Table 5 Studies categorised as ‘no use of a systems approach’ (n = 9)

Blake et al. (2021) [59]

Diet

System referred to in context of the broader ‘social system’ that influenced the spread of interventions. Study involved a strong collaboration between stakeholders across the system; food retailers, local government and researchers, to test intervention and potential scalability

No information on a scale up framework reported in the paper. Rogers’ Diffusion of Innovations (Rogers 2003) and the REAIM framework (Glasgow et al. 1999) guided evaluation

Davis et al. (2017) [62]

Physical activity

Systems referred to in context of ‘evaluation systems’, systems approach not described or utilised, but this multi-component intervention targeted multiple systems points. This included strategies in the community, policies and social support. Strong community-academic partnerships and acknowledgement of local resources, infrastructure, political climate and advocacy were essential

A community-generated logic model was used as a dissemination tool and framework for implementing strategies. Focus included committed community communication, creating and enhancing access to places for physical activity, implementing community design and land-use policies, social support, and individually adapted health behaviour change

Fernandez et al. (2016) [45]

Diet (for the prevention of obesity)

Systems approach not described or utilised, however, refers to ‘innovation-systems fit’ and the ‘social system’. Study utilised organisations from different industry, sectors, and system levels (e.g., food retailers, advertising groups, Federal, provincial and territorial governments and NGOs) that had different pathways to influence the system

Rogers’ Innovation-Decision Process Model (Rogers 2003) was used to evaluate adoption decisions. No information on a framework guiding scale up reported in the paper

Gelli et al. (2016 & 2019) [46, 63]

Diet and malnutrition

Systems approach not described or utilised, systems referred to as ‘monitoring systems’. The intervention combined child-level education and nutrition, alongside household food production. The multi-sectorial intervention sought to link agricultural production with school meals, increasing demand for domestic agriculture and improving school nutrition

Co-ordination and implementation were undertaken by a national secretariat, with programme oversight provided by the Ministry of Local Government and Rural Development. Evaluation involved alternative implementation modalities at scale, acknowledging that implementation relied on interaction between several actors strengthening public institutions and active community engagement. No information on a framework guiding scale up reported in papers

Hassani et al. (2019)

Physical activity and diet

Systems approach not described or utilised, system referred to in context of broader childcare system. Had a focus on capacity building among childcare providers, rather than direct intervention, and incorporated multi-segment intervention strategies. Acknowledged the negative influence on implementation as a result of turbulence in the childcare system, and that changes in policies, practices and environments were necessary

Evaluation was guided by the REAIM framework (Glasgow et al. 1999), no information on a scale up framework reported in the paper. Outcomes included early years providers’ capacity to address physical activity. Stakeholder advisory group established to develop the scale up strategy and create a framework for sustainability. Scale up strategy was implemented through province-level not-for-profit partnerships

Hunt et al. (2020) [58]

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

Systems mentioned in the context of the implementation ‘delivery system’, and the study utilised multiple stakeholder organisations. A systems approach was not described, however, there was a focus on capacity building coaches within professional sports clubs, and a train-the-trainer model, to deliver the intervention sustainably. The authors acknowledged that there must be sufficient organisational or system support for effective scale-up

Evaluation was guided by the REAIM framework (Glasgow et al. 1999). The PRACTIS guide (Koorts et al., 2018) (a systems thinking framework to inform implementation and scale up) was retrospectively applied to describe intervention development, evaluation and scale up

Lonsdale et al. (2016) [50]

Physical activity

Systems referred to in context of intervention ‘delivery systems’, a systems approach not utilised. The multi-component intervention targeted multiple components in the school environment: quality physical education and school support, classroom movement breaks, physically active homework, active playgrounds, community physical activity links, parent and caregiver engagement

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

Rechis et al. (2021) [61]

Physical activity, tobacco use, diet, UV exposure, inadequate preventive care

Systems referred to in terms of the education system where implementation occurred. Principles of systems thinking, e.g., establishing infrastructure, prioritising target areas, and developing community action plans, was incorporated. Collective impact adopted, which is a collaborative approach to addressing complex social issues

Collective impact framework assessed relational processes, shared goals, and facilitators for successful operations and management of the partnership. No information on a scale up framework reported in the paper

Wolfenden et al. (2020) [60]

Physical activity and diet (for the prevention of obesity)

System referred to in terms of an implementation ‘monitoring system’ (a surveillance system). The whole-of-community initiative targeted multiple settings (childcare services, schools, community service organisations, sporting clubs, health services and Aboriginal communities), involving many stakeholders from different sectors. The context of the study was that the intervention sat within and aimed to change broader health system(s). Strong community-academic partnerships were required and acknowledged building capacity, political alignment and significant government funding were essential

Evaluation involved an integrated research-practice approach with co-located researchers and practitioners. Implementation was monitored via a Population Health Intervention Management System. No information on a scale up framework reported in the paper