Scaling up the SuperFIT approach in early childhood education and care: applying the PRACTIS guide

Background Scaling up evidence-based effective interventions is essential to improve health-promoting practices in Early Childhood Education and Care (ECEC) settings. In this study, we investigated the scale-up of SuperFIT, an integrated intervention approach to promote healthy eating and regular physical activity (PA) in preschool children, via the ECEC and home setting. SuperFIT has already been disseminated to 85 ECEC locations in one region, and is now entering a new phase of scale-up to a different region. To ensure effective implementation, knowledge and expertise needs to be transferred to a new local provider. This study examined SuperFIT’s scale-up, by identifying facilitators, barriers and co-creating strategies to tackle barriers. Methods We applied the PRACTIS guide and principles of Design Thinking to guide the study. This involved characterizing the implementation setting, engaging key stakeholders, identifying facilitators and barriers to scale-up, and co-creating strategies. Multiple stakeholders ( N = 14) involved in the scale-up participated in semi-structured individual interviews and/or group sessions. Interview data and the first group session were analysed using a combined deductive-inductive approach, with a predefined framework guiding the analyses while allowing for additional themes to emerge from the data. Notes from the other two group sessions were subsequently reviewed to verify the emerging themes. Results Facilitators and barriers of upscaling existed at four levels: intervention, provider, organizational, and community. Adaptability emerged as the central factor influencing scale-up. At the intervention level, it allowed alignment with ECEC needs but raised fidelity concerns. At the provider level, limited experience with an adaptable intervention posed challenges. Organizational structures, responsibilities, and community level considerations (e.g., costs), are also influenced by adaptability. For each barrier, a strategy was co-created, for example providing guidance for new providers working with the adaptable approach. Conclusions The PRACTIS guide proved to be a valuable tool, and our reporting on using the PRACTIS guide can help others in planning for scale-up in ECEC. The findings from this study provide a path forward, toward further scaling up SuperFIT to new regions. This study highlights the importance of having a scale-up plan from the outset, as well as the necessary knowledge and expertise, for successful scale-up.