Our objectives were two-fold: (i) to describe physiotherapists' experiences of implementing a cognitive behavioural approach (CBA) for managing low back pain (LBP) after completing an extensive online training course (iBeST), and (ii) to identify how iBeST could be enhanced to support long-term implementation before scale up for widespread use.
Many family health innovations that have been shown to be both efficacious and cost-effective fail to scale up for widespread use particularly in low-income and middle-income countries (LMIC).
As indicated by the widespread usage, SCALE-UP has numerous secondary implementers, faculty, and staff who have adopted the SCALE-UP innovation and created classrooms in their institutions.
Widespread antiretroviral scale-up programs are taking place in resource-limited settings (RLS) [ 1].
More recently, the Army Research Laboratories spearheaded the Generalized Intelligent Framework for Tutoring (Sottilare et al. 2013; www.gifttutoring.org) to scale up these systems for more widespread use.
UNICEF is supporting efforts to scale up these childcare forums for widespread national coverage, and help them provide quality, comprehensive services.
In sum, we identified five key components, which our findings suggest interact in a complex adaptive system to explain the process of widespread take up and anticipate the success of scale up efforts.
In Nigeria, the HIV epidemic is widespread and stable, and there are plans to scale up decentralization of services to primary care level to reduce inequalities and sustain access to care, especially in HIV infected children, who are especially vulnerable.
Underscoring the importance of effective policies for the planning and management of scarce HRH are institutions hindered by poor physical infrastructure, shortages of qualified faculty, and lack of external accreditation, all of which persist despite widespread emphasis on scaling up HRH training as part of broader health system strengthening [ 11].
"Why not scale up?" Walsh asked.
"Bridge can scale up and affect millions.
