Abstract
BackgroundTranslating research evidence into practice is challenging and, to date, there are relatively few public health interventions that have been effectively and cost-effectively implemented and delivered at scale. Theories, models and frameworks (herein termed ‘frameworks’) have been used in implementation science to describe, guide and explain implementation and scale-up. While economic constructs have been reported as both barriers and facilitators to effective implementation and scale-up of public health interventions, there is currently no published review of how economic constructs are considered within commonly used implementation and scale-up frameworks. This paper aimed to narratively review the economic constructs incorporated in commonly used implementation and scale-up frameworks.MethodsFrameworks for inclusion in the narrative review were identified from the literature and thematic content analysis was undertaken using a recursive deductive approach. Emergent key themes and sub-themes were identified and results were summarised narratively within each theme.ResultsTwenty-six framework publications were included in our analysis, with wide variation between frameworks in the scope and level of detail of the economic constructs included. Four key themes emerged from the data – ‘resources’, ‘benefit’, ‘cost’ and ‘funding’. Only five frameworks incorporated all four identified key themes. Overarching lenses from which to consider key themes included ‘stakeholder perspectives’, ‘stage in the research translation process’ and ‘context’. ‘Resources’ were most frequently considered in relation to the sub-themes of ‘types of resources’ (e.g. labour, time or infrastructure) and ‘availability’ of resources, and the opportunity for ‘economies of scale’. The ‘relative advantage of interventions’ emerged as an interconnecting sub-theme between ‘cost’ and ‘benefit’. ‘Funding’ was most often considered in relation to ‘funding sources’, ‘availability’, ‘sustainability’ or ‘contextual impact’. The concept of ‘opportunity cost’ was considered in relatively few frameworks, despite being fundamental to economic theory.ConclusionsImplementation and scale-up frameworks provide a conceptual map to inform the effective and cost-effective implementation of public health interventions delivered at scale. Despite evidence of an emerging focus on the economic considerations of implementation and scale-up within some commonly used frameworks, our findings suggest that there is significant scope for further exploration of the economic constructs related to implementation and scale-up.
Highlights
Translating research evidence into practice is challenging and, to date, there are relatively few public health interventions that have been effectively and cost-effectively implemented and delivered at scale
While a relatively large number of implementation and scale-up frameworks currently exist within the literature [8], the results from our thematic analysis of frameworks commonly used by implementation scientists suggest that the inclusion of economic constructs, such as ‘Cost’, ‘Benefit’, ‘Resources’ and ‘Funding’, are currently heterogeneous in terms of scope and level of detail incorporated
Our results demonstrate that the contextual nature of key themes, such as ‘Resources’, ‘Cost’, ‘Benefit’ and ‘Funding’, could be more thoroughly considered in many frameworks in order to better inform implementation and scale-up
Summary
Translating research evidence into practice is challenging and, to date, there are relatively few public health interventions that have been effectively and cost-effectively implemented and delivered at scale. Evidence of successful scale-up of public health interventions — the process by which health interventions shown to be efficacious on a small scale or in controlled conditions are expanded under real-world conditions into broader policy and practice [2, 3] — is limited [4, 5] This sub-optimal translation of evidence into practice has been attributed to the social-ecological differences between controlled testing environments as well as to the challenges of implementation and scale-up in inherently more complex and dynamic real-world contexts and environments [6]. The overarching aims of the use of theories, models and frameworks ( termed ‘frameworks’) in implementation science have been summarised as (1) to describe and/ or guide the process of translating research to practice; (2) to understand and/or explain what influences implementation and scale-up outcomes; and (3) to guide evaluation design [7]. A large number of frameworks exist, with a recent study reporting the use of over 100 different examples by implementation researchers [8]
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