A big day running communications for my team, as well as planning one of our randomised control trials. I spent most of the day drafting a ‘do it yourself’ guide on scaling a successful trial.
Scaling is when we take a successful behavioural intervention from a randomised control trial and then roll it our to a broader population. Research shows it’s actually really hard to scale. It is very rarely done effectively. There are many challenges. It can be resource intensive, even if the intervention is relatively cheap or cost-free. Much of the drain comes from needing time to training staff on how to deliver the intervention. Another issue is that agencies may not have the right infrastructure in place, so you have to work with them to prepare.
In an academic study, a researcher controls all of the dynamics of an intervention. We design the intervention, we deal with participants, we make sure the systems are working, and we do the analysis.
When it’s a scale up, another agency who didn’t do the research now has to implement the behavioural intervention and monitor behavioural change.
There are other challenges in taking an effective intervention that worked for a subset of the population and then then rolling it out to the broader New South Wales public. The intervention may need to be tweaked to the local context. Staff and their customers need to be convinced about the new way of doing things. Personnel need to be given time to incorporate the change into their daily work. The organisation would have to set up some way to monitor the rollout.
So you see, scaling is not just as simple as copying what another study did.
Our team has scaled many ‘first generation’ behaviour interventions, which are less complex behavioural changes. For example, making sure that people pay their taxes on time, or simplifying a government letter, so that people actually understand what’s required of them. Another example is getting people to comply with their housing payment requirements, so that they don’t fall into arrears.
All of these behavioural interventions can be delivered as a change to a letter template, or it’s a system-wide communications change.
‘Second generation’ behavioural interventions are more complicated, and much tougher to scale up as a result.
Three of my ‘second generation’ projects are in scaling phase.
For example, one of my projects takes the intervention from three previous trials (led by another member of our team), which increased the number of preservice teachers doing their final year placement at a rural or remote school. For the scale-up, I bundled the three interventions together to create a group experience. Preservice teachers could go with their fellow students, to make the move less daunting. We used personalised and timely prompts to entice them to sign up to the placements. We provided testimonial videos from teachers who were teaching in rural and remote schools, as well as giving information about the schools and region, to minimise the fear of the unknown.
To make this scale up as effective as our original research, it has meant working with placement officers, reviewing their information and communication systems, coordinating travel and accommodation, and much more.
Often, it’s not enough to show that an intervention is effective. Leaders still want to see a business case showing the cost benefit analysis of the behaviour change. Organisations also require executive support, so lots of briefs and permissions must be sought.
In academia and in policy, new projects get funded all the time. But few of these projects are replicated, and even less are scaled, or implemented as ‘business as usual.’
I’ve been working on this guide on and off for a year. I’m keen to publish our practical tips about how to make scaling work!