Willis Cameron D, Riley Barbara L, Stockton Lisa, Abramowicz Aneta, Zummach Dana, Wong Geoff, Robinson Kerry L, Best Allan
Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada.
Menzies Centre for Health Policy and the Australian Prevention Partnership Centre, University of Sydney, Sydney, NSW, Australia.
Health Res Policy Syst. 2016 Dec 19;14(1):88. doi: 10.1186/s12961-016-0158-4.
Preventing chronic diseases, such as cancer, cardiovascular disease and diabetes, requires complex interventions, involving multi-component and multi-level efforts that are tailored to the contexts in which they are delivered. Despite an increasing number of complex interventions in public health, many fail to be 'scaled up'. This study aimed to increase understanding of how and under what conditions complex public health interventions may be scaled up to benefit more people and populations.A realist synthesis was conducted and discussed at an in-person workshop involving practitioners responsible for scaling up activities. Realist approaches view causality through the linkages between changes in contexts (C) that activate mechanisms (M), leading to specific outcomes (O) (CMO configurations). To focus this review, three cases of complex interventions that had been successfully scaled up were included: Vibrant Communities, Youth Build USA and Pathways to Education. A search strategy of published and grey literature related to each case was developed, involving searches of relevant databases and nominations from experts. Data extracted from included documents were classified according to CMO configurations within strategic themes. Findings were compared and contrasted with guidance from diffusion theory, and interpreted with knowledge users to identify practical implications and potential directions for future research.Four core mechanisms were identified, namely awareness, commitment, confidence and trust. These mechanisms were activated within two broad scaling up strategies, those of renewing and regenerating, and documenting success. Within each strategy, specific actions to change contexts included building partnerships, conducting evaluations, engaging political support and adapting funding models. These modified contexts triggered the identified mechanisms, leading to a range of scaling up outcomes, such as commitment of new communities, changes in relevant legislation, or agreements with new funding partners.This synthesis applies and advances theory, realist methods and the practice of scaling up complex interventions. Practitioners may benefit from a number of coordinated efforts, including conducting or commissioning evaluations at strategic moments, mobilising local and political support through relevant partnerships, and promoting ongoing knowledge exchange in peer learning networks. Action research studies guided by these findings, and studies on knowledge translation for realist syntheses are promising future directions.
预防慢性病，如癌症、心血管疾病和糖尿病，需要复杂的干预措施，涉及多方面和多层次的努力，这些努力要根据实施的具体情况量身定制。尽管公共卫生领域的复杂干预措施越来越多，但许多措施未能得到“推广”。本研究旨在增进对复杂公共卫生干预措施如何以及在何种条件下能够得到推广以惠及更多个人和人群的理解。我们进行了一项实在论综合分析，并在一个由负责推广活动的从业者参加的面对面研讨会上进行了讨论。实在论方法通过激活机制（M）的情境（C）变化之间的联系来审视因果关系，从而产生特定结果（O）（CMO配置）。为了聚焦本次综述，纳入了三个已成功推广的复杂干预案例：活力社区、美国青年建设组织和教育之路。针对每个案例制定了已发表和灰色文献的检索策略，包括对相关数据库的检索和专家提名。从纳入文献中提取的数据根据战略主题内的CMO配置进行分类。将研究结果与扩散理论的指导意见进行比较和对比，并与知识使用者进行解读，以确定实际意义和未来研究的潜在方向。确定了四个核心机制，即意识、承诺、信心和信任。这些机制在两种广泛的推广策略中被激活，即更新与再生以及记录成功案例。在每种策略中，改变情境的具体行动包括建立伙伴关系、进行评估、争取政治支持和调整资助模式。这些改变后的情境触发了所确定的机制，导致了一系列推广成果，如新社区的承诺、相关立法的变化或与新资助伙伴的协议。本综合分析应用并推进了理论、实在论方法以及复杂干预措施推广的实践。从业者可能会从一些协调一致的努力中受益，包括在战略时刻进行或委托进行评估、通过相关伙伴关系调动地方和政治支持，以及在同行学习网络中促进持续的知识交流。以这些研究结果为指导的行动研究以及关于实在论综合分析的知识转化研究是很有前景的未来方向。
