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.
Altman, D. (1995). Sustaining interventions in community systems: On the relationship between researchers and communities. Health Psychology, 14, 526-536.
2.
Barab, S. A., Redman, B. K., & Froman, R. D. (1998). Measurement characteristics of the Levels of Institutionalization scales: Examining reliability and validity. Journal of Nursing Measurement, 6, 19-33.
3.
Bracht, N., Finnegan, J. R., Jr., Rissel, C., Weisbrod, R., Gleason, J., Corbett, J., et al. (1994). Community ownership and program continuation following a health demonstration project. Health Education Research, 9, 243-255.
4.
Elder, J. P., Campbell, N. R., Candelaria, J. I., Talavera, G. A., Mayer, J. A., Moreno. C., et al. (1998). Project Salsa: Development and institutionalization of a nutritional health promotion project in a Latino community. American Journal of Health Promotion, 12, 391-401.
5.
Evashwick, C., & Ory, M. (2003). Organizational characteristics of successful innovative health care programs sustained over time. Family and Community Health, 26, 177-193.
6.
Farquhar, J. W., Fortmann, S. P., Flora, J. A., Taylor, C. B., Haskell, W. L., Williams, P. T., et al. (1990). Effects of community-wide education on cardiovascular disease risk factors: The Stanford Five-City Project. Journal of the American Medical Association, 264, 359-365.
7.
Farquhar, J. W., Fortmann, S. P., Maccoby, N., Haskell, W. L., Williams, P. T., Flora, J. A., et al. (1985). The Stanford Five-City Project: Design and methods. American Journal of Epidemiology, 122, 323-334.
8.
Glaser, E. M. (1981). Durability of innovations in human service organizations. Knowledge: Creation, Diffusion, Utilization, 3, 167-185.
9.
Goodman, R. M., McLeroy, K. R., Steckler, A. B., & Hoyle, R. H. (1993). Development of Level of Institutionalization (LoIn) scales for health promotion programs. Health Education Quarterly, 20, 161-178.
10.
Goodman, R. M., & Steckler, A. (1989). A model for the institutionalization of health promotion programs. Family and Community Health, 11, 63-78.
11.
Goodson, P., Smith, M. M., Evans, A., Meyer, B., & Gottlieb, N. H. (2001). Maintaining prevention in practice: Survival of PPIP in primary care settings. American Journal of Preventive Medicine, 20, 184-189.
12.
Green, L. W. (1989) Comment: Is institutionalization the proper goal of grantmaking?American Journal of Health Promotion, 3, 44.
13.
Harris, D. L., Henry, R. C., Bland, C. J., Starnaman, S. M., & Voytek, K. L. (2003). Lessons learned from implementing multidisciplinary health professions educational models in community settings. Journal of Interprofessional Care, 17, 7-20.
14.
Hawe, P., Noort, M., King, L., & Jordens, C. (1997). Multiplying health gains: The critical role of capacity-building within health promotion programs. Health Policy, 39, 29-42.
15.
Herrera, C. (2002). Report on sustainability in Faith in Action (Draft report to the Robert Wood Johnson Foundation from Public/Private Ventures).
16.
Hogg, W., Baskerville, N., Nykiforuk, C., & Mallen, D. (2002). Improved preventive care in family practices with out-reach facilitation: Understanding success and failure. Journal of Health Services Research & Policy, 7, 195-201.
17.
Jackson, C. J., Fortmann, S. P., Flora, J. A., Melton, R. J., Snider, J. P., & Littlefield, D. (1994) The capacity-building approach to intervention maintenance implemented by the Stanford Five-City Project. Health Education Research, 9, 385-396.
18.
Johnson, K., Hays, C., Center, H., & Daley, C. (2004). Building capacity and sustainable prevention innovations: A sustainability planning model. Evaluation and Program Planning, 27, 135-149.
19.
Labonte, R., & Laverack, G. (2001). Capacity building in health promotion, Part I: For whom? And for what purpose?Critical Public Health, 11, 111-127.
20.
Lichtenstein, E., Thompson, B., Nettekoven, L., & Corbett, K., for the COMMIT Research Group (1996). Durability of tobacco control activities in 11 North American communities: Life after the Community Intervention Trial for Smoking Cessation (COMMIT). Health Education Research, 11, 527-534.
21.
Livit, M., & Wandersman, A. (2004). Organizational functioning: Facilitating effective interventions and increasing the odds of programming success. In D. M. Fetterman & A. Wandersman(Eds.), Empowerment evaluation principles in practice (pp. 123-154). New York: Guilford.
22.
Lodl, K., & Stevens, G. (2002). Coalition sustainability: Long term successes & lessons learned. Journal of Extension, 40, 1-8.
23.
Mancini, J. A., & Marek, L. I. (2004). Sustaining community-based programs for families: Conceptualization and measurement. Family Relations, 53, 339-347.
24.
Newcomer, K. E., Hatry, H. P., and Wholey, J. S. (1994). Meeting the need for practical evaluation approaches: An introduction. In J. S. Wholey, H. P. Hatry, & K. E. Newcomer (Eds.), Handbook of practical program evaluation (pp. 1-10). San Francisco: Jossey-Bass.
25.
O’Loughlin, J., Renaud, L., Richard, L., Sanchez-Gomez, L., & Paradis, G. (1998). Correlates of the sustainability of community-based heart health promotion interventions. Preventive Medicine, 27, 702-712.
26.
Paine-Andrews, A., Fisher, J. L., Campuzano, M. K., Fawcett, S. B., & Berkley-Patton, J. (2000). Promoting sustainability of community health initiatives: An empirical case study. Health Promotion Practice, 1, 249-258.
27.
Pluye, P., Potvin, L., & Denis, J. L. (2004). Making public health programs last: Conceptualizing sustainability. Evaluation and Program Planning, 27, 121-133.
28.
Scheirer, M. A. (1981). Program implementation: The organizational context. Beverly Hills, CA: Sage.
29.
Scheirer, M. A. (1987). Program theory and implementation theory: Implications for evaluators. In L. Bickman (Ed.), New directions for program evaluation, Vol. 33: Using program theory in evaluation (pp. 40-68). San Francisco: Jossey-Bass.
30.
Scheirer, M. A. (1990). The life cycle of an innovation: Adoption versus discontinuation of the Fluoride Mouth Rinse Program in schools. Journal of Health and Social Behavior, 31, 203-215.
31.
Scheirer, M. A. (1993). Are the Level of Institutionalization scales ready for “prime time”? A commentary on “Development of Level of Institutionalization (LoIn) scales for health promotion programs.”Health Education Quarterly, 20, 179-183.
32.
Shediac-Rizkallah, M. C., & Bone, L. R. (1998). Planning for the sustainability of community-based health programs: Conceptual frameworks and future directions for research, practice and policy. Health Education Research, 13, 87-108.
33.
Shediac-Rizkallah, M. C., Scheirer, M. A., & Cassady, C. (1997, May). Sustainability of the Coordinated Breast Cancer Screening Program (Final report to the American Cancer Society). Baltimore: Johns Hopkins University School of Hygiene and Public Health.
34.
Stange, K. C., Goodwin, M. A., Zyzanzki, S. J., & Dietrich, A. J. (2003). Sustainability of a practice-individualized preventive service delivery intervention. American Journal of Preventive Medicine, 25, 296-300.
35.
Steckler, A., & Goodman, R. M. (1989). How to institutionalize health promotion programs. American Journal of Health Promotion, 3, 34-44.
36.
Stevens, B., & Peikes, D. (2004). When the funding stops: Do grantees of the Local Initiative Funding Partners program sustain themselves? (Report to the Robert Wood Johnson Foundation from Mathematica Policy Research).
37.
Thompson, B., Lichtenstein, E., Corbett, K., Nettekoven, L., & Feng, Z. (2000). Durability of tobacco control efforts in the 22 Community Intervention Trial for Smoking Cessation (COMMIT) communities 2 years after the end of intervention. Health Education Research, 15, 353-266.
38.
Wallin, L., Bostrom, A. M., Wikblad, K., & Ewald, U. (2003). Sustainability in changing clinical practice promotes evidence-based nursing care. Journal of Advanced Nursing, 41, 509-518.
39.
Wandersman, A., Imm, P., Chinman, M., & Kaftarian, S. (2000). Getting to outcomes: A results-based approach to accountability. Evaluation and Program Planning, 23, 389-395.
40.
Weiss, H., Coffman J., & Bohan-Baker, M. (2002) Evaluation’s role in supporting initiative sustainability. Cambridge, MA: Harvard Family Research Project. Available at http://www.hfrp.org
41.
Yin, R. K. (1979). Changing urban bureaucracies: How new practices become routinized. Lexington, MA: Lexington Books.
42.
Yin, R. K. (1981). Life histories of innovations: How new practices become routinized. Public Administration Review, 41, 21-28.
