Abstract
BackgroundInterventions that work must be effectively delivered at scale to achieve population level benefits. Researchers must choose among a vast array of implementation frameworks (> 60) that guide design and evaluation of implementation and scale-up processes. Therefore, we sought to recommend conceptual frameworks that can be used to design, inform, and evaluate implementation of physical activity (PA) and nutrition interventions at different stages of the program life cycle. We also sought to recommend a minimum data set of implementation outcome and determinant variables (indicators) as well as measures and tools deemed most relevant for PA and nutrition researchers.MethodsWe adopted a five-round modified Delphi methodology. For rounds 1, 2, and 3 we administered online surveys to PA and nutrition implementation scientists to generate a rank order list of most commonly used; i) implementation and scale-up frameworks, ii) implementation indicators, and iii) implementation and scale-up measures and tools. Measures and tools were excluded after round 2 as input from participants was very limited. For rounds 4 and 5, we conducted two in-person meetings with an expert group to create a shortlist of implementation and scale-up frameworks, identify a minimum data set of indicators and to discuss application and relevance of frameworks and indicators to the field of PA and nutrition.ResultsThe two most commonly referenced implementation frameworks were the Framework for Effective Implementation and the Consolidated Framework for Implementation Research. We provide the 25 most highly ranked implementation indicators reported by those who participated in rounds 1–3 of the survey. From these, the expert group created a recommended minimum data set of implementation determinants (n = 10) and implementation outcomes (n = 5) and reconciled differences in commonly used terms and definitions.ConclusionsResearchers are confronted with myriad options when conducting implementation and scale-up evaluations. Thus, we identified and prioritized a list of frameworks and a minimum data set of indicators that have potential to improve the quality and consistency of evaluating implementation and scale-up of PA and nutrition interventions. Advancing our science is predicated upon increased efforts to develop a common ‘language’ and adaptable measures and tools.
Highlights
Interventions that work must be effectively delivered at scale to achieve population level benefits
We invited participants to complete a three-section online survey (FluidSurvey; Fluidware Inc., Ottawa, ON, Canada); section 1. participants provided demographic data; section 2. we provided a list of implementation frameworks, indicators, and measures and tools generated by attendees during a Special Interest Group (SIG) workshop
We acknowledged the importance of Diffusion of Innovation Theory [37] and a broad reaching conceptual model [26] as they were often noted by participants
Summary
Interventions that work must be effectively delivered at scale to achieve population level benefits. Researchers must choose among a vast array of implementation frameworks (> 60) that guide design and evaluation of implementation and scale-up processes. We sought to recommend conceptual frameworks that can be used to design, inform, and evaluate implementation of physical activity (PA) and nutrition interventions at different stages of the program life cycle. Interventions that work, must be effectively delivered at scale to achieve health benefits at the population level [1]. Despite the importance of scaling-up health promotion strategies for public health, only 20% of public health studies examined ways to integrate efficacious interventions into real-world settings [2]. Only interventions that demonstrated efficacy in purposely designed studies would be scaled-up. Theoretical frameworks and indicators that guide implementation and scale-up processes are often similar [9]
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