Predictors of Sustained Implementation of Low-Literacy Health Education Programs

Abstract

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.