Table 2 Recommendations, sub-recommendations, and ratings

1. Increase awareness of the need for greater attention and activity in scale-up and spread, including research, practice and policy activity.

4.31 (0.78)

 1.1 Educate healthcare and public health agencies and professionals regarding the need for explicit, pro-active initiatives to achieve scale-up and spread of effective health programs.

4.26 (0.90)

 1.2 Provide professional and monetary incentives for researchers, practitioners, and policymakers to pursue scale-up/spread activities.

4.00 (1.08)

 1.3 Convene an Institute of Medicine/Canadian Academy of Health Sciences (or other entity) committee to assess the current status of research, practice and policy activities in scale-up and spread.

3.96 (1.00)

 1.4 Convene a multi-stakeholder group to create an overarching blueprint for expanding interest and activity in scale-up/spread research, practice and policy.

3.56 (1.06)

 1.5 Educate the general public to enhance pull for scale-up/spread of effective programs.

2.88 (1.00)

2. Facilitate better information exchange, collaboration and use of existing knowledge regarding scale-up and spread.

4.28 (0.73)

 2.1 Synthesize existing knowledge (and incorporate new knowledge as developed) to create practical guidance for scale-up and spread practice and policy.

4.34 (0.85)

 2.2 Develop and facilitate online communities of practice in scale-up and spread research, practice and policy that are specific to stakeholder groups, health areas, or delivery settings.

3.75 (0.78)

 2.3 Increase clinical and related data sharing among all major health agencies (e.g., Centers for Medicare & Medicaid Services, Health Resources and Services Administration, Centers for Disease Control and Prevention, etc.).

3.65 (1.06)

 2.4 Create a Center for Scale-up/Spread comprising multiple federal and private agency representatives to increase collaboration and progress in advancing scale-up and spread knowledge and activity.

3.57 (1.13)

 2.5 Create an online, interactive learning network for all types of scale-up/spread stakeholders in health care and public health to engage with one another.

3.55 (0.85)

3. Develop, evaluate and refine innovative scale-up and spread methods, including novel incentives and pull strategies.

4.56 (0.64)

 3.1 Develop new funding announcements to conduct ‘embedded research’ on practice- and policy-led scale-up/spread initiatives (e.g., natural experiments).

4.53 (0.68)

 3.2 Develop new funding programs to support investigator-initiated scale-up/spread research.

4.44 (0.70)

 3.3 Identify and strengthen existing research programs studying scale-up and spread.

4.18 (0.74)

 3.4 Develop taxonomy of scale-up/spread strategies and related concepts to describe scale-up/spread approaches and factors.

4.12 (0.93)

4. Develop and apply new approaches for evaluation of scale-up and spread.

4.46 (0.71)

 4.1 Develop, evaluate and implement practical measures of spread of health practices and programs to facilitate improved research and enhanced tracking of scale-up/spread progress.

4.35 (0.66)

 4.2 Convene a planning group to advance the idea of embedded evaluation to generate more knowledge about scale-up and spread in the context of ongoing policy/practice initiatives.

4.11 (0.93)

 4.3 Convene consensus groups and stimulate research to develop innovative approaches for studying scale-up and spread processes and mechanisms (and their determinants) to better understand how, when, where, and why scale-up and spread strategies operate.

4.08 (0.87)

 4.4 Convene a planning group to address research and evaluation barriers related to Institutional Review Board regulations and other challenges.

3.80 (0.89)

5. Expand capacity for scale-up and spread policy, practice and research.

4.18 (0.83)

 5.1 Identify funding sources to support workforce preparation activities, including course and curriculum development, credentialing, training, and mentoring.

4.17 (1.06)

 5.2 Identify experts in scale-up and spread to serve as mentors for new scale-up/spread research, practice and policy experts.

4.02 (0.83)

 5.3 Develop courses on scale-up/spread in health care and public health for inclusion in established health-related degree programs (e.g., MD, RN, MSW, MPH, MS, PhD).

4.01 (0.95)

 5.4 Develop non-degree courses and training programs for researchers, practitioners, and policymakers focused specifically on scale-up and spread, including courses addressing the role of data in guiding and supporting scale-up and spread efforts.

3.85 (0.98)

 5.5 Convene a group to develop credentialing requirements and programs for individuals engaged in scale-up/spread initiatives.

2.83 (1.16)