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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.

With data from the 2003 and 2005 National Minority Business Owners Survey, we examined the extent to which minority business owners differ from nonminority business owners in their reported use of adjustment strategies, and the relationship between the use of adjustment strategies and perceived business success. The sample consisted of 193 African American, 200 Mexican American, 200 Korean American, and 210 white business owners. Mexican American and Korean American business owners reported higher levels of adjustment strategy use than African American and white business owners. The ordinary least squares show that reallocating family resources to meet business needs and reallocating business resources to meet family needs were negatively associated with perceived business success, whereas hiring paid help was positively associated with perceived business success.