Pathways for scaling up public health interventions

Area of Science:

• Public Health
• Health Services Research
• Intervention Science

Background:

• Population-wide health improvement necessitates scaling up effective interventions.
• Pathways for scaling up public health interventions are not well-defined.
• This study addresses the need to characterize and quantify intervention scaling processes.

Purpose of the Study:

• To identify scaled-up public health interventions.
• To develop a conceptual framework for quantifying intervention scaling pathways.
• To analyze different trajectories of scaling up interventions in high-income countries.

Main Methods:

• Conducted a multi-stage international literature search for scaled-up, chronic disease prevention interventions in high-income countries.
• Reviewed and coded 40 identified interventions into a conceptual framework detailing their scaling process.
• Utilized in-depth article review and internet searches to determine dissemination outcomes.

Main Results:

• Identified 40 public health interventions with evidence of being scaled up.
• Classified four distinct scaling pathways: Type I (Comprehensive, 55%), Type II (Efficacy omitters, 5%), Type III (Trial omitters, 25%), and Type IV (At scale dissemination, 15%).
• Quantified the proportion of interventions following each identified scaling trajectory.

Conclusions:

• This is the first study to classify and quantify pathways for scaling up public health interventions in high-income countries.
• The findings demonstrate diverse scaling trajectories and allow for classification of variations.
• Future research should explore policy and practice determinants influencing these pathways, particularly missing efficacy and replication stages.