Scaling-up an evidence-based intervention for osteoarthritis in real world settings: A pragmatic evaluation using the RE-AIM framework

Abstract Background : Scaling-up and sustaining effective healthcare interventions is essential for improving healthcare; however, relatively little is known about these processes. In addition to quantitative experimental designs we need approaches that use embedded, observational studies on practice-led, naturally-occurring scale-up processes. There are also tensions between having adequately rigorous systems to monitor and evaluate scale-up well that are proportionate and pragmatic in practice. The study investigated the scale-up of an evidence-based complex intervention for knee and hip osteoarthritis (ESCAPE-pain) within ‘real-world’ settings by England’s 15 Academic Health Science Networks (AHSNs). Methods : A pragmatic evaluation of the scale-up of ESCAPE-pain using the RE-AIM framework to measure reach, effectiveness, adoption, implementation and maintenance. The evaluation used routine monitoring data collected from April 2014 to December 2019 as part of a national scale-up programme. Results : Between 2014-2018 ESCAPE-pain was adopted by over 110 clinical and non-clinical sites reaching over 9,000 people with osteoarthritis. The programme showed sustained clinical effectiveness (pain, function and quality of life) and high levels of adherence (78.5% completing 75% of the programme) within a range of real world settings. 770 people (physiotherapists and exercise professionals) have been trained to deliver ESCAPE-pain and 84.1% of sites have continued to deliver the programme post-implementation. Conclusions : ESCAPE-pain successfully moved from being an efficacious “research intervention” into an effective intervention within ‘real world’ clinical and non-clinical community settings. However, scale-up has been a gradual process requiring on-going, dedicated resources over 5 years by a national network of Academic Health Science Networks (AHSNs). Whilst the collection of monitoring and evaluation data is critical in understanding implementation and scale-up, there remain significant challenges in developing systems sufficiently rigorous, proportionate and locally acceptable.

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Scaling-up an evidence-based intervention for osteoarthritis in real world settings: A pragmatic evaluation using the RE-AIM framework

10.21203/rs.2.19098/v1 ◽

2019 ◽

Author(s):

Andrew Walker ◽

Annette Boaz ◽

Amber Gibney ◽

Zoe Zambelli ◽

Michael V Hurley

Keyword(s):

Real World ◽

Scale Up ◽

Hip Osteoarthritis ◽

Monitoring And Evaluation ◽

Scaling Up ◽

Health Science ◽

Evidence Based ◽

Academic Health ◽

National Network ◽

Gradual Process

Abstract Background: Scaling-up and sustaining effective healthcare interventions is essential for improving healthcare; however, relatively little is known about these processes. In addition to quantitative experimental designs we need approaches that use embedded, observational studies on practice-led, naturally-occurring scale-up processes. There are also tensions between having adequately rigorous systems to monitor and evaluate scale-up well that are proportionate and pragmatic in practice. The study investigated the scale-up of an evidence-based complex intervention for knee and hip osteoarthritis (ESCAPE-pain) within ‘real-world’ settings by England’s 15 Academic Health Science Networks (AHSNs).Methods: A pragmatic evaluation of the scale-up of ESCAPE-pain using the RE-AIM framework to measure reach, effectiveness, adoption, implementation and maintenance. The evaluation used routine monitoring data collected from April 2014 to December 2019 as part of a national scale-up programme.Results: Between 2014-2018 ESCAPE-pain was adopted by over 110 clinical and non-clinical sites reaching over 9,000 people with osteoarthritis. The programme showed sustained clinical effectiveness (pain, function and quality of life) and high levels of adherence (78.5% completing 75% of the programme) within a range of real world settings. 770 people (physiotherapists and exercise professionals) have been trained to deliver ESCAPE-pain and 84.1% of sites have continued to deliver the programme post-implementation.Conclusions: ESCAPE-pain successfully moved from being an efficacious “research intervention” into an effective intervention within ‘real world’ clinical and non-clinical community settings. However, scale-up has been a gradual process requiring on-going, dedicated resources over 5 years by a national network of Academic Health Science Networks (AHSNs). Whilst the collection of monitoring and evaluation data is critical in understanding implementation and scale-up, there remain significant challenges in developing systems sufficiently rigorous, proportionate and locally acceptable.

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What does it Take to Scale up and Sustain Evidence-Based Practices?

Council review ◽

10.1177/0014402913079002061 ◽

2013 ◽

Vol 79 (2) ◽

pp. 195-211 ◽

Cited By ~ 1

Author(s):

Janette K. Klingner ◽

Alison G. Boardman ◽

Kristen L. Mcmaster

Keyword(s):

Research Policy ◽

Scale Up ◽

Scaling Up ◽

District Leadership ◽

Small Scale ◽

Evidence Based ◽

Policy And Practice ◽

Evidence Based Practices ◽

Strategic Reading ◽

Collaborative Strategic Reading

This article discusses the strategic scaling up of evidence-based practices. The authors draw from the scholarly work of fellow special education researchers and from the field of learning sciences. The article defines scaling up as the process by which researchers or educators initially implement interventions on a small scale, validate them, and then implement them more widely in real-world conditions. Examples of scale-up research are included. The authors discuss challenges to scaling up and sustaining evidence-based practices, followed by factors that can potentially support scaling up, including professional development and district leadership. A case example describes how these issues can play out by highlighting experiences with a Collaborative Strategic Reading (CSR) scale-up research project in a large urban school district. The article concludes by offering recommendations for research, policy, and practice.

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Multiple pathways to scaling up and sustainability: An exploration of digital health solutions in South Africa

10.21203/rs.3.rs-80041/v1 ◽

2020 ◽

Author(s):

Alison Swartz ◽

Amnesty E LeFevre ◽

Shehani Perera ◽

Mary V. Kinney ◽

Asha S George

Keyword(s):

South Africa ◽

Digital Health ◽

National Level ◽

Scale Up ◽

Monitoring And Evaluation ◽

Scaling Up ◽

Value Proposition ◽

Problem Identification ◽

Human Resource Capacity ◽

Organisational Context

Abstract Background With an aim to support further understanding of scaling up and sustaining digital health, we explore digital health solutions that have or are anticipated to reach national scale in South Africa: the Perinatal Problem Identification Programme and Child Healthcare Problem Identification Programme (mortality audit reporting and visualisation tools), MomConnect (a direct to consumer maternal messaging and feedback service) and CommCare (a community health worker data capture and decision-support application). Results A framework integrating complexity and scaling up processes was used to conceptually orient the study. Findings are presented by case through four domains: value proposition, actors, technology and organisational context. The scale and use of PPIP and Child PIP were driven by ‘champions’; clinicians who developed technically simple tools to digitise clinical audit data. Top-down political will at the national level drove the scaling of MomConnect, supported by ongoing financial and technical support from donors and technical partners. Donor preferences played a significant role in the selection of CommCare as the platform to digitise CHW service information, with a focus on HIV and TB. A key driver of scale across cases is leadership that recognises and advocates for the value of the digital health solution. The technology need not be complex but must navigate the complexity of operating within an overburdened and fragmented South African health system, where adequate and sustained investment from donors and government overall, and in particular in its human resource capacity and in robust monitoring and evaluation continue to threaten the sustainability of digital health solutions. Conclusions There is no single pathway to achieving scale up or sustainability, and there will be successes and challenges regardless of the configuration of the domains of value proposition, technology, actors and organisational context. While scaling and sustaining digital solutions has its technological challenges, perhaps more complex are the idiosyncratic factors and nature of the relationships between actors involved. Scaling up and sustaining digital solutions need to account for the interplay of the various technical and social dimensions involved in supporting digital solutions to succeed, particularly in health systems that are themselves social and political dynamic systems.

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The Feasibility of Recruiting and Training Lay Leaders During Real-World Program Delivery and Scale-up: The Case of Walk With Ease

Health Promotion Practice ◽

10.1177/1524839919840004 ◽

2019 ◽

Vol 22 (1) ◽

pp. 91-101 ◽

Cited By ~ 2

Author(s):

Kathleen P. Conte ◽

Fabian Held ◽

Olivia Pipitone ◽

Sally Bowman

Keyword(s):

Real World ◽

Qualitative Interviews ◽

Scale Up ◽

Training Model ◽

Scaling Up ◽

Lay Leaders ◽

Limited Resources ◽

Program Delivery ◽

Leader Training ◽

Lay Leader

Introduction. To maximize limited resources, many health promotion programs are designed to be delivered by volunteer lay leaders. But this model poses challenges to implementation in real-world settings and barriers to successfully scaling-up programs. This study examines the current lay leader training model for Walk With Ease, a Centers for Disease Control and Prevention–funded evidence-based arthritis program delivered at-scale. Method. Recruited volunteers ( n = 106) opted into free online or in-person training and agreed to deliver one Walk With Ease program within the following year—only 49%, however, did. Using logistic regression models and qualitative interviews, we explored predictors of volunteer delivery. Results. Volunteers had higher odds of delivering programs if they trained online (odds ratio [OR] = 9.04, 95% confidence interval [CI: 2.30, 48.36]), previously taught health programs (OR = 15.52, 95% CI [3.51, 103.55]) or trained in the second year of implementation (OR = 27.08, 95% CI [2.63, 415.78]). Qualitative findings underscored that successful volunteers were readied by their previous health education experience. Conclusions. While online training modes appear effective to prepare experienced volunteers, lay leaders required additional support. This calls into question whether lay-led delivery models are suitable for scaling-up programs with limited resources. Given the many lay-led health interventions for chronic disease self-management, investing in common training and infrastructures for lay leader development could advance the quality and sustainability of real-world program delivery.

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Scaling-Up Cancer Control Innovations

10.1093/med/9780190647421.003.0035 ◽

2018 ◽

Author(s):

Nancy C. Edwards ◽

Barbara L. Riley ◽

Cameron D. Willis

Keyword(s):

Evaluation System ◽

Scale Up ◽

Cancer Control ◽

Monitoring And Evaluation ◽

Scaling Up ◽

Political Support ◽

Human Papillomavirus Vaccination ◽

Media Campaigns ◽

Five Dimensions ◽

Key Stakeholders

This chapter examines characteristics of and approaches to scaling-up innovations and programs, with illustrations from the field of cancer control. It summarizes definitions of scale-up, emphasizing the introduction of innovations with demonstrated effectiveness and the aims of scale-up: improving coverage and equitable access to the innovation(s) and its intended benefits. The chapter proposes a typology to help guide scaling-up activities. The typology includes five dimensions: the object of scale-up, how this object may be adapted, horizontal and vertical directions for scale-up, linear and nonlinear pathways for scale-up, and factors influencing scale-up. Featuring examples of tobacco control and human papillomavirus vaccination, the typology is applied and key scaling-up actions are described, including media campaigns, engaging key stakeholders, mobilizing political support, and investing in a monitoring and evaluation system. Systemic challenges to scale-up are discussed. Future priorities for research on scaling up cancer control initiatives are proposed.

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Protocol for an Effectiveness-Implementation Hybrid Trial to Evaluate Scale up of an Evidence-Based Intervention Addressing Lifestyle Behaviours From the Start of Life: INFANT

Frontiers in Endocrinology ◽

10.3389/fendo.2021.717468 ◽

2021 ◽

Vol 12 ◽

Author(s):

Rachel Laws ◽

Penelope Love ◽

Kylie D. Hesketh ◽

Harriet Koorts ◽

Elizabeth Denney-Wilson ◽

...

Keyword(s):

Clinical Trial ◽

Early Childhood ◽

Cost Effectiveness ◽

Real World ◽

Scale Up ◽

Child Health Services ◽

Evidence Based ◽

Implementation Effectiveness ◽

Lifestyle Behaviours ◽

First Time

IntroductionPromoting healthy eating and active play in early life is critical, however few interventions have been delivered or sustained at scale. The evaluation of interventions at scale is a crucial, yet under-researched aspect of modifying population-level health behaviours. INFANT is an evidence-based early childhood healthy lifestyle intervention that aims to improve parents’ knowledge and skills around promoting optimal energy balance-related behaviours that, in turn, influence children’s diet, activity and adiposity. It consists of: 1) Four group sessions delivered via first time parent groups across the first 12 months of life; 2) access to the My Baby Now app from birth to 18 months of age. This research aims to assess real-world implementation, effectiveness and cost-effectiveness of INFANT when delivered at scale across Victoria, Australia.Methods and AnalysisA hybrid type II implementation-effectiveness trial applying a mixed methods design will be conducted. INFANT will be implemented in collaboration with practice and policy partners including maternal and child health services, population health and Aboriginal health, targeting all local government areas (n=79) in Victoria, Australia. Evaluation is based on criteria from the ‘Outcomes for Implementation Research’ and ‘RE-AIM’ frameworks. Implementation outcomes will be assessed using descriptive quantitative surveys and qualitative interviews with those involved in implementation, and include intervention reach, organisational acceptability, adoption, appropriateness, cost, feasibility, penetration and sustainability. Process measures include organizational readiness, fidelity, and adaptation. Effectiveness outcomes will be assessed using a sample of INFANT participants and a non-randomized comparison group receiving usual care (1,500 infants in each group), recruited within the same communities. Eligible participants will be first time primary caregivers of an infant aged 0-3 months, owning a personal mobile phone and able to communicate in English. Effectiveness outcomes include infant lifestyle behaviours and BMIz at 12 and 18 months of age.ImpactThis is the first known study to evaluate the scale up of an evidence based early childhood obesity prevention intervention under real world conditions. This study has the potential to provide generalisable implementation, effectiveness and cost-effectiveness evidence to inform the future scale up of public health interventions both in Australia and internationally.Clinical Trial RegistrationAustralian and New Zealand Clinical Trial Registry https://www.anzctr.org.au/, identifier ACTRN12620000670976.

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Scaling early child development: what are the barriers and enablers?

Archives of Disease in Childhood ◽

10.1136/archdischild-2018-315425 ◽

2019 ◽

Vol 104 (Suppl 1) ◽

pp. S43-S50 ◽

Cited By ~ 7

Author(s):

Vanessa Cavallera ◽

Mark Tomlinson ◽

James Radner ◽

Bronwynè Coetzee ◽

Bernadette Daelmans ◽

...

Keyword(s):

Early Childhood Development ◽

Scale Up ◽

Monitoring And Evaluation ◽

Scaling Up ◽

Global Strategy ◽

Childhood Development ◽

Semistructured Interview ◽

Snowball Sampling ◽

Strategic Choices ◽

Framework Analysis

The Sustainable Development Goals, Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) and Nurturing Care Framework all include targets to ensure children thrive. However, many projects to support early childhood development (ECD) do not ‘scale well’ and leave large numbers of children unreached. This paper is the fifth in a series examining effective scaling of ECD programmes. This qualitative study explored experiences of scaling-up among purposively recruited implementers of ECD projects in low- and middle-income countries. Participants were sampled, by means of snowball sampling, from existing networks notably through Saving Brains®, Grand Challenges Canada®. Findings of a recent literature review on scaling-up frameworks, by the WHO, informed the development of a semistructured interview schedule. All interviews were conducted in English, via Skype, audio recorded and transcribed verbatim. Interviews were analysed using framework analysis. Framework analysis identified six major themes based on a standard programme cycle: planning and strategic choices, project design, human resources, financing and resource mobilisation, monitoring and evaluation, and leadership and partnerships. Key informants also identified an overarching theme regarding what scaling-up means. Stakeholders have not found existing literature and available frameworks helpful in guiding them to successful scale-up. Our research suggests that rather than proposing yet more theoretical guidelines or frameworks, it would be better to support stakeholders in developing organisational leadership capacity and partnership strategies to enable them to effectively apply a practical programme cycle or systematic process in their own contexts.

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Scaling‐up evidence‐based obesity interventions: A systematic review assessing intervention adaptations and effectiveness and quantifying the scale‐up penalty

Obesity Reviews ◽

10.1111/obr.12845 ◽

2019 ◽

Vol 20 (7) ◽

pp. 964-982 ◽

Cited By ~ 43

Author(s):

Sam McCrabb ◽

Cassandra Lane ◽

Alix Hall ◽

Andrew Milat ◽

Adrian Bauman ◽

...

Keyword(s):

Systematic Review ◽

Scale Up ◽

Scaling Up ◽

Evidence Based ◽

Obesity Interventions

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