Public health program capacity for sustainability: a new framework

Sarah F Schell, Douglas A Luke, Michael W Schooley, Michael B Elliott, Stephanie H Herbers, Nancy B Mueller, Alicia C Bunger, Sarah F Schell, Douglas A Luke, Michael W Schooley, Michael B Elliott, Stephanie H Herbers, Nancy B Mueller, Alicia C Bunger

Abstract

Background: Public health programs can only deliver benefits if they are able to sustain activities over time. There is a broad literature on program sustainability in public health, but it is fragmented and there is a lack of consensus on core constructs. The purpose of this paper is to present a new conceptual framework for program sustainability in public health.

Methods: This developmental study uses a comprehensive literature review, input from an expert panel, and the results of concept-mapping to identify the core domains of a conceptual framework for public health program capacity for sustainability. The concept-mapping process included three types of participants (scientists, funders, and practitioners) from several public health areas (e.g., tobacco control, heart disease and stroke, physical activity and nutrition, and injury prevention).

Results: The literature review identified 85 relevant studies focusing on program sustainability in public health. Most of the papers described empirical studies of prevention-oriented programs aimed at the community level. The concept-mapping process identified nine core domains that affect a program's capacity for sustainability: Political Support, Funding Stability, Partnerships, Organizational Capacity, Program Evaluation, Program Adaptation, Communications, Public Health Impacts, and Strategic Planning. Concept-mapping participants further identified 93 items across these domains that have strong face validity-89% of the individual items composing the framework had specific support in the sustainability literature.

Conclusions: The sustainability framework presented here suggests that a number of selected factors may be related to a program's ability to sustain its activities and benefits over time. These factors have been discussed in the literature, but this framework synthesizes and combines the factors and suggests how they may be interrelated with one another. The framework presents domains for public health decision makers to consider when developing and implementing prevention and intervention programs. The sustainability framework will be useful for public health decision makers, program managers, program evaluators, and dissemination and implementation researchers.

Figures

Figure 1
Figure 1
Characteristics of public health program sustainability literature (85 studies).
Figure 2
Figure 2
Concept map of capacity for sustainability.
Figure 3
Figure 3
Graphic framework and definitions.

References

    1. Farrelly M, Pechacek T, Thomas K, Nelson D. The impact of tobacco control programs on adult smoking. Am J Public Health. 2008;98:304–309.
    1. Miller T, Levy D. Cost-outcome analysis in injury prevention and control: eighty-four recent estimates for the United States. Med Care. 2000;38:562–582.
    1. Proctor E, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B. Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health. 2009;36:24–34.
    1. Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health. 2011;38:4–23.
    1. Scheirer MA, Dearing JW. An agenda for research on the sustainability of public health programs. Am J Public Health. 2011;101:2059–2067.
    1. Glasgow RE, Klesges LM, Dzewaltowski DA, Estabrooks PA, Vogt TM. Evaluating the impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues. Health Educ Res. 2006;21:688–694.
    1. Goodman RM, Steckler A. A model for the institutionalization of health promotion programs. Fam Community Health. 1989;11:63–78.
    1. Savaya R, Spiro S, Elran-Barak R. Sustainability of social programs: a comparative case study analysis. Am J Eval. 2008;29:478–493.
    1. Centers for Disease Control and Prevention. Framework for program evaluation in public health. MMWR Recomm Rep. 1999;48:1–40.
    1. Handler A, Issel M, Turnock B. A conceptual framework to measure performance of the public health system. Am J Public Health. 2001;91:1235–1239.
    1. Hawe P, Noort M, King L, Jordens C. Multiplying health gains: the critical role of capacity-building within health promotion programs. Health Policy. 1997;39:29–42.
    1. Harris JK, Luke DA, Burke RC, Mueller NB. Seeing the forest and the trees: using network analysis to develop an organizational blueprint of state tobacco control systems. Soc Sci Med. 2008;67:1669–1678.
    1. Zaza S, Briss PA, Harris KW. Task Force on Community Preventive Services. New York: Oxford University Press; 2005. (The Guide to Community Preventive Services: What Works to Promote Health?).
    1. The Cochrane Library. Chichester: Wiley; Issue 1; 2013.
    1. Mancini JA, Marek LI. Sustaining community-based programs for families: Conceptualization and measurement. Fam Relat. 2004;53:339–347.
    1. Pluye P, Potvin L, Denis J-L. Making public health programs last: conceptualizing sustainability. Eval Program Plann. 2004;27:121–133.
    1. Shediac-Rizkallah MC, Bone LR. Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. Health Educ Res. 1998;13:87–108.
    1. Scheirer MA. Is sustainability possible? A review and commentary on empirical studies of program sustainability. Am J Eval. 2005;26:320–347.
    1. Kane M, Trochim WMK. Concept Mapping for Planning and Evaluation. Thousand Oaks: Sage; 2007.
    1. Rosas SR. Concept mapping as a technique for program theory development: an illustration using family support programs. Notes. Am J Eval. 2005;26:389–401.
    1. Brownson RC, Kelly CM, Eyler AA, Carnoske C, Grost L, Handy SL, Maddock JE, Pluto D, Ritacco BA, Sallis JF, Schmid TL. Environmental and policy approaches for promoting physical activity in the united states: a research agenda. J Phys Act Health. 2008;5:488–503.
    1. Trochim WMK, Milstein B, Wood BJ, Jackson S, Pressler V. Setting objectives for community and systems change: an application of concept mapping for planning a statewide health improvement initiative. Health Promot Pract. 2004;5:8–19.
    1. Anderson LA, Gwaltney MK, Sundra DL, Brownson RC, Kane M, Cross AW, Mack JR, Schwartz R, Sims T, Carol WR. Using concept mapping to develop a logic model for the prevention research centers program. Prev Chronic Dis. 2006;3:A06.
    1. Graham AL, Kerner JF, Quinlan KM, Vinson C, Best A. Translating cancer control research into primary care practice: a conceptual framework. Am J Lifestyle Med. 2008;2:241–249.
    1. Arrington B, Kimmey J, Brewster M, Bentley J. Building a local agenda for dissemination of research into practice. J Public Health Manag Pract. 2008;14:185–192.
    1. Green A, Aarons G. A comparison of policy and direct practice stakeholder perceptions of factors affecting evidence-based practice implementation using concept mapping. Implement Sci. 2011;6:104.
    1. Bowman C, Sobo E, Asch S, Gifford A. Initiativet HHQER. Measuring persistence of implementation: QUERI series. Implement Sci. 2008;3:21.
    1. Akerlund KM. Prevention program sustainability: the state’s perspective. J Community Psychol. 2000;28:353–362.
    1. Johnson K, Hays C, Center H, Daley C. Building capacity and sustainable prevention innovations: a sustainability planning model. Eval Program Plann. 2004.
    1. Evashwick C, Ory M. Organizational characteristics of successful innovative health care programs sustained over time. Fam Community Health. 2003;26:177–193.
    1. Edgar T, Boyd SD, Palam A, Megan J. Sustainability for behaviour change in the fight against antibiotic resistance: a social marketing framework. J Antimicrob Chemother. 2009;63:230–237.
    1. Steckler A, Goodman RM, McLeroy KR, Davis S, Koch G. Measuring the diffusion of innovative health promotion programs. Am J Health Promot. 1992;6:214–224.
    1. Pluye P, Potvin L, Denis J-L, Pelletier J, Mannoni C. Program sustainability begins with the first events. Eval Program Plann. 2005;28:123–137.
    1. Scott-Findlay S, Golden-Biddle K. Understanding how organizational culture shapes research use. J Nurs Adm. 2005;35:359–365.
    1. Jansen M, Harting J, Ebben N, Kroon B, Stappers J, Van Engelshoven E, de Vries N. The concept of sustainability and the use of outcome indicators. A case study to continue a successful health counseling intervention. Fam Pract. 2008;25:i32–i37.
    1. Wiltsey Stirman S, Kimberly J, Cook N, Calloway A, Castro F, Charns M. The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implementation science: IS. 2012;7:17–17.
    1. Davidson ML. Multidimensional Scaling. New York: John WIley and Sons, Inc; 1983.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться