In 2023, the article “Assessing the sustainability and scalability of a diabetes eHealth innovation: a mixed-methods study” was published. Several members of our unit are part of the team that wrote it.
- Arani Sivakumar
- Rachel Y. Pan
- Angel Wang
- Dorothy Choi
- Ali Ben Charif
- Monika Kastner
- France Légaré
- Catherine H. Yu
Sivakumar, A., Pan, R. Y., Wang, A., Choi, D., Ben Charif, A., Kastner, M., Légaré, F., & Yu, C. H. (2023). Assessing the sustainability and scalability of a diabetes eHealth innovation: a mixed-methods study. BMC Health Services Research, 23, Article 284. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-025-12378-5
Context
In Canada, a research team developed MyDiabetesPlan, a digital decision aid designed to support shared decision-making in diabetes care. However, little information was available on its sustainability and scalability. To avoid short-lived implementation and promote broader adoption, it is essential to understand the factors influencing its long-term viability and scalability.
Method
Using a rigorous approach, the authors collected and analyzed data from various sources, including feedback from twenty individuals involved in the development and implementation of MyDiabetesPlan. Two tools were administered using a “think-aloud” method: the National Health Services Sustainability Model (NHSSM) and the self-administered ISSaQ questionnaire on scalability. Semi-structured interviews were also conducted. Quantitative results were analyzed by aggregate scores and stakeholder type, while qualitative data were analyzed iteratively using content analysis.
Results
Findings indicated that MyDiabetesPlan has high sustainability and scalability. The main facilitator for sustainability was “staff engagement and training to maintain the process.” Key barriers included “adaptability of the improved process,” “senior leadership engagement,” and “infrastructure for sustainability.” For scalability, the most prominent facilitators were “acceptability,” “theory-based development,” and “alignment with policy guidelines.” Major barriers included “financial and human resources,” “feasibility of adoption,” and “broad reach.” Qualitative results confirmed the limiting and facilitating factors identified in the quantitative analyses.
Conclusion
Strengthening staff engagement across diverse care settings and overcoming resource constraints are key levers to enhance the sustainability and scalability of MyDiabetesPlan. Next steps will focus on securing organizational leadership support, which could mitigate resource-related barriers and foster greater staff mobilization. Developers of digital health tools can anticipate these challenges early in the design process to optimize long-term viability and scalability.