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tandfonline.com – The pitfalls of scaling up evidence-based interventions in health

tandfonline.com har udgivet en rapport under søgningen “Teacher Education Mathematics”:

ABSTRACT

Policy-makers worldwide are increasingly interested in scaling up evidence-based interventions (EBIs) to larger populations, and implementation scientists are developing frameworks and methodologies for achieving this. But scaling-up does not always produce the desired results. Why not? We aimed to enhance awareness of the various pitfalls to be anticipated when planning scale-up. In lower- and middle-income countries (LMICs), the scale-up of health programs to prevent or respond to outbreaks of communicable diseases has been occurring for many decades. In high-income countries, there is new interest in the scaling up of interventions that address communicable and non-communicable diseases alike. We scanned the literature worldwide on problems encountered when implementing scale-up plans revealed a number of potential pitfalls that we discuss in this paper. We identified and discussed the following six major pitfalls of scaling-up EBIs: 1) the cost-effectiveness estimation pitfall, i.e. accurate cost-effectiveness estimates about real-world implementation are almost impossible, making predictions of economies of scale unreliable; 2) the health inequities pitfall, i.e. some people will necessarily be left out and therefore not benefit from the scaled-up EBIs; 3) the scaled-up harm pitfall, i.e. the harms as well as the benefits may be amplified by the scaling-up; 4) the ethical pitfall, i.e. informed consent may be a challenge on a grander scale; 5) the top-down pitfall, i.e. the needs, preferences and culture of end-users may be forgotten when scale-up is directed from above; and 6) the contextual pitfall, i.e. it may not be possible to adapt the EBIs to every context. If its pitfalls are addressed head on, scaling-up may be a powerful process for translating research data into practical improvements in healthcare in both LMICs and high-income countries, ensuring that more people benefit from EBIs.

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Troels Gannerup Christensen

Jeg er ansat som adjunkt hos Læreruddannelsen i Jelling, hvor jeg underviser i matematik, specialiseringsmodulet teknologiforståelse, praktik m.m. Jeg har tidligere været ansat som pædagogisk konsulent i matematik og tysk hos UCL ved Center for Undervisningsmidler (CFU) i Vejle og lærer i udskolingen (7.-9. klasse) på Lyshøjskolen i Kolding. Jeg er ejer af og driver bl.a. hjemmesiderne www.lærklokken.dk og www.iundervisning.dk, ggbkursus.dk og er tidligere fagredaktør på matematik på emu.dk. Jeg går ind for, at læring skal være let tilgængelig og i størst mulig omfang gratis at benytte.

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