October Journal Club Feedback

The fourth meeting of the UK-IS Journal Club took place on 26th October 2021. Hosted by UK-IS Honorary Trustee Dr. Alex Ziemann, the group reviewed Mechanisms of scaling up: combining a realist perspective and systems analysis to understand successfully scaled interventions by Harriet Koorts , Samuel Cassar , Jo Salmon , Mark Lawrence , Paul Salmon and Henry Dorling (2021) International Journal of Behavioral Nutrition and Physical Activity 18:42

The group who attended – a mix of researchers, practitioners and post-graduate students – had a really interesting discussion, and this blog contains a summary of the take home messages from the meeting.



Sustainable shifts in population behaviours require system-level implementation and embeddedness of large-scale health interventions. This paper aims to understand how different contexts of scaling up interventions affect mechanisms to produce intended and unintended scale up outcomes.



This recently published empirical paper presents a worked example of applying and combining two relatively new methodological approaches that become more and more relevant in implementation particularly regarding the scaling-up of innovations: systems analysis and realist evaluation.

Discussion points:

  • Participants found this a very interesting paper providing valuable insights into the use and usefulness of applying these two innovative methodological approaches.

  • Realist evaluation methodology does not only have a place in assessing interventions but there are emerging examples like this study showing its application in studying implementation questions.

  • The focus of realist evaluation on mechanisms was generally welcomed but it was also highlighted how the field does not yet have a common understanding what mechanisms are.

  • Participants noticed the large number of Context-Mechanism-Outcome statements presented in the paper and posed the question how this could actually inform implementation or scale-up practice.

  • System thinking was seen as a particularly helpful perspective in the area of public health or global health. It allows to bring together multi-disciplinary, multi-sectoral, and multi-level perspectives and provides a tool to develop a common language and understanding around complex issues.

  • In terms of the systems analysis methodology, the discussion focused on the complexity of the methodology and its main result, the system map, and discussed again, how such a complicated output could be used by practitioners, decision-makers and funders going forward.

  • Participants suggested if the system map could be broken down or focused on certain aspects of the scaling process to increase usability although this might defy the objective of taking a system’s perspective.

  • The potential of leverage points was highlighted as a useful output which might be a transferable finding that could support scaling of innovations.

  • It was suggested that the work by Donella Meadows around systems thinking could provide a useful foundation to dive deeper into systems thinking and its application: https://donellameadows.org/

  • Despite the complexity of the systems analysis methodology the overall conclusion was that we need these kind of approaches and methodologies to make sense of the complex real world that implementers are working in; we cannot be frightened of complexity but need to find a way to live with it.

Hosted/summarised by Dr. Alex Ziemann.

© UK Implementation Society, 2021

All views expressed are the author's own and not those of the UK Implementation Society.

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