Determinants and strategies for successful scale-up of health interventions in the Netherlands

Abstract Background Although many evidence-based health interventions are proven effective, the process of scaling up is often complex and challenging. Yet, some interventions have managed to achieve successful scale-up. This provides a window of opportunity to learn from those experiences to inform future scale up processes. Objectives This mixed-methods study aimed to assess determinants and scale-up strategies contributing to successful scale-up of health promotion interventions in the Netherlands. Methods Semi-structured interviews were conducted with intervention owners (i.e. the individual or team taking the responsible for several aspects related to implementation and scale-up) (N = 25) of successfully scaled interventions (implemented across various health behaviours and different settings), and other relevant stakeholders (N = 10) involved in scaling up. Additionally, a survey was distributed among interventions (N = 306) registered in a national intervention database to assess scale-up experiences. Results Scale-up is often the result of a combination of determinants, such as persistent commitment of intervention owners and stakeholders, new funding opportunities, and accreditation by institutions. Several scale-up strategies were identified related to funding (e.g. reducing costs by setting up collaborations), organizational processes (e.g. infrastructure to support implementation), monitoring and evaluation, and dissemination and advocacy. Conclusions Achieving successful scale-up does not happen automatically and continuous effort of the intervention owner is crucial. There is no such thing as one successful scaling strategy which succeeds across all contexts. The intervention owner typically takes the lead in diverse scaling pathways, where sufficient time, funding, the right moment and added value form the critical ingredients for success. Funding: This study was funded by ZonMw. Key messages • Crucial elements of achieving scale-up are the continuous effort of the intervention owner, sufficient time, funding, the right moment and added value of the intervention. • Funding should not me allocated for new initiatives but also for continuous development of interventions, ongoing evaluation and covering overhead costs.