Table 4 Studies categorised as ‘moderate use of a systems approach’ (n = 7)

Berman et al. (2018) [41]

Diet (for the prevention of obesity)

Intervention targeted different systems points. This included targeting organisations from different levels that influenced behaviour and utilisation of an intervention that featured a range of policy, systems and environmental strategies

The types of policy, systems, and environmental activities were broad, but activities generally were in eight categories: adopt new policy or change exiting policy, adopt new practices, create customized 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 organizational wellness policies. Initiative mapped to Proctor et al. 2013 recommendations for informing implementation strategies, no framework for guiding scale up reported

Betancourt et al. (2017) [42]

Physical activity, and diet (for the prevention of obesity)

This intervention focussed on system changes. It targeted policy, system, and environmental changes

Principles included long-term, sustainable policy, system and environmental changes in the community where people work, play, worship, learn and live (i.e., social determinants of health)

Bolton et al. (2017) [43]

Physical activity and diet (for the prevention of obesity)

Not specific/ explicit to systems but a multi-component approach targeted multiple systems levels. The strategies implemented were directed towards increasing community capacity, creating supportive environments, and promoting healthy behaviours

Analysis Grid for Element Linked to Obesity (ANGELO) (Swinburn et al. 1999) used to develop project objectives, no framework to guide scale up

Principles included achieving pre-defined objectives in each community (e.g., increasing community capacity to promote healthy eating and physical activity)

Livingston et al. (2020) [49]

Tobacco use

The approach and strategies targeted different points in the system. The multifaceted approach included improving access and affordability to cessation services, ensuring the places people live, work, play, and learn are tobacco-free, and reinforcing individuals desire to quit (or never start) smoking

Acknowledged the policy and system infrastructure alignment required to support the state-wide Coordinated Care Organization

McKay et al. (2021) [52]

Physical activity

Systems not explicitly defined, however, the multi-component and multi-level intervention sought to address factors that support physical activity decisions and engagement. Acknowledged that program investment and utilising health promoting opportunities in local environments were associated with sustainment, which is linked to existing systems and services

Principles included community capacity to support awareness of, and access to, local health-promoting opportunities. No information reported in paper on scale up frameworks; ^ascale up guided by conceptual models from Yamey (2011) and Simmons and Shiffman (2007)

Nettlefold et al. (2021) [53]

Physical activity

Schools were acknowledged to be complex and dynamic systems. This presented challenges to scaling up. Systems thinking was incorporated into the intervention by enabling schools and teachers to provide more physical activity opportunities for children via six action zones—school environment, scheduled physical education, classroom action, family, community, extra-curricular, and school spirit

Scale up approach drew on Simmons and Shiffman (2007) framework recommendations. Key scale up strategy included building partnerships with organisations across health, education, sport, government and community sectors

Wilcox et al. (2018) [57]

Physical activity and diet

Multicomponent intervention targeted different systems points within faith-based organisations. Acknowledged the role and impact of systems in a systems thinking way

Evaluation was guided by the REAIM framework (Glasgow et al. 1999). No information on scale up framework reported in paper