What is it about?
Do we think about how interventions will be scaled and expanded to reach more people in real-world settings, without losing their impact? This is “scalability.” We reviewed 50 recent pilot trials and found that most focus on testing whether an intervention works on a small scale, but do not consider important factors needed to successfully roll it out more widely. In fact, many key elements — such as cost, long-term sustainability, and how the intervention would work in everyday practice — were often not reported or considered.
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Why is it important?
This matters because even effective health programs may never benefit the wider population if they are not designed with scale in mind from the start. But perhaps this is because pilot and feasibility trial guidance does not line up with guidance for scalability - which is to consider scaling from the outset. Our findings suggest that researchers should consider scalability earlier when designing and reporting pilot trials, to improve the chances that successful interventions can be implemented in real-world settings and have a broader health impact.
Perspectives
Pilot trial reporting guidelines should be expanded to include scalability considerations, to improve the relevance of research for the real world.
Dr Matthew Mclaughlin
University of Western Australia
Read the Original
This page is a summary of: Do we consider scalability from the outset? A methodological review of pilot randomised controlled health trials, BMJ Open, June 2026, BMJ,
DOI: 10.1136/bmjopen-2025-114008.
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