Vicki Brown, Huong Tran, Miranda Blake, Rachel Laws, Marj Moodie
Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, 3220, Australia.
Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, 3220, Australia.
Health Res Policy Syst. 2020 Oct 1;18(1):115. doi: 10.1186/s12961-020-00633-6.
Translating research evidence into practice is challenging and, to date, there are relatively few public health interventions that have been effectively and cost-effectively implemented and delivered at scale. Theories, models and frameworks (herein termed 'frameworks') have been used in implementation science to describe, guide and explain implementation and scale-up. While economic constructs have been reported as both barriers and facilitators to effective implementation and scale-up of public health interventions, there is currently no published review of how economic constructs are considered within commonly used implementation and scale-up frameworks. This paper aimed to narratively review the economic constructs incorporated in commonly used implementation and scale-up frameworks.
Frameworks for inclusion in the narrative review were identified from the literature and thematic content analysis was undertaken using a recursive deductive approach. Emergent key themes and sub-themes were identified and results were summarised narratively within each theme.
Twenty-six framework publications were included in our analysis, with wide variation between frameworks in the scope and level of detail of the economic constructs included. Four key themes emerged from the data - 'resources', 'benefit', 'cost' and 'funding'. Only five frameworks incorporated all four identified key themes. Overarching lenses from which to consider key themes included 'stakeholder perspectives', 'stage in the research translation process' and 'context'. 'Resources' were most frequently considered in relation to the sub-themes of 'types of resources' (e.g. labour, time or infrastructure) and 'availability' of resources, and the opportunity for 'economies of scale'. The 'relative advantage of interventions' emerged as an interconnecting sub-theme between 'cost' and 'benefit'. 'Funding' was most often considered in relation to 'funding sources', 'availability', 'sustainability' or 'contextual impact'. The concept of 'opportunity cost' was considered in relatively few frameworks, despite being fundamental to economic theory.
Implementation and scale-up frameworks provide a conceptual map to inform the effective and cost-effective implementation of public health interventions delivered at scale. Despite evidence of an emerging focus on the economic considerations of implementation and scale-up within some commonly used frameworks, our findings suggest that there is significant scope for further exploration of the economic constructs related to implementation and scale-up.
将研究证据转化为实践具有挑战性，迄今为止，有效且具成本效益地大规模实施和提供的公共卫生干预措施相对较少。理论、模型和框架（以下简称“框架”）已被用于实施科学，以描述、指导和解释实施及扩大规模的过程。虽然经济因素已被报告为公共卫生干预措施有效实施和扩大规模的障碍及促进因素，但目前尚无已发表的关于常用实施和扩大规模框架如何考虑经济因素的综述。本文旨在对常用实施和扩大规模框架中纳入的经济因素进行叙述性综述。
从文献中确定纳入叙述性综述的框架，并采用递归演绎法进行主题内容分析。确定了新出现的关键主题和子主题，并在每个主题内以叙述方式总结结果。
我们的分析纳入了26篇框架出版物，各框架纳入的经济因素的范围和详细程度差异很大。数据中出现了四个关键主题——“资源”、“效益”、“成本”和“资金”。只有五个框架纳入了所有四个已确定的关键主题。考虑关键主题的总体视角包括“利益相关者视角”、“研究转化过程中的阶段”和“背景”。“资源”最常与“资源类型”（如劳动力、时间或基础设施）、资源的“可用性”以及“规模经济”机会等子主题相关联进行考虑。“干预措施的相对优势”作为“成本”和“效益”之间的一个相互关联的子主题出现。“资金”最常与“资金来源”、“可用性”、“可持续性”或“背景影响”相关联进行考虑。尽管“机会成本”概念是经济理论的基础，但在相对较少的框架中被考虑。
实施和扩大规模框架提供了一个概念图，可以为大规模提供的公共卫生干预措施的有效和具成本效益的实施提供信息。尽管有证据表明一些常用框架中对实施和扩大规模的经济考虑日益受到关注，但我们的研究结果表明，与实施和扩大规模相关的经济因素仍有很大的进一步探索空间。
