A sense of scale: Exploring ways to implement effective prevention

What is the issue?

Evidence-based chronic disease prevention initiatives need to be implemented at a population level (‘at scale’) to maximise their benefits. However, little evidence is available to guide policy makers and practitioners in scaling up projects in key community settings such as childcare services, schools, workplaces or sporting clubs – the places with access to large numbers of children or adults, often for long periods, where prevention initiatives may be implemented.

Without implementation at scale, effective health promoting interventions are unable to benefit public health. Implementing interventions at scale is recommended internationally, and is included in chronic disease prevention strategies across the globe.

How did the project address the issue?

This project sought to address the need for an up-to-date, comprehensive synthesis of strategies to implement chronic disease prevention programs, practices or policies, and particularly those conducted at scale.

The team conducted a series of systematic reviews of trials assessing the impact of strategies to implement policies, practices or programs targeting smoking, nutrition, alcohol, physical activity or obesity, implemented in childcare services, schools, workplaces and sporting clubs. These reviews, to be published by the Cochrane Collaboration, aimed to identify the:

• Effectiveness of implementation support strategies (such as training, performance feedback, opinion leaders, etc) in improving the implementation of setting-based chronic disease prevention programs or police
• Effectiveness of such support strategies delivered at scale (defined as more than 50 organisational units/workplaces, schools, etc.)
• Impact of such strategies on chronic disease risks (tobacco and alcohol use, diet, physical activity or weight status).

What were the outcomes?

The comprehensive program of work provided the first comprehensive evidence synthesis in Australia aiming to guide policy makers in strategies to use when scaling up interventions in the community.

The project found there were relatively few trials into scaling up in community settings, and those that existed were of limited quality and underpowered. There was evidence that implementation strategies can work, but there is considerable heterogeneity in their impact. Overall, the effects of implementation strategies are modest.

The project led to three reviews published by the Cochrane Collaboration.

Relevance for practice

This project has highlighted the need to use comprehensive evaluation frameworks in existing and future prevention programs in community settings. It highlighted serious evidence gaps in our understanding of the use of implementation strategies to scale up prevention interventions. There is a need for coordinated research investment to fill these gaps, and for greater standardisation of implementation methods and processes.