Assessing Capacity for Sustainability of Effective Programs and Policies in Local Health Departments

Abstract

Context Sustainability has been defined as the existence of structures and processes that allow a program to leverage resources to effectively implement and maintain evidence-based public health and is important in local health departments (LHDs) to retain the benefits of effective programs. Objective Explore the applicability of the Program Sustainability Framework in high- and low-capacity LHDs as defined by national performance standards. Design Case study interviews from June-July 2013. Standard qualitative methodology was used to code transcripts; codes were developed inductively and deductively. Setting Six geographically diverse LHD’s (selected from three high- and three low-capacity) Participants 35 LHD practitioners Main Outcome Measures Thematic reports explored the eight domains (Organizational Capacity, Program Adaptation, Program Evaluation, Communications, Strategic Planning, Funding Stability, Environmental Support, and Partnerships) of the Program Sustainability Framework. Results High-capacity LHDs described having environmental support, while low-capacity LHDs reported this was lacking. Both high- and low-capacity LHDs described limited funding; however, high-capacity LHDs reported greater funding flexibility. Partnerships were important to high- and low-capacity LHDs, and both described building partnerships to sustain programming. Regarding organizational capacity, high-capacity LHDs reported better access to and support for adequate staff and staff training compared to low-capacity LHDs. While high-capacity LHDs described integration of program evaluation into implementation and sustainability, low-capacity LHDs reported limited capacity for measurement specifically and evaluation generally. When high-capacity LHDs described program adoption, they discussed an opportunity to adapt and evaluate. Low-capacity LHDs struggled with programs requiring adaptation. High-capacity LHDs described higher quality communication than low-capacity LHDs. High- and low-capacity LHDs described strategic planning, but high-capacity LHDs reported efforts to integrate evidence-based public health. Conclusions Investments in leadership support for improving organizational capacity, improvements in communication from the top of the organization, integrating program evaluation into implementation, and greater funding flexibility may enhance sustainability of evidence-based public health in LHDs.

Perspectives on program mis-implementation among U.S. local public health departments

“…Qualitative studies emphasize the importance of leadership support, planning, partnerships, and communication in capacity to sustain public health EBIs [26,47]. Reassignment of staff, changes in staff workloads, and changes in leadership led to discontinuation of an evidence-based trauma intervention in a large urban school district [48].…”

“…External politics also influence funding and implementation decisions [21,23]. Additional aspects influencing sustainment likely vary by program type and include implementation monitoring to improve program adaptation and delivery, partnerships, planning, and communications [18,[24][25][26]. Therefore, it is important to assess and address both types of mis-implementation in public health practice.…”

The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care

“…There has been a growing literature on the sustainability of interventions implemented in a wide range of public health and community settings (e.g., schools, worksites, community organizations, health departments, churches) (18,29,44,120,124,127,141). Whereas many studies have investigated stakeholder perspectives on barriers and facilitators, several studies have begun empirically testing multilevel predictors of sustainability (27, 108).…”

“…The framework and associated measure that came from it, the 40-item Program Sustainability Assessment Tool (PSAT) (76), can be used by D&I researchers and stakeholders when planning and making decisions about public health programs to implement. Although several studies have applied the PSAT measure or framework (62,76,138,141), it is not evident whether the tool captures all relevant domains, and research is needed to validate the tool across diverse contexts. Other useful sustainability planning frameworks are also available, including Getting to Outcomes (65) and the NHS Sustainability Model and Guide (developed to plan and build capacity for clinical interventions by the National Health Service) (33, 79).…”

Enhancing Sleep Quality for Nursing Home Residents with Dementia: A Pragmatic Randomized Controlled Trial of an Evidence-Based Frontline Huddling Program

“…We plan to investigate the LOCK sleep intervention's sustainment in each nursing home six months after completion. Sustainment of an intervention-the extent to which it becomes part of usual care-is a little studied but signi cant area of implementation research (66)(67)(68). During this follow up, we will conduct semi-structured interviews with participating nursing home staff to elucidate barriers to and facilitators of the intervention's sustainment (or lack thereof).…”