ArticleHealth research policy and systems2021
A systems approach to scale-up for population health improvement.
Article in Health research policy and systems, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
37 citing papers in PubMed, 2 syntheses or guidelines pooled it, 62 citations in OpenAlex.
- Systems approaches to scaling up: a systematic review and narrative synthesis of evidence for physical activity and other behavioural non-communicable disease risk factors.The international journal of behavioral nutrition and physical activity · 2024Pooled it
- Factors Influencing Implementation, Sustainability and Scalability of Healthy Food Retail Interventions: A Systematic Review of Reviews.Nutrients · 2022Pooled it
- Sustainable improvement of interprofessional care for better resident outcomes: protocol for the INTERSCALE hybrid type III effectiveness cluster-randomized trial comparing individualized and collaborative delivery of an evidence-based care model for long-term care.Implementation science : IS · 2026Trial
- How do supermarkets shape the experience of vulnerable people in Australia's food system? A scoping review.Nutrition & dietetics : the journal of the Dietitians Association of Australia · 2026Article
- A scoping review and systems thinking synthesis of scale-up frameworks.BMC health services research · 2026Article
- Theorising pathways of multi-dimensional scaling for population health using implementation and complexity science perspectives.Implementation science communications · 2026Article
- Co-creation, co-design or co-production? Reflections on the development of urban health systems implementation strategies to improve access and quality of primary healthcare services in Bangladesh, Ghana, Nepal and Nigeria.Health research policy and systems · 2026Article
- Expériences et perceptions de la mise à l'échelle d'une intervention de santé publique: entretiens auprès d'une variété d'acteurs français.Canadian journal of public health = Revue canadienne de sante publique · 2026Article
- "The missing piece in the puzzle" - Success factors and barriers for scale-up and sustainment of the Healthy School Start program.Archives of public health = Archives belges de sante publique · 2026Article
- Developing an implementation strategy to scale a community-based football intervention for Men's health: an implementation science study.Frontiers in health services · 2026Article
- Towards a complex systems model of evidence for public health.BMJ global health · 2025Review
- Development and testing of the capacity of organisations for system practices scale.Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals · 2025Article
- 'It's about collaboration': a whole-systems approach to understanding and promoting movement in Suffolk.The international journal of behavioral nutrition and physical activity · 2025Article
- Scale-up influences and definitions of scale-up 'success': evidence from globally scaled interventions.Translational behavioral medicine · 2025Article
- Learning Care Pathways Framework: A New Method to Implement, Learn, Replicate, and Scale up Care Pathways for and With the Patient.International journal of health policy and management · 2025Article
- Using Collective Intelligence to Develop Design Requirements for a Complex Intervention for Advance Care Planning in the Community.Journal of clinical nursing · 2025Article
- Risky outdoor play in the early years: how are parental and practitioner perceptions of danger and benefits associated with young children's outdoor play experiences?International journal of play · 2025Article
- A qualitative study on facilitators and barriers to adoption and implementation of nutrition interventions in higher education settings in Flanders.Scientific reports · 2024Article
- Leveraging group model building to operationalize implementation strategies across implementation phases: an exemplar related to child maltreatment intervention selection.Implementation science communications · 2024Article
- The Impact of Place-Based Approaches Addressing Mental Health and Substance Use Among Adolescents: A Systematic Review of the Literature.Public health reviews · 2024Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Despite a number of important global public health successes, for many health behaviours there is a continued lack of interventions that have been sufficiently scaled up to achieve system-wide integration. This has limited sustainable and equitable population health improvement. Systems change plays a major role in the relation between implementation processes and at-scale institutionalisation of public health interventions. However, in research, systems approaches remain underutilised in scaling up. Public health scale-up models have typically centred on intervention replication through linear expansion. In this paper, we discuss current conceptualisations and approaches used when scaling up in public health, and propose a new perspective on scaling that shifts attention away from the intervention to focus instead on achieving the desired population-level health outcomes. In our view, 'scaling up' exists on a continuum. At one end, effective scaling can involve a linear, intervention-orientated expansive approach that prioritises the spread of evidence-based interventions into existing systems in order to drive expansion in the application of that intervention. At the other end, we contend that scale-up can sit within a complex systems paradigm in which interventions are conceptualised as events in systems. In this case, implementation and scale-up activities should focus on generating changes within the system itself to achieve the desired outcome. This we refer to as 'systems-orientated scale-up' to achieving population health improvement, which can complement traditional approaches in relevant situations. We argue that for some health behaviours, our proposed approach towards scaling up could enhance intervention implementation, sustainability and population health impact.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.