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From intervention studies to national programs, what are the favoring and hindering factors? a scoping review

Renata Cristina Ferreira Rola¹, Tatiana Rivera Ramirez^2,3, Axel Kroeger¹

¹Centre for Medicine and Society, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

BMC Public Health

|October 29, 2025

Abstract

Background:

The translation of successful health projects into public health practice is among the most relevant challenges to pursue better health results, including the outcomes established by the United Nations Sustainable Development Goals (SDGs). Healthcare interventions proven cost-effective should be expanded into broader policies and practices. This process is called scaling-up and its success depends on several factors. To critically think about how to scale-up projects or adapt programs, it is necessary to identify potential favoring and hindering factors. In this sense, this study aims to document the type of public health programs which have been scaled up, describe the favoring and hindering factors of this process, and critically analyze the findings about it.

Methods:

To reach this goal, this project used the scoping review method to map and summarize the existing evidence on scaling up health interventions through available publications. The databases used in this review were PubMed, Web of Science, Cochrane Library, Scopus, VHL, Scielo, and Google Scholar.

Results:

Through the selection process from a total of 7,027 search hints, 30 relevant papers were included. The found factors that impacted the scaling-up process were organized based on categories of the ExpandNet/WHO framework. The results indicate that poor "user organization", "institutional environment" and "resource mobilization" were the most frequently mentioned hindering factors for scaling-up processes. Favoring factors included strong leadership, well defined roles, good coordination, positive political environment and community support and engagement.

Conclusion:

Hindering and favoring factors do not exist in isolation, but are correlated, interact, enhance or hinder one another. Beyond the practical advice given in this paper, further research recommended that investigates the association between different factors.

Keywords:

Favoring factors Hindering factors Public health interventions Scaling up Translational research

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