Table 11 The applicability and feasibility of the collected TMFs

 1

DSF (Dynamic Sustainability Framework)

The Dynamic Sustainability Framework: Addressing the Paradox of Sustainment Amid Ongoing Change

Applicability: This framework (DSF) is potentially suitable for LMICs due to its focus on continuous adaptation and learning, aligning with the diverse healthcare challenges in these regions.

Feasibility: DSF's feasibility in LMICs depends on factors such as each region's healthcare infrastructure, cultural factors, and resource availability. Its emphasis on ongoing learning, adaptation, and tailoring interventions to local contexts is critical for addressing specific needs and conditions in LMIC environments.

 2

AIDED Model

A model for scale up of family health innovations in low-income and middle-income settings: a mixed methods study

Applicability: This model offers a practical approach for scaling up family health innovations in LMICs, focusing on adapting to local contexts and engaging user groups, crucial for addressing the challenges in these regions.

Feasibility: It emphasizes developing support systems and effectively spreading innovation, involving essential concepts like assessing the landscape and tailoring innovations to user needs. This approach is designed to overcome barriers to scaling up in LMICs, making it feasible for application in diverse healthcare environments.

 3

NPT (Normalization Process Theory)

Normalisation Process Theory: a framework for developing, evaluating and implementing complex interventions

Applicability: This Theory (NPT) aids in implementing complex health interventions in LMICs by focusing on their integration into routine practices. It addresses challenges of assimilating these interventions within existing systems and cultural contexts, making it highly applicable in LMICs.

Feasibility: NPT concepts such as coherence, cognitive participation, collective action, and reflexive monitoring are crucial for facilitating intervention adoption. These principles enhance the feasibility of NPT in LMICs, considering socio-organizational factors and the need for interventions to resonate with local healthcare environments.

 4

A Proposed Framework for Success

Scaling Up Global Health Interventions: A Proposed Framework for Success

Applicability: This framework is designed to guide the implementation of new health programs, policies, or interventions in LMICs, considering their unique challenges and requirements, making it suitable for these contexts.

Feasibility: A tailored approach for LMICs, drawing on literature and expert interviews, underscores its feasibility in these unique settings. Key aspects enhancing feasibility include simplicity of interventions, local engagement, using state and non-state actors, political will, and incorporating research into implementation, as evidenced in successful health interventions across various LMICs.

 5

Theory of Change (ToC)

Theory of Change: a theory-driven approach to enhance the Medical Research Council's framework for complex interventions

Applicability: This approach, successfully piloted for mental health projects in LMICs, is adaptable to the varied local conditions in these settings. Its emphasis on stakeholder engagement and identifying causal pathways makes it highly relevant for designing, implementing, and evaluating complex interventions in LMICs.

Feasibility: Success of the ToC in LMICs depends on effectively customizing it to local conditions and ensuring active stakeholder participation. While it is adaptable and useful, challenges like significant stakeholder involvement and genuine ownership of ToC maps must be addressed to ensure its feasibility.

 6

Conceptual framework of sustainability of interventions implemented in SSA

Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework

Applicability: The study focus on challenges of sustaining health interventions in Sub-Saharan Africa (SSA), emphasizes the importance of sustainability for both communicable and non-communicable diseases in LMICs. It provides insights relevant to regions with similar challenges.

Feasibility: While addressing sustainability in SSA, the study faces limitations in resource availability, healthcare workforce, and system strength. Its primary focus on sustainability in SSA may not fully encompass all relevant concepts for broader LMIC contexts, indicating a need for a more comprehensive understanding of LMICs' diverse needs.

 7

IHI Framework for Going to Full Scale

A Framework for Scaling Up Health Interventions

Applicability: This framework has proven practical in LMICs, particularly in African health initiatives. Its stages effectively address the critical aspects of scaling up health interventions in the resource-varied and infrastructurally challenging contexts of LMICs.

Feasibility: Comprehensive coverage of all phases, from initial setup to full-scale implementation and sustainability, demonstrates its feasibility in LMICs, accommodating their diverse healthcare environments and operational challenges.

TMFs Requiring Adaptation

 1

PRISM Model

A Practical, Robust Implementation and Sustainability Model (PRISM) for Integrating Research Findings into Practice

Applicability: This framework (DSF) is suitable for LMICs due to its emphasis on continuous adaptation and learning. It aligns to the diverse healthcare challenges in LMICs, focusing on adapting and improving health interventions. DSF's adaptability makes it relevant for various regional health concerns.

Feasibility: Feasibility in LMICs hinges on factors like healthcare infrastructure, cultural context, and resource availability in each region. Its principles of ongoing learning, adaptation, and fitting interventions to local contexts require consideration of these specific regional needs and conditions.

 2

Chronic Care Model (CCM)

Factors influencing the implementation of chronic care models: A systematic literature review

Applicability: The model’s effectiveness in LMICs depends on its alignment with the specific health challenges and infrastructures of these regions. While it broadly covers various chronic diseases and settings, indicating a comprehensive approach, its relevance varies based on the unique healthcare contexts in different LMICs.

Feasibility: Implementing CCM in LMICs requires meticulous planning and is influenced by factors at multiple healthcare levels. Its adaptability and feasibility in LMICs hinge on the region-specific healthcare needs, infrastructure, and resource capabilities.

 3

EPIS Framework

Advancing a Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors

Applicability: The conceptual model is broadly relevant for LMICs, particularly when tailored to address their unique cultural and systemic differences. It encompasses crucial aspects like local needs and the sociopolitical environment, underscoring its adaptability for diverse LMIC settings.

Feasibility: The model's feasibility in LMICs involves consideration of local resources and capacities, given its complexity and the multiple phases of exploration, adoption, implementation, and sustainment. Effective application in LMICs demands a deep understanding of local contexts and resource constraints.

 4

Triple C Model

Implementation of sustainable complex interventions in health care services: the triple C model

Applicability: The model focuses on sustainable complex interventions in healthcare, is well-suited to LMICs, especially when adapted to local contexts. Its stages of consultation, collaboration, and consolidation emphasize key aspects like stakeholder engagement and teamwork, aligning with the needs in LMICs.

Feasibility: This model's simplicity and practical approach make it feasible for LMICs, particularly in settings constrained by resources. Its emphasis on clear communication and sustainable practices is critical for the success of healthcare interventions in these resource-limited environments.

 5

NASSS Framework

Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies

Applicability: This framework, designed for health and social care technologies, has potential applicability to LMICs. Its broad design covers key areas such as health conditions, technology, adopters, and the wider context, offering concepts likely beneficial for LMICs, especially in informing technology design and implementation planning.

Feasibility: Feasibility in LMICs depends on local contexts, resources, and healthcare needs. Its development, informed by empirical case studies and a hermeneutic literature review, makes it adaptable to the diverse settings and challenges characteristic of LMICs.

 6

A comprehensive conceptual framework for implementation science

Developing a conceptual framework for implementation science to evaluate a nutrition intervention scaled-up in a real-world setting

Applicability: This framework provides well-defined concepts that suggest clarity and potential usability in LMICs. It effectively connects components essential for identifying, scaling up, and sustaining effective interventions, indicating relevance for LMICs.

Feasibility: While framework is clear and has proven effective in programs like those in Bangladesh, its adaptation to specific LMIC contexts may require further clarification, ensuring it meets local needs and conditions.

 7

EPIS Framework

Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework

Applicability: Focus on inner and outer context factors, innovation factors, and bridging factors, suggests potential adaptability to diverse settings, including LMICs. Its comprehensive approach to different implementation stages and context factors make it broadly relevant.

Feasibility: Feasibility of applying to LMICs depends on the specific contexts and available resources in these regions. While it covers factors crucial for implementing EBPs, the review doesn’t explicitly confirm inclusion of all useful concepts for LMICs, indicating a need for further assessment in these unique settings.

 8

The systems transformation framework (STF)

The Power of the Frame: Systems Transformation Framework for Health Care Leaders

Applicability: Adaptability and relevance for LMICs, particularly in structuring healthcare leadership and change management, are evident. However, it lacks a specific focus on LMIC contexts, suggesting a need for further contextualization.

Feasibility: While concepts are broadly applicable to healthcare systems, their direct relevance and practical implementation in LMICs might require adaptations. This is due to varying healthcare challenges and resource constraints characteristic of LMICs.

 9

A Proposed Framework for Success

Scaling Up—From Vision to Large-Scale Change: A Management Framework for Practitioners

Applicability: This field-tested framework, applicable across various sectors, aligns well with the challenges of scaling up interventions in LMICs. Its comprehensive approach, encompassing strategic planning, change management, resource allocation, and momentum maintenance, is aptly suited for these regions.

Feasibility: Given its proven applicability in different sectors, principles and methodologies show promise for effective implementation in LMICs, considering their specific challenges and needs in healthcare and resource management.

 10

CFIR framework

Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Applicability: The CFIR offers a comprehensive and pragmatic approach, making it adaptable for LMICs. Its flexibility and thorough consideration of both internal and external factors in implementation align well with the diverse challenges of health service implementation in LMICs.

Feasibility: Includes wide range of relevant concepts for LMICs, including its adaptability to local social, economic, and cultural contexts, supporting its feasibility in these varied settings, guiding effective management of health service implementation processes.

 11

the Context and Implementation of Complex Interventions (CICI) framework

Making sense of complexity in context and implementation: the Context and Implementation of Complex Interventions (CICI) framework

Applicability: The CICI framework's comprehensive approach and focus on socio-economic and cultural contexts make it suitable for application in LMICs. It addresses a broad spectrum of factors vital for the success of complex interventions in these diverse environments.

Feasibility: Given its emphasis on context, the CICI framework is relevant and feasible for LMICs, providing a guide for effectively handling the unique challenges and complexities of health service implementation in these settings.

 12

Conceptual framework for sustainability of public health programs

An Agenda for Research on the Sustainability of Public Health Programs

Applicability: Suggestions are adaptable for LMICs, focusing on sustainability of health interventions, particularly maintaining benefits post-funding. This aspect is highly relevant for LMICs, where sustaining health initiatives is a critical concern.

Feasibility: For effective application in LMICs, must consider specific resource limitations and health system dynamics prevalent in these regions. Comprehensive approach to addressing sustainability highlights feasibility in LMICs, considering their unique healthcare environments.

 13

Framework of Dissemination in Health Services Intervention Research

Interventions in Organizational and Community Context: A Framework for Building Evidence on Dissemination and Implementation in Health Services Research

Applicability: This framework emphasizes adapting health interventions to diverse community settings in LMICs, focusing on the importance of community-based approaches given the varied resources and cultural contexts. It covers understanding multi-layered community dynamics and the diffusion of new practices.

Feasibility: Including essential elements like contextual factors, diffusion stages, and intervention outcomes, tailored to unique challenges in LMICs, making it a feasible approach for health interventions in these regions.

 14

A Person-Focused Model of Care

A Person-Focused Model of Care for the Twenty-First Century: A System-of-Systems Perspective

Applicability: The model, integrating physical, mental, and social health aspects using a system-of-systems approach, is suitable for LMICs. It addresses multi-morbidity and provides a holistic view of health, essential for LMICs facing complex health challenges.

Feasibility: The focus on realigning and integrating existing resources, rather than requiring new infrastructure, makes the model feasible for LMICs. Including key elements like various health dimensions and stakeholder roles, the model effectively caters to the healthcare challenges in these regions.

 15

Integrated sustainability framework

The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care

Applicability: Sustaining EBIs in LMICs necessitates adapting to their specific resources, cultural differences, and economic conditions. This adaptation addresses the challenges of applying interventions initially developed in more resource-rich settings.

Feasibility: While concepts like community engagement and cultural adaptability are essential for the success of EBIs in LMICs, sustainability frameworks that highlight these aspects require further exploration. More research is needed to fully grasp their applicability across LMICs' diverse contexts, ensuring interventions are effectively tailored to local needs and realities.

 16

RE-AIM Framework

Evaluating the Public Health Impact of Health Promotion Interventions: The RE-AIM Framework

Applicability: The RE-AIM framework, focusing on reach, efficacy, adoption, implementation, and maintenance, is adaptable for evaluating public health interventions in LMICs, addressing their effectiveness and sustainability.

Feasibility: Adapting to LMICs presents challenges due to resource limitations, cultural differences, and health system disparities. Unique challenges in these regions may require additional considerations beyond the five dimensions, ensuring comprehensive and context-sensitive application.

 17

FRAME

The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions

Applicability: The FRAME framework, focusing on characterizing modifications to interventions, is suitable for LMICs as it addresses both planned and unplanned changes, critical in their diverse, resource-limited settings. It encompasses a wide range of intervention changes, including proactive adaptations and reactive modifications.

Feasibility: While FRAME provides a structure for understanding modifications, LMIC-specific challenges such as infrastructure, resource constraints, and cultural diversity may necessitate further consideration. This involves ensuring modifications align with original intervention goals while being sensitive to local contexts.

 18

ExpandNet framework

Practical guidance for scaling up health service innovations

Applicability: Focus on addressing technical, managerial, and financial aspects is crucial for LMICs, ensuring that interventions are suited to their specific healthcare contexts and resource limitations.

Feasibility: The necessity for additional resources poses a challenge in LMICs, where such resources are often limited. Effectiveness in these settings hinges on practical testing under real-life conditions unique to LMICs, to validate its adaptability and utility.

 19

Multiple models

Framework for the establishment of a feasible tailored and effective perinatal education programme

Applicability: Focus on adapting antenatal education to the specific needs of women in LMICs, considering local healthcare systems and cultural contexts, makes it highly applicable. It addresses diverse population needs and covers comprehensive maternal and child health aspects, vital in culturally and socioeconomically diverse LMICs.

Feasibility: The emphasis on adaptability and relevance enhances feasibility in LMICs. Key concepts like personalized education and community involvement are essential for effective implementation in these regions, where tailored approaches are necessary to meet unique healthcare challenges.

 20

A cross-cultural adaptation framework

A framework for cross-cultural development and implementation of complex interventions to improve palliative care in nursing homes: the PACE Steps to Success programme

Applicability: The PACE Steps to Success program, aimed at enhancing palliative care in nursing homes, is universally relevant for LMICs. Its comprehensive approach to palliative care is applicable across different cultural contexts, including those in LMICs.

Feasibility: Implementing this program in LMICs requires adaptations to align with their unique health and social care systems, legal policies, and cultural norms. Adjustments are necessary to accommodate diverse resource availabilities and healthcare infrastructures, ensuring the program's effectiveness in these varied settings.

 21

Greenhalgh et al.’s diffusion of innovation model

Explaining high and low performers in complex intervention trials: a new model based on diffusion of innovations theory

Applicability: The model emphasizes the importance of innovation adoption, organizational readiness, leadership, and managerial relations for the success of health interventions in LMICs, highlighting key aspects that are crucial for implementation in these contexts.

Feasibility: While these concepts are fundamental, additional context-specific factors may be necessary for LMICs. This includes adapting the model to align with the unique healthcare challenges and varying conditions of these regions, ensuring its practicality and effectiveness in local settings.

 22

WICID framework

WICID framework version 1.0: criteria and considerations to guide evidence-informed decision-making on non-pharmacological interventions targeting COVID-19

Applicability: This framework, aligned with the WHO-INTEGRATE model, is designed for managing COVID-19 interventions and needs adaptation for LMICs, considering their cultural diversity and health infrastructure.

Feasibility: While it addresses health, social, economic, and rights-related aspects of COVID-19 management, customization is necessary for LMICs to address specific challenges like healthcare disparities and economic constraints, due to their unique contexts and resource limitations.

 23

Hybrid Framework for Understanding Interventions to Reduce Under-5 Mortality

Development and application of a hybrid implementation research framework to understand success in reducing under-5 mortality in Rwanda

Applicability: Tailored for LMICs like Rwanda, offers comprehensive approach to reducing under-5 mortality, adapting existing frameworks with practical implementation suggestions and emphasizing local health system design, leadership, and community involvement.

Feasibility: This hybrid framework, focusing on equitable healthcare access and LMIC-specific factors, includes relevant concepts for implementing, adapting, and sustaining health interventions. It addresses contextual factors unique to LMICs, ensuring practicality in these diverse settings.

 24

Conceptual framework for evaluating the scale-up and sustainability of digital solutions for front-line health workers

A tale of ‘politics and stars aligning’: analysing the sustainability of scaled up digital tools for front-line health workers in India

Applicability: The study on digital health tools in India provides insights applicable to LMICs, focusing on adaptability to local contexts and stakeholder engagement. It underscores the importance of addressing specific challenges like data governance and sustainability in these regions.

Feasibility: The scalability and sustainability of such tools in LMICs are contingent on strong government leadership, stakeholder collaboration, and a supportive ecosystem. These factors are crucial for the successful scaling of digital health solutions in LMICs.

TMFs with Limited Applicability and feasibility

 1

Complex Population Health Intervention Adjustment

Adapting Evidence-Informed Complex Population Health Interventions for New Contexts

Applicability: Emphasizes adapting interventions to new contexts and conserving resources, relevant for LMICs with their complex systems, norms, and structures. Highlights importance of tailoring interventions to specific characteristics and needs of target populations in LMICs.

Feasibility: Acknowledges the challenges posed by the complexities in LMICs. While not explicitly focused on LMICs, its principles of adaptation and resource conservation are key to practical implementation in these settings, considering their unique challenges.

 2

Sustainable Oral Health Promotion Framework

A framework for implementing sustainable oral health promotion interventions

Applicability: Framework for sustainable oral health interventions, encompassing prevention, intervention, and recovery, is adaptable to LMICs. It addresses various stages including training, adoption, implementation, and practice improvement, making it relevant for oral health challenges in these regions.

Feasibility: Feasibility in LMICs depends on factors like local resource availability, cultural relevance, and healthcare infrastructure. While comprehensive, specific applicability of its concepts may vary according to each LMIC's unique healthcare challenges and context.

 3

Conceptual Framework to Prevent Childhood Obesity Through Policy-Level Initiatives in Afterschool Programs

Translating Policies Into Practice: A Framework to Prevent Childhood Obesity in Afterschool Programs

Applicability: Designed for U.S. afterschool programs, focuses on policies and practices relevant to childhood obesity and physical activity but doesn't explicitly address its applicability to LMICs, overlooking factors like resource availability, cultural norms, and economic conditions in these regions.

Feasibility: While covering policy implementation, organizational change, and public health, it lacks specific consideration for adapting these concepts to the unique challenges and needs of LMICs, indicating a gap in its feasibility for application in these diverse contexts.

 4

Complex adaptive system

Moving alcohol prevention research forward—Part I: Introducing a complex systems paradigm

Applicability: Focused on complex systems paradigm in context of U.S. college drinking. Doesn't address applicability to LMICs, neglecting aspects like resource availability, cultural differences, and economic conditions relevant in these regions.

Feasibility: While discussing complex systems and computational modeling, does not explore their relevance to LMICs, where context, particularly alcohol misuse and socio-ecological factors, differs significantly. Lack of specific coverage for unique LMIC challenges impacts feasibility of applying these concepts in such settings

 5

Organizational theory

Organizational theory for dissemination and implementation research

Applicability: Discusses SafeCare's implementation theory in developed contexts, lacking specific guidance for LMICs. Its concepts, tailored for developed countries, may not directly translate to the diverse contexts of LMICs.

Feasibility: Focuses on general organizational theories and does not address unique challenges and requirements of LMICs, impacting the direct feasibility of applying these theories in such varied settings.