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To ensure that more people will benefit from integrated care initiatives, scaling-up of successful initiatives is the way forward. However, new challenges present themselves as knowledge on how to achieve successful large-scale implementation is scarce. The EU-funded project SCIROCCO uses a step-based scaling-up strategy to explore what to scale-up, and how to scale-up integrated care initiatives by matching the complementary strengths and weaknesses of five European regions involved in integrated care. The purpose of this paper is to describe a multi-method evaluation protocol designed to understand what factors influence the implementation of the SCIROCCO strategy to support the scaling-up of integrated care.

The first part of the protocol focuses on the assessment of the implementation fidelity of the SCIROCCO step-based strategy. The objective is to gain insight in whether the step-based strategy is implemented as it was designed to explore what works and does not work when implementing the scaling-up strategy. The second part concerns a realist evaluation to examine what it is about the SCIROCCO’s strategy that works for whom, why, how and in which circumstances when scaling-up integrated care.

The intended study will provide valuable information on the implementation of the scaling-up strategy which will help to explain for what specific reasons the implementation succeeds and will facilitate further improvement of project outcomes.

The expected insights could be useful to guide the development, implementation and evaluation of future scaling-up strategies to advance the change towards more sustainable health and care systems.

This paper aims to increase related knowledge across personal, social and ecological dimensions of sustainability and how it can be applied to support transformative learning.

The paper provides a reflexive case study of the design, content and impact of a course on eco-justice that integrates relational learning with an equity and justice lens. The reflexive case study provides a critical, exploratory self-assessment, including interviews, group discussions and surveys with key stakeholders and course participants.

The results show how relational approaches can support transformative learning for sustainability and provide concrete practices, pathways and recommendations for curricula development that other universities/training institutions could follow or learn from.

Sustainability research, practice and education generally focuses on structural or systemic factors of transformation (e.g. technology, governance and policy) without due consideration as to how institutions and systems are shaping and shaped by the transformation of personal agency and subjectivity. This presents a vast untapped and under-studied potential for addressing deep leverage points for change by using a relational approach to link personal, societal and ecological transformations for sustainability.