. 2020 Feb 27;24(Suppl 1):s7–s22. doi: 10.1017/S1368980019004415

Table 3.

Synthesis of review findings

Component	Review findings
Identifying an effective intervention	Understand what exactly is to be scaled-up to achieve large-scale impact⁽¹²⁾ Intervention characteristics: intervention sources, evidence strength and quality, relative advantage, adaptability, trialability, complexity, design quality and packaging⁽²⁴⁾ Assess the nature and strength of the evidence and its potential for implementation⁽²⁵⁾ Determining the impact of intervention through assessing reach and efficacy of an intervention implemented in a real-world setting by individuals who are not part of the original research⁽²⁶⁾ Pre-conditions – identifying need, target population and suitable intervention and pre-implementation – intervention packaging and community input⁽²⁸⁾ The effective implementation starts with the identification of relevant practice issues (problems or best practices) and matching research findings or guidelines⁽²⁹⁾ Explore what needed – conducting a comprehensive formative evaluation to determine the nature of what service or resource is needed⁽³³⁾ Initial consideration regarding the host setting, conduct need assessment and readiness assessment⁽³⁴⁾ Gather evidence that a technology or modality works from basic science as well as controlled assessments of effectiveness⁽³⁸⁾ Exploration – assess fit to ensure a useable innovation⁽⁴³⁾ Evidence synthesis and describe the problem as encountered in practice in terms of problem magnitude, severity, societal burden and problem context⁽⁵⁰⁾
Implementation fidelity	Assess implementation process to understand the quality of implementation⁽¹⁰⁾ Provided a pragmatic and high-level summary of the implementation factors and processes⁽¹¹⁾ Focusing on scaling-up strategy, process and pathways (need to address context, process, enabler and barriers of scale-up)⁽¹²⁾ Outer setting, inner setting, characteristics of the individuals involved and the process of implementation⁽²⁴⁾ Addressing context or setting’s characteristics for successful implementation⁽²⁵⁾ Assessing adoption process of and barriers to adaption for a successful implementation of intervention⁽²⁸⁾ Measuring implementation fidelity means evaluating whether the result of the implementation process is an effective realisation of the intervention as planned by its designers⁽²⁷⁾ Implementation – package dissemination, training, technical assistance and evaluation⁽²⁸⁾ The importance of building bridges between the innovation and the context⁽²⁹⁾ Understand barriers and facilitators at individual, organisation, legal and political level before implementing an intervention⁽³¹⁾ Gave importance of contextual factors and consider patient and community variables such as geography (e.g. distance to care)⁽³²⁾ Deliverable, implementation guide, activities, pre-training and training⁽³³⁾ Create and organise a structure for implementation⁽³⁴⁾ Consider change that happened over time in the use of intervention, characteristic of settings and ecological systems (policy, population characteristics)⁽³⁵⁾ Consider determinants of implementation (guideline factors, individual health professional factors, patient factors, professional interactions, incentives and resources, capacity for organisational change, and social, political and legal factors)⁽³⁶⁾ Consider stakeholder input and partnerships to increase the relevance of research to practice settings and improved public health benefits⁽³⁷⁾ At the planning phase considered community, individual and social determinants; at guiding programme implementation consider health systems (provider and facilities)⁽³⁸⁾ Considered evidence-based intervention with programme logic and mechanism of change⁽³⁹⁾ Considered setting characteristics, implementation strategy and partnership for planning to disseminate and implement an intervention⁽³⁹⁾ At the implementation stage delivery of intervention to be ensured by reach, adoption and fidelity of implementation⁽³⁹⁾ Identifying setting, core goals, key opinion leaders and resources for implementation⁽⁴⁰⁾ Setup, develop scalable unit and go for full scale-up⁽⁴¹⁾ A comprehensive assessment of the implementation fidelity-adaptation balance⁽⁴²⁾ Create, implementation team, examine implementation drivers and develop fidelity measure⁽⁴³⁾ Consider the three dimensions context, implementation and setting⁽⁴⁴⁾ Implementation – an ideal and endeavour and the effective implementation stage – the successful endpoint; adoption – the degree of uptake of new ideas, behaviours, practices and organisational structures⁽⁴⁵⁾ Inform development and implementation of an initiative⁽⁴⁶⁾ Establish a knowledge transfer group consisting of representativeness of key stakeholders, practitioners and researchers with expertise on the evidence at hand⁽⁵⁰⁾
Concurrent evaluation	Require a culture of inquiry, evaluation and learning⁽¹⁰⁾ Consider interdisciplinary research to assess coverage, equity, utilisation, demand, outcomes and impacts⁽¹¹⁾ Monitoring and evaluation, learning, accountability⁽¹²⁾ Context or environment into which the research is to be placed, and the method or way in which the process is facilitated⁽²⁵⁾ Evaluating the interventions to assess positive and negative outcomes as we as public health impact⁽²⁶⁾ Evaluation must measure all the factors listed above that influence the degree of implementation fidelity, such as intervention complexity and the adequacy of facilitation strategies⁽²⁷⁾ For effective implementation, requires continuous evaluation and adapting plan⁽²⁹⁾ Process evaluation to support the implementation effort effectively⁽³⁴⁾ Conducting programme evaluation to inform policy⁽³⁸⁾ Consider evolution to assess intervention effectiveness and economic evaluation: cost-benefit/effectiveness budget impact⁽³⁹⁾ Evaluation frameworks should be in place as part of new research design, ready to be applied at the appropriate stage in the implementation process⁽⁴⁵⁾ Evaluation of contextual factors⁽⁴⁶⁾ Evaluate within the RE-AIM Framework (reach, effectiveness, adoption, implementation and maintenance)⁽⁵⁰⁾
Course correction during implementation	Response among program implementers and resolving inherent tensions between program implementation and research⁽¹⁰⁾ Real-time feedback-loop processes⁽³³⁾ Supportive feedback mechanism – an effective process through which key findings from process data related to implementation are communicated, discussed and acted upon⁽³⁴⁾ Suggested policy-practice feedback loop – data-driven process to inform decision making around innovation improvement and institutionalisation⁽⁴³⁾ Consider a feedback loop that demands monitoring, adoption and extended uptake phases, so that with each cycle, the intervention becomes more firmly entrenched within a system⁽⁴⁵⁾
Sustainability	The strategic and management capacities for sustainability⁽¹¹⁾ Long-term maintenance of implementation essential in the collection of programme-level measures of institutionalisation⁽²⁶⁾ Maintenance and evolution (e.g. preparing the intervention for sustainability)⁽²⁸⁾ Considered dependent and independent variables for assessing sustainability: dependents variables (benefits and out to be continued; continuation of programme activities, partnership, adapting new organisational practice and sustaining attention to the issue or problem, diffusion and replication in other sites), and independent variables (intervention characteristics, organisational level factors, community-level factors)⁽³⁰⁾ Sustainability involves the implementation team handing over the continuation of the project the local champion and stakeholders enter the confirmation stage⁽³³⁾ Dynamic view of sustainability – ongoing evidence that can be cycled to continuously improve intervention design, testing and ongoing system change⁽³⁵⁾ Long-term outcomes: sustainability evaluability transportability replication and uptake of intervention⁽³⁹⁾ Identify available resources to implement and sustain the service model⁽⁴⁰⁾ Adoption mechanism and system support for sustainability⁽⁴¹⁾ Sustainability: once new knowledge and the intervention have been successfully applied and embedded⁽⁴⁵⁾ Use of programmatic approaches and strategies that favour long-term program maintenance⁽⁴⁷⁾ Considered core domains that affect a program’s capacity for sustainability⁽⁴⁸⁾ Framework with factors that influence sustainability – the intersection between the intervention itself and broader socio-cultural and community context within which the intervention is implemented as well as the role of organisational factors in influencing the sustainability of the intervention over time⁽⁴⁹⁾