Using social networks to scale up and sustain community-based programmes to improve physical activity and diet in low-income and middle-income countries: a scoping review protocol

Introduction The World Health Organisation endorses community-based programmes as a cost-effective, feasible and a ‘best buy’ in the prevention and management of non-communicable diseases (NCDs). These programmes are particularly successful when the community actively participates in its design, implementation and evaluation. However, they may be only useful insofar as they can be scaled up and sustained in some meaningful way. Social network research may serve as an important tool for determining the underlying mechanisms that contribute to this process. The aim of this planned scoping review is to map and collate literature on the role of social networks in scaling-up and sustaining community-based physical activity and diet programmes in low-income and middle-income countries. Methods and analysis This scoping review protocol has been planned around the Arksey and O'Malley framework and its enhancement. Inclusion criteria are peer-reviewed articles and grey literature exploring the role of social networks in the scale-up and/or sustainability of NCD prevention community-based programmes in adult populations. Studies must have been published since 2000, in English, and be based in a low-income or middle-income country. The following databases will be used for this review: PubMed, Cochrane, Scopus, Web of Science, CINAHL, SocIndex, the International Bibliography of the Social Sciences, Google and Google Scholar. Books, conference abstracts and research focused only on children will be excluded. Two reviewers will independently select and extract eligible studies. Included publications will be thematically analysed using the Framework Approach. Ethics and dissemination Ethical approval will not be sought for this review as no individual-level data or human participants will be involved. This protocol is registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/KG7TX). The findings from the review will be published in an accredited journal. The Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews checklist will be used to support transparency and guide translation of the review.


Abstract:
• The method subsection could include 70% of the abstract content. Please state the study design (i.e., scoping review) as a method and provide information related to the inclusion criteria. • The following sentence is unclear: "Two reviewers will screen and analyze the publications." It could be "two reviewers will independently select and extract eligible studies." • The following sentence could be removed/moved from the introduction subsection: "The findings will be used to determine the scope of research, identify gaps in the literature, and contribute to a broader research investigation." • If registered, provide the name of the registry, registration number, and date.
Background: • Please replace "intervention" with "CBP" in the following sentence: "If the intervention does not reach enough people, then their effects are spread thin and the CBP has less chance of making a sustainable and significant impact." Please note that intervention could be: the CBP (i.e., the object to be scaled up) or a scale-up strategy (i.e., the strategy used to scale up the CBP). • Please note that there is a difference between "scalability" (Milat et al. 2012) and "scale up." Authors provided a definition of scalability in reference to the process of scaling up. Here is some content from a previously published article: "The World Health Organization defines the process of "scaling up" as "deliberate efforts to increase the impact of successfully tested health innovations so as to benefit more people and to foster policy and program development on a lasting basis" [8]. Here, we understand scaling up to optimize equity, for example, as enlarging the scope of evidence-based innovation (EBI) not only numerically but also in other respects, e.g., increasing its range to a wider variety of socio-economic backgrounds [5]. While anticipating scaling up should begin at the earliest stages of research [5,9], we summarized the main scaling-up steps as follows [1]: (1) scalability assessment, (2) development of a scaling-up strategy, (3) implementation and evaluation of the strategy, and (4) promoting the long-term sustained use of the successfully scaled-up EBI. The scalability assessment, the preliminary and essential step in scaling up an EBI, refers to assessment of the "ability of a health innovation shown to be efficacious on a small scale and/or under controlled conditions to be expanded under real world conditions to reach a greater proportion [or range] of the eligible population, while retaining effectiveness" [5,10]." (https://systematicreviewsjournal.biomedcentral.com/articles/10.1 186/s13643-021-01597-6) • The reference 14 should be replaced with Milat et al. 2012 (https://pubmed.ncbi.nlm.nih.gov/22241853/). • Please provide a clear and comprehensive explanation to help readers understand the differences or similarities between the concepts "scale up" and "sustainability." • Page 5, lines 10-17: I would like to suggest authors to make some changes because a knowledge synthesise showed a gap in scaling up methods in high-income country contexts (https://implementationscience.biomedcentral.com/articles/10.118 6/s13012-015-0301-6). Indeed, there is a growing interest in scaling up health innovations around the world, especially in highincome countries. But research on scaling up is effectively taking place in low-and middle-income countries (LMICs), especially in context of community-based primary health care in the fight against epidemics (https://implementationscience.biomedcentral.com/articles/10.118 6/s13012-017-0672-y). Today, we would like to learn from this LMICs expertise to scaling up health innovations in high-income countries (https://www.idrc.ca/fr/livres/scaling-impact-innovationpublic-good). Methods: • Please indicate if a registration of your review title exists and provide registration information, including the name of the registry (e.g., OSF), registration number, and date. • I wonder how "scale-up" could be emphasized as an outcome or variable of interest. • Authors have omitted many key terms related to the concept of "scale up" (e.g., spread, widespread, scaling, upscaling, scaling out, rolling out, scalability). Please adapt your search strategy using existing one (https://systematicreviewsjournal.biomedcentral.com/articles/10.1 186/s13643-021-01597-6).
• "Data extraction and analysis" subsection could be split into two subsections for easier reading: 1) Data extraction and 2) Data analysis. Please describe the methods of extracting data and any processes for obtaining and confirming data from investigators. English only presented as a study limitation.

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What will be the role of the other authors? Given the LMIC context, it would be good to see the South African co-authors having a more prominent role?
All the authors have helped to conceptualise and create this review. The South African co-authors will lead in data collection (SNA and interviews) of the broader research project.

Reviewer 2 comments
16 Title: • …authors could remove the word "systematic" from the title "systematic" removed from title. The method subsection could include 70% of the abstract content. Please state the study design (i.e., scoping review) as a method and provide information related to the inclusion criteria. • The following sentence is unclear: "Two reviewers will screen and analyze the publications." It could be "two reviewers will independently select and extract eligible studies." • The following sentence could be removed/moved from the introduction subsection: "The findings will be used to determine the scope of research, identify gaps in the literature, and contribute to a broader research investigation." 'Scoping review' and inclusion criteria indicated.
Sentence updated.
Sentence removed.
OSF registration given.

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If registered, provide the name of the registry, registration number, and date.

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Background: • Please replace "intervention" with "CBP" in the following sentence: "If the intervention does not reach enough people, then their effects are spread thin and the CBP has less chance of making a sustainable and significant impact." Please note that intervention could be: the CBP (i.e., the object to be scaled up) or a scale-up strategy (i.e., the strategy used to scale up the CBP). • Please note that there is a difference between "scalability" (Milat et al. 2012) and "scale up." Authors provided a definition of scalability in reference to the process of scaling up.

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Please provide a clear and comprehensive explanation to help readers understand the differences or similarities between the concepts "scale up" and "sustainability." • Page 5, lines 10-17: I would like to suggest authors to make some changes because a knowledge synthesise showed a gap in scaling up methods in high-income country contexts (https://implementationscience.biomedcentral.co m/articles/10.1186/s13012-015-0301-6). Indeed, there is a growing interest in scaling up health innovations around the world, especially in highincome countries. But research on scaling up is effectively taking place in low-and middleincome countries (LMICs), especially in context of community-based primary health care in the fight against epidemics (https://implementationscience.biomedcentral.co m/articles/10.1186/s13012-017-0672-y). Today, we would like to learn from this LMICs expertise to scaling up health innovations in high-income countries (https://www.idrc.ca/fr/livres/scalingimpact-innovation-public-good). These terms have been used with similar intent (Milat et al., 2015). However, we acknowledge the importance of clear and intentional use of terms in the literature. The scale-up definition has been updated in line with the WHO ExpandNet model of scale-up (appropriate to an LMIC context). Further justification and discussion of this framework will be explored in the findings' publication. Reference following 'scale-up' definition updated to Milat et al., 2013 Explanation that sustainability is a component of scale-up given. Distinction made as included publications can explore scale-up more generally or can have just considered the sustainability component of scale-up (indicated as 'and/or' in search strategy) CBP updated to "NCD prevention" in this sentence. LMIC scale-up evidence focuses heavily on primary care, infectious disease, medication/vaccine uptake but less on complex physical activity/nutrition/lifestyle. A discussion on what we can and cannot learn from other LMIC primary care etc scale-up can be brought into the discussion section of the findings' publication. However, the dearth in literature, and the justification of focusing on LMICs for the current review still stands.
Reference has now been corrected.

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Methods: • Please indicate if a registration of your review title exists and provide registration information, including the name of the registry (e.g., OSF), registration number, and date. • I wonder how "scale-up" could be emphasized as an outcome or variable of interest.
• "Data extraction and analysis" subsection could be split into two subsections for easier reading: 1) Data extraction and 2) Data analysis. Please describe the methods of extracting data and any processes for obtaining and confirming data from investigators.
Protocol registered on OSF. Indicated under 'ethics and dissemination' heading and in abstract.
The authors acknowledge that this is a broad and qualitative investigation that will require continuous engagement to ensure this is done systematically. We have added "deliberate intention" as another defining factor.
Based on repeat searches with updated search terms per Charif et al (2021) on PubMed and SocINDEX, no new relevant publications for inclusion were identified. Therefore, a new search will not be run. Potential limitation of this has been acknowledged.
Section split into extraction and analysis. -English-only given as a limitation.
-The public will have a chance to refine the findings as part of the broader research -Sex and gender indicated as a scoping review question.

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Ethics and dissemination: • Authors could register the review on the Open science framework (OSF).
Protocol registered on OSF.