Sustainability of Public Health Interventions: Where Are the Gaps?

Overview

Journal Health Res Policy Syst

Publisher Biomed Central

Specialties Health Services
Public Health

Date 2019 Jan 17

PMID 30646911

Citations 79

Authors

David Roger Walugembe

Shannon Sibbald

Marlene Janzen Le Ber

Anita Kothari

Affiliations

Soon will be listed here.

Abstract

The current scholarly focus on implementation science is meant to ensure that public health interventions are effectively embedded in their settings. Part of this conversation includes understanding how to support the sustainability of beneficial interventions so that limited resources are maximised, long-term public health outcomes are realised, community support is not lost, and ethical research standards are maintained. However, the concept of sustainability is confusing because of variations in terminology and a lack of agreed upon measurement frameworks, as well as methodological challenges. This commentary explores the challenges around the sustainability of public health interventions, with particular attention to definitions and frameworks like Normalization Process Theory and the Dynamic Sustainability Framework. We propose one important recommendation to direct attention to the sustainability of public health interventions, that is, the use of theoretically informed approaches to guide the design, development, implementation, evaluation and sustainability of public health interventions.

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References

Shediac-Rizkallah M, BONE L . Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. Health Educ Res. 1998; 13(1):87-108. DOI: 10.1093/her/13.1.87. View

Glasgow R, Vogt T, Boles S . Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999; 89(9):1322-7. PMC: 1508772. DOI: 10.2105/ajph.89.9.1322. View

Thompson B, Lichtenstein E, Corbett K, Nettekoven L, Feng Z . Durability of tobacco control efforts in the 22 Community Intervention Trial for Smoking Cessation (COMMIT) communities 2 years after the end of intervention. Health Educ Res. 2000; 15(3):353-66. DOI: 10.1093/her/15.3.353. View

Innvaer S, Vist G, Trommald M, Oxman A . Health policy-makers' perceptions of their use of evidence: a systematic review. J Health Serv Res Policy. 2002; 7(4):239-44. DOI: 10.1258/135581902320432778. View

Bonetti D, Eccles M, Johnston M, Steen N, Grimshaw J, Baker R . Guiding the design and selection of interventions to influence the implementation of evidence-based practice: an experimental simulation of a complex intervention trial. Soc Sci Med. 2005; 60(9):2135-47. DOI: 10.1016/j.socscimed.2004.08.072. View

LaPelle N, Zapka J, Ockene J . Sustainability of public health programs: the example of tobacco treatment services in Massachusetts. Am J Public Health. 2006; 96(8):1363-9. PMC: 1522114. DOI: 10.2105/AJPH.2005.067124. View

Rabin B, Brownson R, Haire-Joshu D, Kreuter M, Weaver N . A glossary for dissemination and implementation research in health. J Public Health Manag Pract. 2008; 14(2):117-23. DOI: 10.1097/01.PHH.0000311888.06252.bb. View

May C, Mair F, Finch T, MacFarlane A, Dowrick C, Treweek S . Development of a theory of implementation and integration: Normalization Process Theory. Implement Sci. 2009; 4:29. PMC: 2693517. DOI: 10.1186/1748-5908-4-29. View

Hoddinott P, Britten J, Pill R . Why do interventions work in some places and not others: a breastfeeding support group trial. Soc Sci Med. 2009; 70(5):769-78. DOI: 10.1016/j.socscimed.2009.10.067. View

10.

Glanz K, Bishop D . The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health. 2010; 31:399-418. DOI: 10.1146/annurev.publhealth.012809.103604. View

11.

Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A . Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2010; 38(2):65-76. PMC: 3068522. DOI: 10.1007/s10488-010-0319-7. View

12.

Foy R, Ovretveit J, Shekelle P, Pronovost P, Taylor S, Dy S . The role of theory in research to develop and evaluate the implementation of patient safety practices. BMJ Qual Saf. 2011; 20(5):453-9. DOI: 10.1136/bmjqs.2010.047993. View

13.

Scheirer M, Dearing J . An agenda for research on the sustainability of public health programs. Am J Public Health. 2011; 101(11):2059-67. PMC: 3222409. DOI: 10.2105/AJPH.2011.300193. View

14.

Schell S, Luke D, Schooley M, Elliott M, Herbers S, Mueller N . Public health program capacity for sustainability: a new framework. Implement Sci. 2013; 8:15. PMC: 3599102. DOI: 10.1186/1748-5908-8-15. View

15.

Colquhoun H, Brehaut J, Sales A, Ivers N, Grimshaw J, Michie S . A systematic review of the use of theory in randomized controlled trials of audit and feedback. Implement Sci. 2013; 8:66. PMC: 3702512. DOI: 10.1186/1748-5908-8-66. View

16.

Chambers D, Glasgow R, Stange K . The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement Sci. 2013; 8:117. PMC: 3852739. DOI: 10.1186/1748-5908-8-117. View

17.

Chalmers I, Bracken M, Djulbegovic B, Garattini S, Grant J, Gulmezoglu A . How to increase value and reduce waste when research priorities are set. Lancet. 2014; 383(9912):156-65. DOI: 10.1016/S0140-6736(13)62229-1. View

18.

Luke D, Calhoun A, Robichaux C, Elliott M, Moreland-Russell S . The Program Sustainability Assessment Tool: a new instrument for public health programs. Prev Chronic Dis. 2014; 11:130184. PMC: 3900326. DOI: 10.5888/pcd11.130184. View

19.

Hooker L, Small R, Humphreys C, Hegarty K, Taft A . Applying normalization process theory to understand implementation of a family violence screening and care model in maternal and child health nursing practice: a mixed method process evaluation of a randomised controlled trial. Implement Sci. 2015; 10:39. PMC: 4379540. DOI: 10.1186/s13012-015-0230-4. View

20.

Nilsen P . Making sense of implementation theories, models and frameworks. Implement Sci. 2015; 10:53. PMC: 4406164. DOI: 10.1186/s13012-015-0242-0. View