Scaling up public health interventions
Project title: Scaling up public health interventions
Start date: July 2018
Estimated end date: December 2021
What is the issue?
Even where there is evidence that a prevention program is effective, not every intervention can or should be scaled up. Scaling up requires considerable financial and human resources, so it is important that decision makers choose interventions that are likely to succeed and be sustainable at scale.
There has been little Australian research into which factors should be taken into consideration when deciding whether to scale up an intervention. As a consequence, decisions about which programs to scale up may be influenced by political, strategic and infrastructure requirements, rather than by evidence of their scalability.
There are several scaling up frameworks and guides in Australia. All of these require an initial assessment of the scalability of the intervention. This PhD project aims to assist policy makers, program managers and other decision makers to make more robust decisions when considering which programs and interventions to scale up.
How is the project addressing the issue?
This project builds on previous understanding of the different pathways to scaling up. We will investigate how scaling up is being implemented in Australia and highlight the facilitators and barriers that decision makers encounter when scaling up.
We will develop and test a tool for policy makers to help them assess the scalability of public health interventions. This will support policy makers and practitioners consider all the different factors that may influence decisions on whether to scale up an intervention, such as financial sustainability, workforce issues and how to maintain fidelity.
Relevance for practice
It is hoped this work will provide policy makers with robust evidence of potential success factors that can be taken into account in future scaling up decisions.
Policy makers will be provided with resources and clarity around how to plan for scaling up, and evidence to inform better decisions on which interventions are suitable for scaling up.
What are the expected outcomes?
This project comprises five studies:
- An analysis to quantify dissemination and implementation studies in Australia.
- Development of a user-friendly and practical tool to help policy makers and practitioners assess the scalability of an intervention, based on implementation science principles.
- A study to assess the feasibility and utility of the newly developed scalability assessment tool.
- A literature review to understand how researchers define and use the term ‘scalability’.
- A study of the perspectives and experiences of policy makers and practitioners on the barriers, facilitators and influencers in decision making for scaling up population health interventions.
Karen Lee, PhD candidate, Prevention Centre, University of Sydney
Professor Adrian Bauman, University of Sydney
Dr Anne Grunseit, University of Sydney
Andrew Milat, NSW Ministry of Health
Associate Professor Luke Wolfenden, University of Newcastle
This project is funded by the NHMRC, Australian Government Department of Health, ACT Health, Cancer Council Australia, NSW Ministry of Health, South Australian Department for Health and Wellbeing, Tasmanian Department of Health, and VicHealth.
The publication of the Intervention Scalability Assessment Tool (ISAT) has been well received. I have received several requests for advice on using the ISAT, including from:
- Sydney Local Health District – Health Promotion Unit who are seeking to use the ISAT to evaluate the scalability of one of their early maternal health interventions
- The International Agency for Research on Cancer, World Health Organization based in Nice, France are developing a French translation of the guide for use in assessing the scalability of a number of their interventions in Morocco, with the Moroccan Ministry of Health. Advice has been provided and they are keen to collaborate further. The final version will be available here once finalised.
The Intervention Scalability Assessment Tool (ISAT) was developed to help practitioners, policymakers, program managers and researchers determine the scalability of a discrete health program or intervention. Information on how to complete an assessment can be found in the guide below. A scoring sheet in Excel is also available to help score readiness questions within the guide.
- The Intervention Scalability Assessment Tool: A guide for assessing the scalability of health interventions (PDF 1.3MB)
- The ISAT scoring sheet (Excel 76KB)
The International Agency for Research on Cancer, World Health Organization based in Nice, France has translated the ISAT into French for use in assessing the scalability of a number of their interventions in Morocco, with the Moroccan Ministry of Health.
- French translation: The Intervention Scalability Assessment Tool: A guide for assessing the scalability of health interventions (PDF 1.0MB)
- French translation: The ISAT scoring sheet (Excel 76KB)
- Lee K, Milat A, Grunseit A, Conte K, Wolfenden L, Bauman A. The Intervention Scalability Assessment Tool: a pilot study assessing five interventions for scalability. Public Health Res Pract. 2020;30(2):e3022011. doi: 10.17061/phrp30
- Milat A, Lee K, Conte K, Grunseit A, Wolfenden L, van Nassau F, et al. Intervention Scalability Assessment Tool: A decision support tool for health policy makers and implementers. Health Res Policy Sys. 2020;18:1. doi: 10.1186/s12961-019-0494-2
- Lee K, van Nassau F, Grunseit A, Conte K, Milat A, Wolfenden L, Bauman A. Scaling up population health interventions from decision to sustainability–a window of opportunity? A qualitative view from policy-makers. Health Research Policy and Systems. 2020;18(1):1-2. doi: 10.1186/s12961-020-00636-3
- Lee K. Presentation to representatives from the NUS School of Public Health on the scaling up public health interventions and the Intervention Scalability Assessment Tool. National University of Singapore (NUS) School of Public Health, 24 January 2019.
- Lee K. Presentation at the EMCR conference on the Intervention Scalability Assessment Tool. Menzies School of Health Policy – Emerging Health Policy Researchers Conference. June 2019.
- Lee K. Presentation on the Intervention Scalability Assessment Tool. School of Public Health Research Showcase. July 2019.
Sax Institute News, 21 July 2020: Assessing the ‘scalability’ of health programs: 5 tips to think big
Prevention Centre News, April 2019: Our new PhD projects