Scale, sustainability and evidence-based programmesLouise MorpethSocial Research Unit at Dartington

We struggle to scale things that work and sometimes scale things that harm

No EBP has achieved scale but FNP is heading in the right direction

SUSTAINABILITY

I’m evidence-based

NO! I am ignore her! look at me!

I’m not evidence-based, I’m evidence-informed

1. Intervention specificity - what is it?

2. Evaluation quality - is the method robust enough for us to believe the findings?

3. Intervention impact - which aspects of child health and development are affected and to what extent?

4. System readiness - is the intervention replicable?

Standards of Evidence

*Approximately 5,000 6th and 7th grade students @ baseline and follow-up

Data from Pentz, Trebow, Hansen, MacKinnon, Dwyer, Johnson, Flay, Daniels, &CormackEffects of Program Implementation on Adolescent Drug Use Behavior: The Midwestern Eval Rev.1990; 14: 264-289

Control Group (N=313)Individual Therapists (N=387)Group Mean (Average)

18

-Mo

nth

Un

adju

sted

Maj

or

Rec

idiv

ism

Per

cen

tage

17

12

55

47

42

14

34

18

23

3128

14

26

17

33

23

14

33

22

1717

11

0

C 1 2 3 4 5 6 7 M 8 9 10111213M 1415161718M 19202122232425M

Low Fidelity High Fidelity

8

1820

43

47

63

26

FFT Results

From: Outcome Evaluation of Washington State's Evidence-Based Programs for Juvenile Offenders, January

2004. Washington State Institute for Public Policy, Report #04-01-1201

SCALE UP

Innovation vs invention

Small, simple, effective

When attending a home birth in rural Nepal, a birth attendant brings a delivery kit the size of a deck of cards: a small bar of soap for washing hands, a plastic sheet to serve as the delivery surface, clean string for tying the umbilical cord, and a new razor blade for cutting the cord. It’s cheap and basic, but it helps mothers and babies avoid infection.

Photo: Bill & Melinda Gates Foundation / Toni Greaves

Start with scale in mind

Community members participate in discussions after watching video documentaries screened by the Self Employed Women’s Association in an urban slum. (Ahmedabad, India, 2010)

Photo: Bill & Melinda Gates Foundation/PrashantPanjiar

What is core and what is adaptable?

Mother’s new car is a cargo bike

The residents of Christiania, a communal neighborhood in Copenhagen, have long had an affinity for customized bikes – easily personalized but practical to the core.

Photo: Mikael Colville-Andersen

Scale can be local

The potential of social networks

Charting contagion

Harvard medical sociologist Nicholas Christakis is one of the foremost researchers and communicators on social networks. He and his collaborators have found that many surprising phenomena are contagious, such as loneliness, altruism, and obesity.

Network image: Nicholas Christakis

Diffusion vs dissemination

The S-curve of diffusion

In 1962, sociologist Everett Rogers set out the ideas of “dissemination” and “diffusion.” The S-curve predicts how an innovation proceeds from a trickle of early adopters, to a flood of mainstream users, until only a few laggards remain.

Image: Everett M. Rogers. 2003[1962]. Diffusion of Innovations, 5th Ed. New York: Free Press.

Pull beats push

The demand for vaccination

In many parts of the world, the demand for vaccination shows how “pull” beats “push.” In Pantasma, Nicaragua, mothers are willing to wait in line for hours so that their children can receive the rotavirus vaccine – with the result that 80 percent of children in Nicaragua have been vaccinated against this life-threatening disease.

Photo: Bill & Melinda Gates Foundation / Brent Stirton

We need to understand demand as well as need

There are no blueprints for scale up

Any blueprints for our work?

A World War II poster from the US prescribes a “Blueprint for Victory.”

Image: US National Archives and Records Administration

Data is essential but we need stories too

It was 1970 when designer Jeremy Sinclair, at the advertising agency Cramer Saatchi, created the “pregnant man” poster for the UK’s Health Education Council. It aimed to tell a story that men would recognize.

Advertisement: Jeremy Sinclair

Great impact might come from a simple innovation widely adopted

A new use for an old wheel

The pulley – a simple re-configuring of wheels and rope – is one of the all-time great radical ideas. Here, a pulley helps to raise water from a traditional indoor well in a house in Chettinad. (Tamil Nadu, India, 2008)

Photo: Ramaswamy N.

lmorpeth@dartington.org.uk

01803 762400

www.dartington.org.uk

www.preventionaction.org