Abstract
BackgroundPopulation health interventions (PHIs) have the potential to improve the health of large populations by systematically addressing underlying conditions of poor health outcomes (i.e., social determinants of health) and reducing health inequities. Scaling-up may be one means of enhancing the impact of effective PHIs. However, not all scale-up attempts have been successful. In an attempt to help guide the process of successful scale-up of a PHI, we look to the organizational readiness for change theory for a new perspective on how we may better understand the scale-up pathway. Using the change theory, our goal was to develop the foundations of an evidence-based, theory-informed framework for a PHI, through a critical examination of various PHI scale-up experiences documented in the literature.MethodsWe conducted a multi-step, critical interpretive synthesis (CIS) to gather and examine insights from scale-up experiences detailed in peer-reviewed and grey literatures, with a focus on PHIs from a variety of global settings. The CIS included iterative cycles of systematic searching, sampling, data extraction, critiquing, interpreting, coding, reflecting, and synthesizing. Theories relevant to innovations, complexity, and organizational readiness guided our analysis and synthesis.ResultsWe retained and examined twenty different PHI scale-up experiences, which were extracted from 77 documents (47 peer-reviewed, 30 grey literature) published between 1995 and 2013. Overall, we identified three phases (i.e., Groundwork, Implementing Scale-up, and Sustaining Scale-up), 11 actions, and four key components (i.e., PHI, context, capacity, stakeholders) pertinent to the scale-up process. Our guiding theories provided explanatory power to various aspects of the scale-up process and to scale-up success, and an alternative perspective to the assessment of scale-up readiness for a PHI.ConclusionOur synthesis provided the foundations of the Scale-up Readiness Assessment Framework. Our theoretically-informed and rigorous synthesis methodology permitted identification of disparate processes involved in the successful scale-up of a PHI. Our findings complement the guidance and resources currently available, and offer an added perspective to assessing scale-up readiness for a PHI.
Highlights
Population health interventions (PHIs) have the potential to improve the health of large populations by systematically addressing underlying conditions of poor health outcomes and reducing health inequities
critical interpretive synthesis (CIS) leads to the generation of a synthesizing argument, a critically informed analysis that provides new insights by identifying relationships within and/or between existing constructs in the literature and ‘synthetic constructs’
Synthesis: foundations of the scale-up readiness assessment framework Based on our critical synthesis of our 20 real-life scale-up experiences, we identified 11 key actions involved in the successful scale-up of a PHI; as described below these actions were organized over three progressive phases (i.e., Groundwork preparation phase; Implementing scale-up phase; and Sustained the scaled-up PHI phase)
Summary
Population health interventions (PHIs) have the potential to improve the health of large populations by systematically addressing underlying conditions of poor health outcomes (i.e., social determinants of health) and reducing health inequities. In an attempt to help guide the process of successful scale-up of a PHI, we look to the organizational readiness for change theory for a new perspective on how we may better understand the scale-up pathway. A PHI is defined as a discrete set of actions (e.g., policy, program) that impact a number of people by attending to underlying conditions (i.e., social determinants) of health risk, thereby improving population health and reducing health inequities [6]. ExpandNet, a network of public health professionals that was developed in collaboration with the World Health Organization (WHO), has published several important resources, including the ExpandNet conceptual framework [5], which helps facilitate the strategic planning and management of the scale-up process. Subsequent ExpandNet resources include practical guidance for scaling up health innovations [7], steps for developing a scale-up strategy [8], and scale-up planning [9]. Other notable frameworks include Cooley and colleagues’ Scaling Up Management framework [10–12], Yamey’s framework regarding scale-up success factors [13], and Greenhalgh et al.’s framework about predicting and evaluating scale-up [14], to name a few
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