From Implementation to Scale-Up of Health Promoting Innovations: Two Real World Case Studies

Oct 21, 2019 - 12:00pm to 1:00pm
700-828 W. 10 Ave., VGH Research Pavilion
Heather McKay

“developing effective interventions is only the first step toward improving the health and well-being of populations. Transferring effective programs into real world settings and maintaining them there is a complicated, long-term process…,” Durlak and Dupre 2008

Health interventions are important but without effective strategies to enhance their reach they cannot improve the health of populations in BC or Canada. Policy makers want to know how health promotion (or any) interventions that led to better health on a small scale can be disseminated on a broader scale – while retaining their effectiveness. Currently there is an evidence gap as scale-up studies of effective implementation of health promoting physical activity interventions, are almost non-existent.

Heather will present the central tenets of conceptual frameworks that guide implementation and evaluation of interventions delivered at scale. She will describe Hybrid I, II and II studies and discuss ‘the tug of war’ between adaptation and fidelity, especially as interventions are delivered at larger and larger scale. Heather will embed implementation and scale-up science within two real world scale-up case studies that she led, in collaboration with an interdisciplinary team of researchers, BC Ministry of Health and many community partner organizations.

Choose to Move (CTM): In Canada, 31% of older people live with 2 or more chronic diseases and one in five older Canadians report being lonely. Physical activity (PA) is an important, modifiable lifestyle factor for healthy aging. To address these health concerns, we entered into a partnership with BC Ministry of Health who in 2015 entrusted us to devise and implement an adaptable, co-created, scalable upstream solution- called Choose to Move (CTM). CTM includes elements of PA and social engagement–it has effectively improved the health of older adults in BC and is currently being scaled up across the province.

Action Schools BC (AS! BC): The benefits of physical activity (PA), healthy eating (HE) patterns to ameliorate many health risk factors in children is now well established. Comprehensive school health frameworks were identified as one of ‘seven best investments for physical activity’. AS! BC illustrates how, through committed and sustained cross-sectoral partnerships, comprehensive evaluation, feedback and adaptation, an innovative whole school model was implemented, scaled up and sustained for >10 years in British Columbia (2004-2016). The reach of AS! BC was substantial—94% of schools (>500K children) and over 80 000 teachers, administrators and other key stakeholders.

By the end of my presentation attendees will be able to:

  • Describe the central tenets of implementation and scale up frameworks in health promotion;
  • Define and differentiate between hybrid Type I, II and III effectiveness studies;
  • Describe how implementation and scale-up frameworks have been applied in the real word setting to improve the health of children and older adults.