J. Diabetes Complic. 31:891–97
    [Google Scholar]
  27. 27. 
    Igras S, Sinai I, Mukabatsinda M, Ngabo F, Jennings V, Lundgren R 2014. Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda. Glob. Health Sci. Pract. 2:234–44
    [Google Scholar]
  28. 28. 
    Indig D, Lee K, Grunseit A, Milat A, Bauman A. 2017. Pathways for scaling up public health interventions. BMC Public Health 18:68
    [Google Scholar]
  29. 29. 
    Janus ED, Best JD, Davis-Lameloise N, Philpot B, Hernan A et al. 2012. Scaling-up from an implementation trial to state-wide coverage: results from the preliminary Melbourne Diabetes Prevention Study. Trials 13:152
    [Google Scholar]
  30. 30. 
    Keyonzo N, Nyachae P, Kagwe P, Kilonzo M, Mumba F et al. 2015. From project to program: Tupange's experience with scaling up family planning interventions in urban Kenya. Reprod. Health Matters 23:103–13
    [Google Scholar]
  31. 31. 
    Khan S, Chambers D, Neta G. 2021. Revisiting time to translation: implementation of evidence-based practices (EBPs) in cancer control. Cancer Causes Control 32:221–30
    [Google Scholar]
  32. 32. 
    Kreuter MW, Bernhardt JM. 2009. Reframing the dissemination challenge: a marketing and distribution perspective. Am. J. Public Health 99:2123–27
    [Google Scholar]
  33. 33. 
    Krist AH, Aycock RA, Etz RS, Devoe JE, Sabo RT et al. 2014. MyPreventiveCare: implementation and dissemination of an interactive preventive health record in three practice-based research networks serving disadvantaged patients—a randomized cluster trial. Implement. Sci. 9:181
    [Google Scholar]
  34. 34. 
    Leeman J, Beeber L, Hodges E, Kneipp S, Toles M et al. 2018. Engaging national and regional partners to accelerate broad-scale implementation of nurse-developed interventions. Nurs. Outlook 66:18–24
    [Google Scholar]
  35. 35. 
    Leeman J, Birken SA, Powell BJ, Rohweder C, Shea CM 2017. Beyond “implementation strategies”: classifying the full range of strategies used in implementation science and practice. Implement. Sci. 12:125
    [Google Scholar]
  36. 36. 
    Leeman J, Myers AE, Ribisl KM, Ammerman AS. 2015. Disseminating policy and environmental change interventions: insights from obesity prevention and tobacco control. Int. J. Behav. Med. 22:301–11
    [Google Scholar]
  37. 37. 
    Leeman J, Nilsen P 2020. Strategies. Handbook on Implementation Science P Nilsen, SA Birken 234–58 Cheltenham, UK: Edward Elgar
    [Google Scholar]
  38. 38. 
    Leeman J, Toles M. 2020. What does it take to scale-up a complex intervention? Lessons learned from the Connect-Home transitional care intervention. J. Adv. Nurs. 76:387–97
    [Google Scholar]
  39. 39. 
    Leeman J, Wiecha JL, Vu M, Blitstein JL, Allgood S et al. 2018. School health implementation tools: a mixed methods evaluation of factors influencing their use. Implement. Sci. 13:48
    [Google Scholar]
  40. 40. 
    Lombard CB, Harrison CL, Kozica SL, Zoungas S, Keating C, Teede HJ. 2014. Effectiveness and implementation of an obesity prevention intervention: the HeLP-her Rural cluster randomised controlled trial. BMC Public Health 14:608
    [Google Scholar]
  41. 41. 
    Lubans DR, Smith JJ, Peralta LR, Plotnikoff RC, Okely AD et al. 2016. A school-based intervention incorporating smartphone technology to improve health-related fitness among adolescents: rationale and study protocol for the NEAT and ATLAS 2.0 cluster randomised controlled trial and dissemination study. BMJ Open 6:e010448
    [Google Scholar]
  42. 42. 
    Manios Y, Androutsos O, Lambrinou C-P, Cardon G, Lindstrom J et al. 2018. A school- and community-based intervention to promote healthy lifestyle and prevent type 2 diabetes in vulnerable families across Europe: design and implementation of the Feel4Diabetes-study. Public Health Nutr 21:3281–90
    [Google Scholar]
  43. 43. 
    McKay HA, Macdonald HM, Nettlefold L, Masse LC, Day M, Naylor P-J. 2015. Action Schools! BC implementation: from efficacy to effectiveness to scale-up. Br. J. Sports Med. 49:210–18
    [Google Scholar]
  44. 44. 
    McPherson R, Hodgins S. 2018. Postnatal home visitation: lessons from country programs operating at scale. J. Glob. Health 8:010422
    [Google Scholar]
  45. 45. 
    Means AR, Kemp CG, Gwayi-Chore M-C, Gimbel S, Soi C et al. 2020. Evaluating and optimizing the Consolidated Framework for Implementation Research (CFIR) for use in low- and middle-income countries: a systematic review. Implement. Sci. 15:17
    [Google Scholar]
  46. 46. 
    Milat A, Lee K, Conte K, Grunseit A, Wolfenden L et al. 2020. Intervention Scalability Assessment Tool: a decision support tool for health policy makers and implementers. Health Res. Policy Syst. 18:1
    [Google Scholar]
  47. 47. 
    Milat AJ, Bauman A, Redman S. 2015. Narrative review of models and success factors for scaling up public health interventions. Implement. Sci. 10:113
    [Google Scholar]
  48. 48. 
    Miller WC, Hoffman IF, Hanscom BS, Ha TV, Dumchev K et al. 2018. A scalable, integrated intervention to engage people who inject drugs in HIV care and medication-assisted treatment (HPTN 074): a randomised, controlled phase 3 feasibility and efficacy study. Lancet 392:747–59
    [Google Scholar]
  49. 49. 
    Moullin JC, Dickson KS, Stadnick NA, Rabin B, Aarons GA 2019. Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Implement. Sci. 14:1
    [Google Scholar]
  50. 50. 
    Nettlefold L, Naylor P-J, Macdonald HM, McKay HA. 2021. Scaling up Action Schools! BC: How does voltage drop at scale affect student level outcomes? A cluster randomized controlled trial. Int. J. Environ. Res. Public Health 18:5182
    [Google Scholar]
  51. 51. 
    Nguyen DTK, McLaren L, Oelke ND, McIntyre L. 2020. Developing a framework to inform scale-up success for population health interventions: a critical interpretive synthesis of the literature. Glob. Health Res. Policy 5:18
    [Google Scholar]
  52. 52. 
    Nguyen G, Costenbader E, Plourde KF, Kerner B, Igras S. 2019. Scaling-up normative change interventions for adolescent and youth reproductive health: an examination of the evidence. J. Adolesc. Health 64:S16–30
    [Google Scholar]
  53. 53. 
    Nguyen MXB, Chu AV, Powell BJ, Tran HV, Nguyen LH et al. 2020. Comparing a standard and tailored approach to scaling up an evidence-based intervention for antiretroviral therapy for people who inject drugs in Vietnam: study protocol for a cluster randomized hybrid type III trial. Implement. Sci. 15:64
    [Google Scholar]
  54. 54. 
    NIH (Natl. Inst. Health) 2019. PAR-19-274: Dissemination and implementation research in health (R01 clinical trial optional) Part 1 Overview Inf. Dep. Health Hum. Serv. Washington, DC: https://grants.nih.gov/grants/guide/pa-files/PAR-19-274.html
    [Google Scholar]
  55. 55. 
    Nilsen P, Bernhardsson S. 2019. Context matters in implementation science: a scoping review of determinant frameworks that describe contextual determinants for implementation outcomes. BMC Health Serv. Res. 19:189
    [Google Scholar]
  56. 56. 
    Olivier de Sardan J-P, Diarra A, Koné FY, Yaogo M, Zerbo R 2015. Local sustainability and scaling up for user fee exemptions: medical NGOs vis-à-vis health systems. BMC Health Serv. Res. 15:Suppl. 3S5
    [Google Scholar]
  57. 57. 
    Omimo A, Taranta D, Ghiron L, Kabiswa C, Aibe S et al. 2018. Applying ExpandNet's systematic approach to scaling up in an integrated population, health and environment project in East Africa. Soc. Sci. 7:8
    [Google Scholar]
  58. 58. 
    Ono SS, Crabtree BF, Hemler JR, Balasubramanian BA, Edwards ST et al. 2018. Taking innovation to scale in primary care practices: the functions of health care extension. Health Aff. 37:222–30
    [Google Scholar]
  59. 59. 
    Pappa S, Muralidharan A, Dayal R, Das M. 2015. Promoting gender equality in India: three approaches to scale-up Rep. Fut. Group, Health Policy Proj. Washington, DC: https://www.healthpolicyproject.com/pubs/573_PromotingGenderEqualityinIndiaFINAL.pdf
    [Google Scholar]
  60. 60. 
    Phadraig CMG, Nunn J, Guerin S, Normand C 2016. Should we provide oral health training for staff caring for people with intellectual disabilities in community based residential care? A cost-effectiveness analysis. Eval. Program Plan. 55:46–54
    [Google Scholar]
  61. 61. 
    Powell BJ, Beidas RS, Lewis CC, Aarons GA, McMillen JC et al. 2017. Methods to improve the selection and tailoring of implementation strategies. J. Behav. Health Serv. Res. 44:177–94
    [Google Scholar]
  62. 62. 
    Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL et al. 2015. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement. Sci. 10:21
    [Google Scholar]
  63. 63. 
    Proctor E, Hooley C, Morse A, McCrary S, Kim H, Kohl PL 2019. Intermediary/purveyor organizations for evidence-based interventions in the US child mental health: characteristics and implementation strategies. Implement. Sci. 14:3
    [Google Scholar]
  64. 64. 
    Proctor EK, Powell BJ, McMillen JC 2013. Implementation strategies: recommendations for specifying and reporting. Implement. Sci. 8:139
    [Google Scholar]
  65. 65. 
    Reis RS, Salvo D, Ogilvie D, Lambert EV, Goenka S, Brownson RC 2016. Scaling up physical activity interventions worldwide: stepping up to larger and smarter approaches to get people moving. Lancet 388:1337–48
    [Google Scholar]
  66. 66. 
    Schneider H, Coetzee D, Van Rensburg D, Gilson L. 2010. Differences in antiretroviral scale up in three South African provinces: the role of implementation management. BMC Health Serv. Res. 10:Suppl. 1S4
    [Google Scholar]
  67. 67. 
    Sutherland R, Brown A, Nathan N, Janssen L, Reynolds R et al. 2019. Protocol for an effectiveness- implementation hybrid trial to assess the effectiveness and cost-effectiveness of an m-health intervention to decrease the consumption of discretionary foods packed in school lunchboxes: the ‘SWAP IT’ trial. BMC Public Health 19:1510
    [Google Scholar]
  68. 68. 
    Sutherland R, Nathan N, Brown A, Yoong S, Finch M et al. 2019. A randomized controlled trial to assess the potential efficacy, feasibility and acceptability of an m-health intervention targeting parents of school aged children to improve the nutritional quality of foods packed in the lunchbox ‘SWAP IT. ’. Int. J. Behav. Nutr. Phys. Act 16:54
    [Google Scholar]
  69. 69. 
    Svanemyr J, Baig Q, Chandra-Mouli V. 2015. Scaling up of life skills based education in Pakistan: a case study. Sex. Educ. 15:249–62
    [Google Scholar]
  70. 70. 
    Taylor MJ, McNicholas C, Nicolay C, Darzi A, Bell D, Reed JE 2014. Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Qual. Saf. 23:290–98
    [Google Scholar]
  71. 71. 
    Toles M, Colón-Emeric C, Naylor MD, Asafu-Adjei J, Hanson LC. 2017. Connect-Home: transitional care of skilled nursing facility patients and their caregivers. J. Am. Geriatr. Soc. 65:2322–28
    [Google Scholar]
  72. 72. 
    Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H et al. 2018. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann. Intern. Med. 169:467–73
    [Google Scholar]
  73. 73. 
    Wandersman A, Duffy J, Flaspohler P, Noonan R, Lubell K et al. 2008. Bridging the gap between prevention research and practice: the Interactive Systems Framework for dissemination and implementation. Am. J. Community Psychol. 41:171–81
    [Google Scholar]
  74. 74. 
    Weiner BJ, Lewis MA, Clauser SB, Stitzenberg KB. 2012. In search of synergy: strategies for combining interventions at multiple levels. . J. Natl. Cancer Inst. Monogr. 2012:34–41
    [Google Scholar]
  75. 75. 
    Weis J, Festin M. 2020. Implementation and scale-up of the standard days method of family planning: a landscape analysis. Glob. Health Sci. Pract. 8:114–24
    [Google Scholar]
  76. 76. 
    World Bank 2021. High income countries. World Bank, Data https://data.worldbank.org/country/XD
    [Google Scholar]
  77. 77. 
    Zomahoun HTV, Ben Charif A, Freitas A, Garvelink MM, Menear M et al. 2019. The pitfalls of scaling up evidence-based interventions in health. Glob. Health Action 12:1670449
    [Google Scholar]
/content/journals/10.1146/annurev-publhealth-052020-113438
Loading
/content/journals/10.1146/annurev-publhealth-052020-113438
Loading

Data & Media loading...

Supplementary Data

  • Article Type: Review Article
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error