Adaptability, Scalability and Sustainability (ASaS) of complex health interventions: a systematic review of theories, models and frameworks
Open accessAbstract
Background: Complex health interventions (CHIs) are increasingly used in public health, clinical research and education to reduce the burden of disease worldwide. Numerous theories, models and frameworks (TMFs) have been developed to support implementation of CHIs. This systematic review aims to identify and critique theoretical frameworks concerned with three features of implementation; adaptability, scalability and sustainability (ASaS). By dismantling the constituent theories, analysing their component concepts and then exploring factors that influence each theory the review team hopes to offer an enhanced understanding of considerations when implementing CHIs. Methods: This review searched PubMed MEDLINE, CINAHL, Web of Science, and Google Scholar for research investigating the TMFs of complex health interventions. Narrative synthesis was employed to examine factors that may influence the adaptability, scalability and sustainability of complex health interventions. Results: A total of 9763 studies were retrieved from the five databases (PubMed, MEDLINE, CINAHL, Web of Science, and Google Scholar). Following removal of duplicates and application of the eligibility criteria, 35 papers were eligible for inclusion. Influencing factors can be grouped within outer context (socio-political context; leadership funding, inter-organisational networks), inner context; (client advocacy; organisational characteristics), intervention characteristics (supervision, monitoring and evaluation), and bridging factors (individual adopter or provider characteristics). Conclusion: This review confirms that identified TMFS do not typically include the three components of adaptability, scalability, and sustainability. Current approaches focus on high income countries or generic “whole world” approaches with few frameworks specific to low- and middle-income countries. The review offers a starting point for further exploration of adaptability, scalability and sustainability, within a low- and middle-income context. Trial registration: Not registered.
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Flagged first, then by citations
- Authors
- Sun, L., Booth, A., & Sworn, K.
- Affiliations
- University of Sheffield (GB)
- Corresponding author
- Sun, Lixin
- Venue
- Implementation Science
- Published
- 2024-07-17
- Volume
- 19
- Issue
- 1
- Pages
- 52-52
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC11253497
- OpenAlex
- W4400737368
- Cited by
- 42
- References
- 26
- Citations by year
- 2026: 25 · 2025: 16 · 2024: 1
- FWCI
- 3.77
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Implementation Science (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Decision Sciences › Management Science and Operations Research › Evaluation and Performance Assessment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- complex health interventions, implementation theory, scalability, sustainability, adaptability, implementation framework, low- and middle-income countries, sociopolitical context, organizational characteristics, customer advocacy, interorganizational networks, monitoring and supervision
- MeSH terms
- Implementation Science, Delivery of Health Care, Humans, Models, Theoretical, Public Health, Program Evaluation
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