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Table 1 Comparison of outcomes, actions and contexts identified in the program theory and observed in case study documentation

From: Scaling up complex interventions: insights from a realist synthesis

Outcomes, Actions or Contexts

As identified in program theory

As observed in case study documentation

Outcomesa

Initiative adapted to context

Initiative adapted to local community needs

Increased organizational/community capacity and readiness

Increased local organizational capacity

Finalized scaling up strategy

Intentional and explicit efforts to scale-up through planned processes

Increased demand for action

Issue prioritized

Increased participation of communities

Increased community participation

Actions

Develop and adapt funding models and partners involved

Develop mergers between existing organizations with shared objectives

Adapt funding model to engage community based organizations

Implement membership fee for peer learning community

Identify external resources

Develop competitive funding proposals

Assess potential readiness and demand for intervention

Conduct needs assessment

Engage leaders and other stakeholders: develop shared vision; align priorities; recruit champions

In-person engagement sessions for community groups and organizations in peer learning networks

Engage national leaders in cross jurisdictional summits

Identify and engage local representatives and leaders

Identify and engage local champions

Launch campaigns to secure local political support

Establish cross-sectoral and jurisdictional partners

Form new partnerships with key funding and social policy organizations

Develop coalitions of local and national organizations

Adapt the initiative design to changing contexts

Refine criteria by which communities/sites are selected

Adapt governance mechanism for initiative

Wind-up/ descale the initiative

Develop an action and implementation plan

Develop action plans by founding individuals

Hold strategic dialogue for developing action plans

Systematically evaluate implementation and outcomes

Commission external evaluations

Conduct evaluations of pilot settings

Conduct interim evaluations

Conduct end of campaign evaluations

Conduct data mining to derive maximal learning

Develop/implement shared measures

Conduct economic evaluation

Conduct social return on investment

Develop, implement and evaluate a knowledge-to-action strategy

Hold information session for community members

Share promising results from early evaluations through a range of products and mediums

Disseminate results widely through tailored information packages

Conduct site visits

National summits to encourage in-person knowledge exchange

Develop communities of practice

Publicly release evaluation results

Implement learning community for disseminating information

Create supportive amendments to policy

Identify and engage lobby groups

Encourage a systems perspective

Not observed in case study documentation

Integrate change into organizational culture

Not observed in case study documentation

Provide technical assistance and training to communities

Provide coaching support to communities

Review existing evidence

Review best practices

Advocated on behalf of community

Contexts

Availability of resources: money, training, technical expertise, data systems, effective communication channels, human resources, managerial skills, evaluation capacity, leadership skills, existing relationships

Credibility of organization

Staff difficulty in implementing action plan

High turnover of staff

Scarcity of financial resources

Lack of staff skills and capacity

High quality leadership skills

History of collaboration

Funding available

Lack of time among funders

Staff skilled in relevant activities

Degree of political support

Uncertain political support

Strong political support

Degree to which socio-cultural conditions and climates support scaling up

Persistent sociological problem

Social and economic hardship

Stalling of efforts

Tragedy in community

Degree of readiness for intervention

Recognized need for change

Available local funds

Realistic expectations

Evidence of impact of the intervention

Uncertainty/variability of intervention effectiveness

Promising early results

A history of intervention success

Degree of consistency in objectives and mandates between stakeholders

Organizational mandate supports solution

Alignment with user needs

Unrealistic expectations

Users value owned interventions

Degree of interest and demand for interventions (in communities and organizations)

Other comparable interventions

Unique needs identified

Growing support for issue

Interventions and models available

Interest from funding organizations

Variability in funding support

  1. aOther outcomes were observed in the case studies but not identified in the program theory: launch of spin-off initiatives; shift in emphasis of initiative; legislation enacted; and launch/renewal of initiative