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. 2024 Nov 8;24(4):6.
doi: 10.5334/ijic.7600. eCollection 2024 Oct-Dec.

Process Evaluations for the Scale-Up of Complex Interventions - a Scoping Review

Lekha Rathod  1 , Martin Heine  1   2 , Daniel Boateng  1   3 , Monika Martens  4   5 , Josefien van Olmen  5 , Grace Marie Ku  4 , Kerstin Klipstein-Grobusch  1   6
Affiliations

Process Evaluations for the Scale-Up of Complex Interventions - a Scoping Review

Lekha Rathod et al. Int J Integr Care. .

Abstract

Introduction: Complex health interventions (CHIs) are common in (public) health and social care practice and policy. A process evaluation (PE) is an essential part of designing and testing CHIs and questions what is implemented, the mechanisms of change, and how context affects implementation. The scale-up of CHIs is challenging and heterogeneous, making the accompanying PE unique to the nature of the inquiry.

Methods: We conducted a scoping review to describe the current practice of conducting PEs alongside or following the scale-up of CHI. Eight primary data sources were searched and data extracted on study characteristics, intervention characteristics, methods used in relation to the PE, and stakeholders included.

Results: We reviewed 10,538 records and included 56 studies. Seven common thematic areas emerged in which CHIs were being scaled-up. The use of scale-up specific frameworks was rare, and common outcomes of the process evaluation focussed on barriers and facilitators in relation to the context; often obtained "once-off" using qualitative and quantitative data sources. Scale-up strategies reported were: supporting increased coverage, comprehensiveness, and institutionalisation; often simultaneously.

Conclusion: Variations in the conduct of process evaluations during the scale-up phase of complex health interventions may reflect differences in context, conceptual challenges, the multi-dimensional nature of scale-up, and the point of engagement with the health care system (e.g., community-level). Ideally, a process evaluation is a recurrent continuous process, leveraging a systems-driven understanding and triangulation of qualitative and quantitative data, that takes place alongside the scale-up project to inform real-world adaptations of scale-up strategies and (untoward) mechanisms of impact when applicable.

Keywords: complex health interventions; implementation research; integrated care; process evaluation; scale-up.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Flow diagram of scoping review in- and exclusion process
Figure 1
Flow diagram of scoping review in- and exclusion process [7980] *Databases: PubMed, Embase, CENTRAL, Web of Science, CINAHL, Global Health, Scielo and African Index Medicus; ** excluded manually.
See this image and copyright information in PMC

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