Funders of programs in public health and community health are increasingly concerned about the sustainability of changes they initiate. Despite a recent increase in sustainability research and evaluation, this literature has not developed a widely used paradigm for conducting research that can accumulate into generalizable findings. We provide guidance for research and evaluation of health program sustainability, including definitions and types of sustainability, specifications and measurements of dependent variables, definitions of independent variables or factors that influence sustainability, and suggestions for designs for research and data collection. We suggest viewing sustainability research as a further stage in the translation or dissemination of research-based interventions into practice. This perspective emphasizes ongoing relationships with earlier stages of a broader diffusion framework, including adoption and implementation processes.

An important final step in the life cycles of programs and their evaluation involves assessing new programs’ or innovations’ sustainability. This review and synthesis of 19 empirical studies of the sustainability of American and Canadian health-related programs examines the extent of sustainability achieved and summarizes factors contributing to greater sustainability. Three definitions for measuring sustainability were examined: continued program activities (18 studies), continued measured benefits or outcomes for new clients (2 studies), and maintained community capacity (6 studies). Methods of studying sustainability were also assessed. In 14 of 17 studies covering the continuation of program activities, at least 60% of sites reported sustaining at least one program component. Although these studies’ methods had substantial limitations, cross-study analysis showed consistent support for five important factors influencing the extent of sustainability: (a) A program can be modified over time, (b) a “champion” is present, (c) a program “fits” with its organization’s mission and procedures, (d) benefits to staff members and/or clients are readily perceived, and (e) stakeholders in other organizations provide support.

Researchers, funders, and managers of health programs and interventions have become concerned about their long-term sustainability. However, most research about sustainability has not considered the nature of the program to be sustained. Health-related interventions may differ in their likelihood of sustainability and in the factors likely to influence continuation. I suggest a framework for analyzing the sustainability of 6 types of interventions: (1) those implemented by individual providers; (2) programs requiring coordination among multiple staff; (3) new policies, procedures, or technologies; (4) capacity or infrastructure building; (5) community partnerships or collaborations; and (6) broad-scale system change. Hypotheses for future research and strategies that program managers might use to achieve sustainability also differ by program or intervention type.

This is the first study to adopt a realist approach for understanding how changes in organizational culture may be sustained. Through doing so, this review highlights the broad principles by which organizational action may be organized within enabling contextual settings.

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BackgroundUse of technology is increasing in health promotion and has continued growth potential in intervention research. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this paper reports on the adoption, reach, and implementation of Project HEAL (Health through Early Awareness and Learning)—a community-based implementation trial of a cancer educational intervention in 14 African American churches. We compare adoption, reach, and implementation at the organizational and participant level for churches in which lay peer community health advisors (CHAs) were trained using traditional classroom didactic methods compared with a new online system.MethodsFifteen churches were randomized to one of two study groups in which two CHAs per church were trained through either classroom (“Traditional”; n = 16 CHAs in 8 churches) or web-based (“Technology”; n = 14 CHAs in 7 churches) training methods. Once trained and certified, all CHAs conducted a series of three group educational workshops in their churches on cancer early detection (breast, prostate, and colorectal). Adoption, reach, and implementation were assessed using multiple data sources including church-level data, participant engagement in the workshops, and study staff observations of CHA performance.ResultsThe project had a 41% overall adoption rate at the church level. In terms of reach, a total of 375 participants enrolled in Project HEAL—226 participants in the Traditional group (43% reach) and 149 in the Technology group (21% reach; p < .10). Implementation was evaluated in terms of adherence, dosage, and quality. All churches fully completed the three workshops; however, the Traditional churches took somewhat longer (M = 84 days) to complete the workshop series than churches in the Technology group (M = 64 days). Other implementation outcomes were comparable between both the Traditional and Technology groups (p > .05).ConclusionsOverall, the Project HEAL intervention had reasonable adoption, though reach could have been better. Implementation was strong across both study groups, suggesting the promise of using web-based methods to disseminate and implement evidence-based interventions in faith-based settings and other areas where community health educators work to eliminate health disparities.