# From intervention studies to national programs, what are the favoring and hindering factors? a scoping review

## TL;DR

This study reviews factors that help or hinder scaling up health interventions into national programs, using a scoping review of 30 papers.

## Contribution

The study systematically identifies and categorizes favoring and hindering factors for scaling up health interventions using the ExpandNet/WHO framework.

## Key findings

- Poor user organization, institutional environment, and resource mobilization are key hindering factors for scaling up.
- Strong leadership, defined roles, coordination, political support, and community engagement are favoring factors.
- Factors interact and influence each other, suggesting the need for further research on their associations.

## Abstract

The translation of successful health projects into public health practice is among the most relevant challenges to pursue better health results, including the outcomes established by the United Nations Sustainable Development Goals (SDGs). Healthcare interventions proven cost-effective should be expanded into broader policies and practices. This process is called scaling-up and its success depends on several factors. To critically think about how to scale-up projects or adapt programs, it is necessary to identify potential favoring and hindering factors. In this sense, this study aims to document the type of public health programs which have been scaled up, describe the favoring and hindering factors of this process, and critically analyze the findings about it.

To reach this goal, this project used the scoping review method to map and summarize the existing evidence on scaling up health interventions through available publications. The databases used in this review were PubMed, Web of Science, Cochrane Library, Scopus, VHL, Scielo, and Google Scholar.

Through the selection process from a total of 7,027 search hints, 30 relevant papers were included. The found factors that impacted the scaling-up process were organized based on categories of the ExpandNet/WHO framework. The results indicate that poor “user organization”, “institutional environment” and “resource mobilization” were the most frequently mentioned hindering factors for scaling-up processes. Favoring factors included strong leadership, well defined roles, good coordination, positive political environment and community support and engagement.

Hindering and favoring factors do not exist in isolation, but are correlated, interact, enhance or hinder one another. Beyond the practical advice given in this paper, further research recommended that investigates the association between different factors.

The online version contains supplementary material available at 10.1186/s12889-025-24770-1.