Table 7 Case example of a ‘moderate use’ systems approach to scaling up

Study: Wilcox et al. 2018: Faith, Activity, and Nutrition Randomized Dissemination and Implementation Study: Countywide Adoption, Reach, and Effectiveness

Intervention and scale up context: Faith, Activity, and Nutrition (FAN), targets improvements in physical activity and diet among church attendees. Implemented by church committees, at a policy, systems and environmental level. County level implementation across South Carolina, USA, among African Methodist Episcopal churches

Use of a systems approach or term ‘systems’: Multicomponent intervention targeting different systems points within faith-based organisations. Acknowledged the role and impact of systems in a systems thinking way, for example, focus was on the church environment, policies and church systems, rather than individual church members. Use of community members/'lay leaders' for implementation