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Mechanisms of scaling up - combining a realist perspective and systems analysis to understand successfully scaled interventions2.02 MB
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Journal article
Mechanisms of scaling up: combining a realist perspective and systems analysis to understand successfully scaled interventions
International Journal of Behavioral Nutrition and Physical Activity, Vol.18(1), pp.42-42
2021
PMID: 33752681
Abstract
Background:
Sustainable shifts in population behaviours require system-level implementation and embeddedness of large-scale health interventions. This paper aims to understand how different contexts of scaling up interventions affect mechanisms to produce intended and unintended scale up outcomes.
Methods:
A mixed method study combining a realist perspective and systems analysis (causal loop diagrams) of scaled-up physical activity and/or nutrition interventions implemented at a state/national level in Australia (2010–18). The study involved four distinct phases: Phase 1 expert consultation, database and grey literature searches to identify scaled-up interventions; Phase 2 generating initial Context-Mechanism-Outcome configurations (CMOs) from the WHO ExpandNet framework for scaling up; Phase 3 testing and refining CMOs via online surveys and realist interviews with academics, government and non-government organisations (NGOs) involved in scale up of selected interventions (Phase 1); and Phase 4 generating cross-case mid-range theories represented in systems models of scaling up; validated by member checking. Descriptive statistics were reported for online survey data and realist analysis for interview data.
Results:
Seven interventions were analysed, targeting nutrition (n = 1), physical activity (n = 1), or a combination (n = 5). Twenty-six participants completed surveys; 19 completed interviews. Sixty-three CMO pathways underpinned successful scale up, reflecting 36 scale up contexts, 8 key outcomes; linked via 53 commonly occurring mechanisms. All five WHO framework domains were represented in the systems models. Most CMO pathways included ‘intervention attributes’ and led to outcomes ‘community sustainability/embeddedness’ and ‘stakeholder buy-in/perceived value’. Irrespective of interventions being scaled in similar contexts (e.g., having political favourability); mechanisms still led to both intended and unintended scale up outcomes (e.g., increased or reduced sustainability).
Conclusion:
This paper provides the first evidence for mechanisms underpinning outcomes required for successful scale up of state or nationally delivered interventions. Our findings challenge current prerequisites for effective scaling suggesting other conditions may be necessary. Future scale up approaches that plan for complexity and encourage iterative adaptation throughout, may enhance scale up outcomes. Current linear, context-to-outcome depictions of scale up oversimplify what is a clearly a complex interaction between perceptions, worldviews and goals of those involved. Mechanisms identified in this study could potentially be leveraged during future scale up efforts, to positively influence intervention scalability and sustainability.
Details
- Title
- Mechanisms of scaling up: combining a realist perspective and systems analysis to understand successfully scaled interventions
- Authors
- Harriet Koorts (Author) - Deakin UniversitySamuel Cassar (Author) - Deakin UniversityJo Salmon (Author) - Deakin UniversityMark Lawrence (Author) - Deakin UniversityPaul Salmon (Author) - University of the Sunshine Coast, Queensland, Centre for Human Factors and Systems ScienceHenry Dorling (Author) - Southampton Solent University
- Publication details
- International Journal of Behavioral Nutrition and Physical Activity, Vol.18(1), pp.42-42
- Publisher
- BioMed Central Ltd.
- Date published
- 2021
- DOI
- 10.1186/s12966-021-01103-0
- ISSN
- 1479-5868
- PMID
- 33752681
- Copyright note
- © The Author(s). 2021. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
- Organisation Unit
- Centre for Human Factors and Systems Science; University of the Sunshine Coast, Queensland; School of Law and Society
- Language
- English
- Record Identifier
- 99522508902621
- Output Type
- Journal article
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- Nutrition & Dietetics
- Physiology
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