Coleman Associates

Widespread implementation (ie, scale-up) of interventions typically involves providing training, technical assistance, and other implementation strategies to the settings intended to deliver the intervention. Researchers rarely plan for how to provide these strategies beyond the period of research funding. Specifically, they do not develop the infrastructure (ie, workforce, resources) required to sustain scale-up. Our research team addressed this gap by developing the infrastructure needed to sustain scale-up of the Med-South Lifestyle Intervention (Med-South) following the end of 10 years of research funding. Med-South is a research-tested intervention with demonstrated effectiveness at improving participants' dietary and physical activity behaviors. Existing staff in health departments and community clinics deliver Med-South over a series of 4 monthly counseling sessions and 3 booster phone calls. Implementation strategies (eg, training, technical assistance) also have been developed to support Med-South scale-up. We followed a 3-step process to develop infrastructure to support Med-South scale-up. We assessed existing infrastructure (step 1), identified determinants (ie, barriers and facilitators) of adoption (step 2), and then tailored scale-up to fit existing infrastructure and address determinants (step 3). Scale-up infrastructure included: (1) workforce to support implementation, (2) training curriculum, (3) intervention protocols, (4) data monitoring systems, and (5) communication systems. We engaged 170 public health practitioners in 3 iterative improvement cycles to refine scale-up infrastructure. We evaluated impact on participants' engagement, perceptions of Med-South acceptability, and confidence to deliver and implement Med-South. A total of 88 public health practitioners engaged in all training sessions (51.8%). Practitioners reported high levels of acceptability and confidence in their ability to deliver and implement Med-South. Findings suggest that our 3-step process has potential for use in developing the infrastructure needed to sustain intervention scale-up following the end of research funding.