Table 2 Study characteristics

1

Berman, 2018, [41] USA

Evaluation of the healthy lifestyles initiative for improving community capacity for childhood obesity prevention

Mixed method evaluation of an intervention tested at scale. The aim was to evaluate the Healthy Lifestyles Initiative

Community organisations (e.g., schools, faith-based organisations), State, children and families. Diet (for the prevention of obesity)

The Healthy Lifestyles Initiative. This included policy action, systems, environmental activities, and a messaging campaign

The ad-hoc Healthy Lifestyles Initiative conceptual model, retrospectively mapped to the Proctor framework. There were five core implementation strategies to increase uptake and penetration of coordinated policy, systems, and environmental activities in local communities and disseminate a consistent message on family healthy lifestyles

The Healthy Lifestyles Initiative promoted evidence-based policy, systems, and environmental practices (7–9) more generally to support adoption and implementation across a range of community sectors, including schools, childcare providers, health care providers, businesses, non-profit community organizations, and government organizations (e.g., health departments, parks and recreation departments)

Adopt new policy or change exiting policy, adopt new practices, create customised plans or goals with those served, develop or continue partnerships, initiate staff wellness activities, provide healthy lifestyles screenings or assessments, refer people served to primary care or other resources, and review organisational wellness policies

Barriers: Lack of guidance on the adaptations

Facilitators: Community-capacity-building efforts (e.g., led by CDC and local hospitals and health dept.)

2

Betancourt 2017, [42] USA

Empowering one community at a time for policy, system, and environmental changes to impact obesity

Summary/descriptive article, which aimed to describe expansion and scale up of the Mayors Mentoring Mayors program. This was expanded to five additional states

Community level, Multi-state, Children and families. Physical activity and diet, for the prevention of obesity

A healthy communities toolkit, which helped to guide communities with best practices for health. It includes data to show how health supports the economy, tools for analysis, funding and resources, planning, and tools for city projects

A multi-state approach was used to expand the Mayors Mentoring Mayors program. Partnership was used to identify new mayors

Mayors Mentoring Mayors initiative. Build capacity within local communities to reduce obesity by implementing environmental and policy changes that support healthy living. By working to improve the built environment (i.e., parks, bike lanes, sidewalks, farmer’s markets, healthy food retailers, and community gardens), government officials can lay the foundation for improved health and well-being of their residents

Facilitators: Involving key stakeholders in the planning and implementation

GHC where the mayor was involved had the most significant changes toward better health. These mayors were recruited to share their successes, lessons learned, and best practices with their colleagues through a series of Lunch & Learns

3

Blake, 2021, [59] Australia

The ‘Eat Well @ IGA’ healthy supermarket randomised controlled trial: process evaluation

Mixed method process evaluation to investigate the experiences of customers, staff and stakeholders involved in Eat Well @ IGA development and implementation, maintenance and scalability

Independent Grocers of Australia (IGA) supermarket stores in regional Victoria, Australia. Supermarket customers (adults). Heathy eating

The intervention included three components: (i) signage, (ii) local area and in-store promotion; and (iii) shelf tags highlighting (healthiest) packaged foods store-wide

Co-design and strong collaboration with multisectoral partners essential for sustainability, and for planning and evaluating implementation strategies

Diffusions of Innovations (Rogers 2003) underpinned evaluation, to inform on potential scalability of the intervention

Stakeholders that prioritised the value on community health

Barriers: lack of intervention effectiveness may inhibit scale up, as well as sustainable funding and significant buy-in to ensure implementation is sustained at scale. g Organisational and resourcing difficulties were potential for scale up to other IGAs

Facilitators: Collaboration between food retailers, governments and academics

Co-design approach to implementation planning and evaluation. Awareness of contextual factors related to the food industry on implementation and aligning stakeholder objectives and outcomes

4

Bolton, 2017, [43] Australia

The outcomes of health-promoting communities: being active and eating well initiative—a community-based obesity prevention intervention in Victoria, Australia

Mixed method and multi-level quasi-experimental evaluation to assess the impact of the Health-Promoting Communities: Being Active Eating Well initiative

Community settings including schools and workplaces, State, Primary and secondary school aged children, Diet and physical activity, for the prevention of obesity

The main intervention components included stakeholder engagement and partnership development, needs assessment and capacity building, social marketing

State government funding was provided to deliver activity and eating well community programs in areas of disadvantage. The intervention was based on the Colac Be Active Eat Well programme. Analysis Grid for Environments Linked to Obesity (ANGELO) framework, with input from community and stakeholder workshops, expert advisory group, steering committees

Barriers: insufficient implementation, time constraints, competing priorities, lack and engagement, project delays, heterogeneity in community contexts

5

Conte, 2017, [44] Australia

Dynamics behind the scale up of evidence-based obesity prevention: protocol for a multi-site case study of an electronic implementation monitoring system in health promotion practice

Mixed methods multi-site case studies using ethnographic design. This study examined how Population Health Information Management System (PHIMS) intersects with health promotion practice. It aimed to determine whether e-monitoring systems improve the dissemination, adoption, and ongoing delivery of evidence-based preventive programs

Local health districts, State, Childcare and elementary school aged children. Physical activity and diet, for the prevention of obesity

An E-monitoring system to facilitate the dissemination of evidence-based obesity prevention programs targeting healthy eating and physical activity practices (Live Life Well at School and Munch & Move) into every primary school and childcare centre across the state of New South Wales

PHIMS was created to support the dissemination of obesity prevention programs and is delivered across all local health districts in the state of New South Wales. This was designed, implemented, and funded by state level organisations

No information reported in paper

6

^aDavis, 2017, [62] USA

Research to practice: implementing physical activity recommendations

Mixed methods evaluation describing a model for, and aims to identify important factors in, the process of dissemination and implementation of evidence-based recommendations in rural and under-resourced communities

Rural and under resourced tri-ethnic community, Rural/ regional, Community members, Physical activity

The intervention included six strategies: community-wide campaigns, creation of or enhanced access to places for physical activity, information outreach, community-scale and street-scale design, land-use policies, social support, and individually adapted health behaviour change strategies

Alliance partners studied translation of pre-existing community prevention taskforce recommendations. Alliance members then selected strategies to implement that were considered feasible in the local context

The strategies were selected and implemented in ways that the Alliance thought would be feasible

Facilitators: Building on a community-academic partnership; engaging multiple local and external partners; employing culturally appropriate strategies; and using approaches that fit local context and place characteristics (topography, land ownership, population clusters, and existing roadways)

7

Fernandez, 2016, [45] Canada

Factors influencing the adoption of a healthy eating campaign by federal cross-sector partners: a qualitative study

A qualitative study that aimed to describe factors that influence cross-sector partner decisions to adopt the Eat Well campaign

Government, council, and community, National, Children. Diet, for the prevention of obesity

The Eat Well Campaign is a social marketing campaign that focusses on food skills

Cross-sector partners, including food retail, advertising, media, government, and non-government organisations adopted components of the Eat Well Campaign. Adoption was influenced by values, attitudes, and the notion of partnership

Organisations from different industry and sectors (e.g., food retailers, NGOs, advertising groups) that have different means of influencing the system

Barriers: Lack of resources and capacity; reserved/conservative attitudes towards the intervention and the lack of exposure to the mass media channels; political issues; strict control of information by the intervention; lack of relevant population groups; lack of clear objectives; difficulties integrating activities within the organisation

Facilitators: Targeted approach selecting partners through networks with high opinion leadership value (invitation-based approach); high perceptions of fit and favourable attitudes; feel-good nature of the campaign; recognizing in-kind and paid collaborators; previous experience and relationships; desire to be a part of a group; simplicity/ complexity of the innovation; having skills and knowledge

8

Gelli, 2016, [63] Ghana

Evaluation of alternative school feeding models on nutrition, education, agriculture, and other social outcomes in Ghana: rationale, randomised design, and baseline data

Protocol for a cluster randomised trial to evaluated the impact of a large-scale school meals program in Ghana on school-age children’s anthropometry

Schools, caterers, and farmers, National, school aged children, diet, and malnutrition

The Government of Ghana School Feeding Program (GSFP), which is a school catering intervention

The intervention/ program was implemented across 10 regions of Ghana. The program was government funded and overseen by a ministry department with additional support from a school implementing committee. Caterers are provided funding to purchase food from markets

Multiple sectors to increase food production, household income, and food security in deprived communities

Barriers: Delays in disbursement; suboptimal service delivery; older children progressing to secondary school less likely to receive intervention

Implementation requires multiple stakeholders, in Ghana are challenges with information flow, supervision and monitoring between these different stakeholders

Facilitators:

Ability of communities to actively engage in program and the strengthening of public institutions involved

Gelli, 2019, [46] Ghana

A school meals program implemented at scale in Ghana increases height-for-age during mid childhood in girls and in children from poor households: A cluster randomised trial

Outcome evaluation of a cluster randomised trial that evaluated the impact of a large-scale school meals program in Ghana on school-age children’s anthropometry

Schools, caterers, and farmers, National, School aged children, diet and malnutrition

The Government of Ghana School Feeding Program (GSFP), which is a school catering intervention

9

Hassani, 2020, [47] Canada

Implementing appetite to play at scale in British Columbia: Evaluation of a capacity-building intervention to promote physical activity in the early years

A mixed methods study that examined the implementation and impact of Appetite to Play scale-up using the RE-AIM framework (Glasgow et al. 1999)

Community childcare providers, State, Early years children and educators, physical activity, and healthy eating

Appetite to Play is a capacity building intervention for childcare providers. Capacity building was achieved via training, toolkits, technical support, community of practice, and marketing and communications

The scale-up and implementation of Appetite to Play was based on consultation and engagement with early years stakeholders across the province. A “train the trainer” model was used to spread the capacity-building intervention across the province. Master trainers trained regional trainers. Regional trainers then delivered workshops within the community. Training was embedded into existing training infrastructure

A provincial stakeholder advisory group was set up to advise the partnership group on the development of both the resource, scale-up strategy, implementation (course correction), and to create a framework for sustainability

Barriers: Environment (space, weather); multiple initiatives occurred provincially

Facilitators: Organisational supports (equipment and indoor space); resources (planning, access to websites/books); mandate (childcare facilities were required to adhere to PA policies); stakeholder network engagement

10

Hunt, 2020, [58] UK

Scale-Up and Scale-Out of a Gender-Sensitized Weight Management and Healthy Living Program Delivered to Overweight Men via Professional Sports Clubs: The Wider Implementation of Football Fans in Training (FFIT)

Summary/descriptive article describing the development, evaluation and scale up of FFIT, mapped onto the PRACTIS guide (Koorts et al. 2018), including scale up outcomes and adaptations to scale out into other contexts

Implemented via professional football clubs in Scotland and England, UK, targeting overweight/obese men aged 35–65 years, with a BMI > 28kgm². Targets healthy diet and physical activity for the prevention of obesity

FFIT is a 12-week group-based weight management and healthy living program. Implemented by trained club coaches

Implementation of FFIT builds on and develops existing structures within clubs; congruence with aims and aspirations of newly-established Scottish Premier League Trust (SPL-T); congruence with public health priorities to address rising obesity, poor diet and physical inactivity. Funding secured from the Scottish Government to reimburse clubs

Uses infrastructure & experience of FFIT & other community football initiatives as an overarching organisational structure, supporting community coaches within clubs to deliver health-promoting programs to adults

The PRACTIS guide (Koorts et al. 2018) was retrospectively applied to describe intervention development, evaluation and scale up

Barriers: Coaches lack of experience in target population, scepticism, competing demands on coaches time and club facilities. Lack of a fully developed model for routine scale up, prior to licensing model

Facilitators: Intervention effectiveness and cost effectiveness. Cultural push and pull factors. Organisational/provider level included adequate resources, coaches and community wing, and funding. Organisational buy-in and support, use of existing infrastructure and skills of coaches. Established reputation

11

Joyce, 2018, [48] Australia

The ‘Practice Entrepreneur’ – An Australian case study of a systems thinking inspired health promotion initiative

A qualitative case study that examined the experience of practitioners involved in a state-wide systems intervention

Healthy Together Victoria (HTV) included settings-based initiatives (i.e., the Achievement Program), community based programs, social marketing strategies, and research/policy initiatives. Community members across all aged. Broadly, HTV targeted priority areas of physical activity, tobacco use, alcohol consumption and diet; obesity prevention becoming the dominant focus over time

HTV was a systems initiative that included several policy and program initiatives used in combination. This paper focussed on one of HTV settings initiative: the Achievement Program that targeted schools, workplaces, and early childhood services

Healthy Together Victoria was developed by the State Government. Fourteen local governments receive funding to implement the initiative, with most of the funding directed towards staffing

Explored how system elements were connected, how organisations were connected (e.g., schools, workplaces, early childhood services, and local health and welfare organisations), and

understanding of the values and connections between organisations, people, policies, and programmes

Barriers: Harder process related to planning and getting approval to implement identified opportunities within local government; lack of understanding of systems and rigid approaches to planning in partner organisations

Facilitators: Agile in planning and implementation; access to multiple departments within local government; Easier to implement a systems approach in smaller, finite, well-defined communities; local adaptation and reflective process, more opportunities to collaborate

12

Livingston, 2020, [49] USA

Reducing tobacco use in Oregon through multisector collaboration: aligning Medicaid and public health programs

Summary/descriptive article describing an implementation evaluation. It aimed to evaluate the impact of the state-wide smoking cessation intervention

Coordinated care organisations (CCOs), State, Medicaid members, Smoking and tobacco use

A state-wide CCO cigarette smoking incentive metric for Medicaid members in 2016. The intervention included a cross-agency collaboration to decrease smoking via increasing smoke-free environments, increasing public awareness about risk, and supporting access to cessation services through Quitline. It was combined with tobacco surveillance. A tobacco incentive metric to encouraged reductions in tobacco prevalence

These healthcare strategies were first established via collaboration between public health and healthcare partners. Accountability and incentives support continued partnership and application

Multifaceted cross-agency approach that includes improving access and affordability to cessation services, ensuring the places people live, work, play, and learn are tobacco-free and reinforce individuals desire to quit or never start

Working together to ensure alignment across state-level programs, policies, and systems and to support CCOs in their efforts to reduce tobacco prevalence

Facilitators: Cross-agency alignment. Multisector intervention statements. Connecting local public health departments and CCOs

13

Lonsdale, 2016, [50] Australia

Scaling-up an efficacious school-based physical activity intervention: Study protocol for the ‘Internet-based Professional Learning to help teachers support Activity in Youth’ (iPLAY) cluster randomized controlled trial and scale-up implementation evaluation

A protocol for a cluster randomized controlled trial and scale up implementation study. The aim was to evaluate the intervention’s effectiveness and implementation at scale

Schools, State, Primary school aged children, physical activity and fitness

iPLAY is a multi-component intervention supported by mentors and online learning platform

All state funded schools in NSW will be invited to participate in scale up of the SCORES intervention. The scale-up implementation study will be guided by the RE-AIM framework

No information reported in the paper

14

Malakellis, 2017, [51] Australia

School-based systems change for obesity prevention in adolescents: outcomes of the Australian Capital Territory ‘It’s Your Move!’

A quasi experimental, repeated measures study. The purpose was to utilise a systems intervention to prevent obesity development in children and to test the practical application of a systems approach

Schools, State, Adolescents/ secondary school aged children. Diet for the prevention of obesity

A food at school initiative, which encompasses the whole food system. Includes canteen food, food at fundraising, and events. This was achieved via collaboration with local food producers and nutrition Australia to develop policies, commit to increasing healthy food consumption among staff and students, a focus on the relationship between health and food across all areas of the curriculum, traffic light colour coding of food sold at the canteen, provision of healthy foods and reduction of unhealthy foods at events, healthy morning teas for staff to encourage role modelling, cooking classes outside school hours for students and families, and increased access to water fountains

The intervention was an extension of an ‘It’s your move’ program implemented previously in Victoria. The program was adopted to incorporate a greater systems approach. Government schools in the Australian Capital Territory were provided funds to support participation

Barriers: Time and resources are needed to detect systems changes. Allow for sufficient lead in time

15

Matheson, 2019, [12] New Zealand

Strengthening prevention in communities through systems change lessons from the evaluation of Healthy Families NZ

A mixed method comparative case study. This study aimed to evaluate the Healthy Families New Zealand initiative

Rural and urban communities with high levels of socioeconomic deprivation, National, Community members, all four chronic disease risk factors (diet, physical activity, tobacco use, alcohol consumption)

Investment in dedicated systems thinking and acting health promotion workforce and activating local leadership to influence change

Healthy Families NZ is a government funded initiative delivered in areas with higher socio-economic deprivation. The initiative is delivered via partnership with indigenous organisations, regional sports trusts, and local councils

Facilitators: Quality leadership; highly skilled and flexible workforce to meet local needs and adapt; stability in workforce and Strategic Leadership Groups (SLGs); early demonstration of implementation success; sensitivity to initial conditions; being able to develop deep connections into diverse communities; facilitating strategic alignment between organizational and community leaders; local government connections

Barriers: Remote and dispersed geographical location; recruitment, stability, and cohesion of the workforce; staff turnover; time spent on understanding how to implement work; modest resources; siloed and competitive service funding approaches; competing interests of industries; lack of data at the local level

16

McKay 2021, [52] Canada

Status Quo or Drop-Off: Do Older Adults Maintain Benefits from Choose to Move-A Scaled-Up Physical Activity Program-12 Months After Withdrawing the Intervention?

A type 2 hybrid effectiveness implementation study design that evaluated the maintenance of intervention gains 12 months following delivery of the Choose to Move intervention

Community, State, Older adults, Physical activity

The Choose to Move intervention is not prescriptive but was designed as an adaptable model whereby participants choose what they enjoy and are able to do. At the organization level it builds community capacity to support awareness of, and access to, local health-promoting opportunities. At the individual level, it provides personalized support to create action plans customised to individual’s activity preferences, resources, and mobility capacity

The implementation approach adopted core element of frameworks that consider research to practice, community-centred implementation, multi-level stakeholder perspectives, and two-way communication. Scale up was facilitated via partnership that included government and community organisations

An integrated approach to scale-up acknowledges levels of influence on behaviour change across a socioecological continuum that spans individual to systems-level influences

Facilitators: Participants’ positive relationship with the activity coach; participants’ interactions with other participants

17

Nettlefold, 2021, [53] Canada

Scaling up Action Schools! BC: How Does Voltage Drop at Scale Affect Student Level Outcomes? A Cluster Randomized Controlled Trial

A cluster randomised controlled trial. This study aimed to describe strategies to support implementation and scale-up, evaluate implementation and students’ PA/ fitness, assess relationships between teacher-level implementation and student outcome

Schools, Province wide, Children, Physical activity

Action Schools! BC is a whole of school model that provides elementary schools and generalist teachers with tools and support to create physical activity action plans

Implementation and scale up was led by a support team. Strategies included engaging and consulting with interested schools, funding and providing teacher training, resource provision, incentives, development of advisory committees, and mentorship with ongoing consultation

A whole of school model that provided elementary schools and generalist teachers with tools and support to create PA action plans. Recognising schools are complex and dynamic systems

Barriers:

Schools were acknowledged to be complex and dynamic systems, posed challenges to scaling up

Facilitators: Governance, leadership, resources, outsourcing delivery, accountability structures and committed stakeholder engagement. Capacity-building activities. Multi-component model with flexibility that allowed schools' autonomy. New implementation strategies were added over time

18

^aRechis, 2021, [61] USA

Be Well Communities: mobilizing communities to promote wellness and stop cancer before it starts

Mixed method evaluation of 16 different interventions implemented via six collaborating organisations

Schools, food banks, YMCA, childcare settings, community settings and tourism settings. Community members including children, families, and adults. Tobacco use, healthy eating, physical activity, UV exposure, inadequate preventive care (cancer screening and human papillomavirus vaccination)

Note: tobacco control and HPV vaccination elements of Be Well Communities reported as underway, not evaluated in included paper

The multiple interventions included healthy food initiatives, school-based Physical Education, an education program, active classrooms, extracurricular activities, places for physical activity, community physical activity, skin cancer prevention intervention, outdoor settings, and childcare/school interventions

Utilised partnership and followed a collective impact model. Stages included community assessment, planning, implementation, and then sustainability

The steering Committee built a deep collaborative network. The initiative was led by 'wants and needs of the community' that establishes the infrastructure, prioritises target areas and community action plan

Facilitators: Deep collaborative network

Barriers: Natural disasters

19

Tong, 2020, [56] USA

The Emergence of a Sustainable Tobacco Treatment Program across the Cancer Care Continuum: A Systems Approach for Implementation at the University of California Davis Comprehensive Cancer Centre

Summary/descriptive article describing use of an implementation framework to describe the emergence of a sustainable tobacco treatment program across cancer care, using a systems approach

A comprehensive cancer centre, State, Smokers, Smoking

The sustainable tobacco treatment program. The intervention targets multiple points across the cancer care continuum

Utilised a Consolidated Framework for Implementation Research. This covers components of the intervention, individuals and stakeholders, the outer setting/ context, the inner setting or context, and the implementation process

The study applied constructs from an implementation research framework to describe implementation of the programme

Barriers: Leadership engagement (e.g., coordination, reporting pathways), resources (money, training/ education, physical space, time), access to information and knowledge

Facilitators: Core components of the intervention: referral to Quitline or UCD Group Class. Quality programmes and accreditation standards that support operations. Leadership engagement. available resources, knowledge, and information

20

Wilcox, 2018, [57] USA

Faith, Activity, and Nutrition Randomized Dissemination and Implementation Study: Countywide Adoption, Reach, and Effectiveness

A group randomised trial. The study aimed to report the countywide adoption, reach, and effectiveness from the Faith, Activity, and Nutrition dissemination and implementation study

Community church organisations, County level, Church members, healthy eating and physical activity

Church committee training provided an overview of physical activity and healthy eating guidelines and benefits. A set of activities, handouts, messaging, educational materials, bulletin board, would suggest policies that a pastor could set. Regular technical assistance provided

Churches and faith-based groups across the county were invited to participate. Adaptations to the original intervention were made to support broader dissemination. Community health advisors deliver training to churches and each church group formed a committee that received training, funding, held meetings, and implemented the program with their church. Implementation evaluation was guided by the RE-AIM framework

The structural model of health behaviour by Cohen et al. guided the intervention (availability of protective or harmful products, physical structures (or physical characteristics of products), social structures and policies, and media and cultural messages)

Church environment, church policies, church systems, rather than individual church members. Use of community members/ 'lay leaders'

Facilitators: Earlier participation in initiatives led to improved participation. Building relationships, having a community presence, and making multiple contacts are important ingredients for engaging churches in health promotion efforts

21

Wolfenden, 2020, [60] Australia

From demonstration project to changes in health systems for child obesity prevention: the legacy of ‘Good for Kids, Good for Life’

Summary/descriptive article from key policy and practice stakeholders describing the Good for Kids, Good for Life (GfK) initiative and its impact

Whole-of-community initiative, using a community settings approach targeting childcare services, schools, community service organisations, sporting clubs, health services and Aboriginal communities. Targeting physical activity and diet (for the prevention of obesity)

Initiatives targeted childhood obesity via healthy eating and physical activity policies and practices. Initiatives delivered in each setting were prioritised using a public health planning framework informed by local stakeholder input, Aboriginal cultural review and expert review of published evidence

Implementation strategies used in the service delivery models to enhance consistent implementation of the initiatives at-scale in and across the settings included soliciting organisational leadership, provision of program resources and information, training workshops, follow-up support, accreditation schemes and feedback

Implementation was facilitated through a surveillance system to assess implementation of targeted policies and practices. Feedback was provided on performance targets, evidence to inform program planning, monitor program achievements and enable provision of feedback to community organisations

Facilitators: Surveillance system to capture implementation data routinely. Increased capacity of health service staff. Significant state and national funding for prevention and alignment with a policy need

Engagement of end-users and local and state-level leadership