Table 6.

Dimensions of scalability of universal, selective, and integrated prevention to be assessed in qualitative interviews

ISAT domains	• the problem (is it of sufficient concern to warrant scale-up to the proposed level?) • the program/intervention (how well does it address needs of target group/problem?) • strategic/political context (is problem consistent with policy/funding/strategic directions/priorities?) • evidence of effectiveness (of ROSE as selective, indicated, or universal prevention) • program/intervention costs (of ROSE as selective, indicated, or universal prevention) • fidelity and adaptation (can program fidelity be monitored/maintained if implemented at scale?) • reach and acceptability (of selective, indicated or universal prevention, esp to people from marginalized groups) • delivery setting/workforce (feasibility/acceptability of selective, indicated, universal prevention in existing structures) • are implementation infrastructure requirements of selective, indicated, universal prevention feasible for scale-up? • sustainability (are integration, resourcing, workforce needed for selective, indicated, universal prevention sustainable at scale?)
IHI Model for going to Full Scale48,49	• support systems (learning systems, data systems, infrastructure, human capacity, capability for scale-up, sustainability) • adoption mechanisms (leadership, communication, social networks, culture of urgency and persistence) • content (develop and validate change package, replicate/adapt it across contexts)
Zamboni definition	• the ability of a health intervention shown to be efficacious on a small scale or under controlled conditions to be expanded under real-world conditions to reach a greater proportion of the eligible population, while retaining effectiveness50–52