Defining sustainability outcomes of health programs: Illustrations from an on-line survey

Scheirer, Mary Ann; Hartling, Gretchen; Hagerman, Diane

doi:10.1016/j.evalprogplan.2008.08.004

Cited by 71 publications

(74 citation statements)

References 15 publications

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“…Without attention to the problem of how to sustain this intervention, it will likely weaken and dissipate over time. 36,38,39 Incorporating the intervention into the standard electronic health record may help universal integration into pediatric work flow in the future.…”

Section: Resultsmentioning

confidence: 99%

Implementation of a Parental Tobacco Control Intervention in Pediatric Practice

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Young adult smokers frequently encounter the health care system as parents coming in for their child' s medical visit. Child health care clinicians, however, do not typically provide smoking cessation assistance to parents. WHAT THIS STUDY ADDS:This national cluster-randomized trial demonstrates that a tobacco dependence intervention for parents can be effectively implemented in routine pediatric outpatient practice.abstract OBJECTIVE: To test whether routine pediatric outpatient practice can be transformed to assist parents in quitting smoking. METHODS:Cluster RCT of 20 pediatric practices in 16 states that received either CEASE intervention or usual care. The intervention gave practices training and materials to change their care delivery systems to provide evidence-based assistance to parents who smoke. This assistance included motivational messaging; proactive referral to quitlines; and pharmacologic treatment of tobacco dependence. The primary outcome, assessed at an exit interview after an office visit, was provision of meaningful tobacco control assistance, defined as counseling beyond simple advice (discussing various strategies to quit smoking), prescription of medication, or referral to the state quitline, at that office visit.RESULTS: Among 18 607 parents screened after their child' s office visit between June 2009 and March 2011, 3228 were eligible smokers and 1980 enrolled (999 in 10 intervention practices and 981 in 10 control practices). Practices' mean rate of delivering meaningful assistance for parental cigarette smoking was 42.5% (range 34%-66%) in the intervention group and 3.5% (range 0%-8%) in the control group (P , .0001). Rates of enrollment in the quitline (10% vs 0%); provision of smoking cessation medication (12% vs 0%); and counseling for smoking cessation (24% vs 2%) were all higher in the intervention group compared with the control group (P , .0001 for each). CONCLUSIONS:A system-level intervention implemented in 20 outpatient pediatric practices led to 12-fold higher rates of delivering tobacco control assistance to parents in the context of the pediatric office visit.

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Section: Resultsmentioning

confidence: 99%

Implementation of a Parental Tobacco Control Intervention in Pediatric Practice

et al. 2013

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“…In recent years, sustainability outcomes have been conceptualized as (118,119,135) (a) continuing or improving health benefits or outcomes for patients/consumers at the individual level; (b) maintaining community-level partnerships or coalitions and community capacity for collaboration; (c) maintaining organizational practices, procedures, and policies started during implementation (institutionalization) (100,126,130); and (d ) continuing the program activities or core elements of the original intervention. Additional proposed sustainability outcomes include documentation of the extent to which the interventions continue to be implemented (135), adaptation of intervention components (135), sustained attention to an issue or problem (media, public, policy agendas) (118), and program diffusion and replication in other sites (118).…”

Section: Measuring Sustainability As An Outcomementioning

confidence: 99%

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

Shelton

Cooper

Stirman

2024

Annual Review of Public Health

475

569

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intensity for the sustained achievement of desirable program goals and population outcomes. This understudied area has been identified as one of the most significant translational research problems. Adding to this challenge is uncertainty regarding the extent to which intervention adaptation and evolution are necessary to address the needs of populations that differ from those in which interventions were originally tested or implemented. This review critically examines and discusses conceptual and methodological issues in studying sustainability, summarizes the multilevel factors that have been found to influence the sustainability of interventions in a range of public health and health care settings, and highlights key areas for future research. AbstractThere is strong interest in implementation science to address the gap between research and practice in public health. Research on the sustainability of evidence-based interventions has been growing rapidly. Sustainability has been defined as the continued use of program components at sufficient (17,97,109). Although numerous evidence-based public health interventions and clinical preventive strategies and treatments are available, it can be challenging to implement and sustain them outside of controlled settings, particularly if they were originally tested in narrow populations or unrepresentative circumstances (49). As a rapidly growing field, implementation science has focused on understanding factors and strategies that influence the initial adoption and integration of evidence-based interventions (EBIs) in real-world settings (103). Whereas significant advancements have been made in understanding the adoption and implementation of EBIs across a range of community and health care settings, less is known about their sustainability. Recently, experts have prioritized sustainability as an understudied area (45), identifying it as "one of the most significant translational research problems of our time" (103, p. 2) and as a persistent challenge across a range of settings and service delivery sectors, and across health behaviors and outcomes.Maximizing the public health impact of EBIs will require investing in sustainability research. This research will enable us to better understand what factors and processes influence the sustainability of interventions and how to plan proactively for the continuation of EBIs. Moreover, there has been growing consideration of the policy and ethical implications of developing effective health programs without investing in sustainability (118). Researchers, health leaders, advocates, policy makers, practitioners, and funders alike have concerns about the long-term impact and value of their investment in discontinued interventions. In addition to lost investments, time, and resources, there are other reasons for which advancing our understanding of the sustainability of EBIs has value (99, 122). Maintaining effective programs and practices is critical for achieving health benefits, particularly if there is a latency period betwee...

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“…Scheirer, Hartling & Hagerman (2008) conducted a similar online survey grantees from the New Jersey Health Initiative, a program funded by the Robert Wood Johnson Foundation, and found that approximately 75% of grantees continued their projects beyond the initial grant period, although often in modified forms [15]. Other previous research has demonstrated that sustainability of health promotion and health education programs is possible [16], although few key factors have been measured empirically.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Sustained Implementation of Low-Literacy Health Education Programs

Nelson¹,

Teutsch²,

Herman³

2014

J Community Med Health Educ

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Sustained implementation of health education interventions is important to optimize the impact of initial investments in program development and training. From 2002-2012, the Health Care Institute (HCI) at UCLA trained 192 Head Start grantees, serving low-income preschool children and families in the U.S., on how to implement lowliteracy health education programs, using a train-the-trainer (TTT) model. The purpose of this study was to investigate what key factors of implementation are associated with sustainability of HCI programs, based on an online survey of Head Start grantees who have participated in the HCI TTT. A 51% response rate was achieved, with 96 surveys returned from the 188 sent to agencies that are still open. Of the grantees responding to the survey, 84% reported that they continue to implement HCI programs and 71% continue to implement them annually. Key predictors of annual implementation included: engagement of stakeholders at all levels; continuing to provide incentives for families; putting HCI into the annual training and technical assistance budget; sending additional staff to the TTT; seeing an improvement in overall program performance; and adapting HCI topics to meet local Head Start grantee needs. Qualitative responses described these same factors in additional detail. These results are consistent with previous research on program sustainability and suggest which elements of implementation may be most important as initial and ongoing investments, if sustainability is a program goal.

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Defining sustainability outcomes of health programs: Illustrations from an on-line survey

Cited by 71 publications

References 15 publications

Implementation of a Parental Tobacco Control Intervention in Pediatric Practice

Implementation of a Parental Tobacco Control Intervention in Pediatric Practice

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

Predictors of Sustained Implementation of Low-Literacy Health Education Programs

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