Abstract
BackgroundSustainment, an outcome indicating an intervention continues to be implemented over time, has been comparatively less studied than other phases of the implementation process. This may be because of methodological difficulties, funding cycles, and minimal attention to theories and measurement of sustainment. This review synthesizes the literature on sustainment measures, evaluates the qualities of each measure, and highlights the strengths and gaps in existing sustainment measures. Results of the review will inform recommendations for the development of a pragmatic, valid, and reliable measure of sustainment.MethodsA narrative review of published sustainment outcome and sustainability measures (i.e., factors that influence sustainment) was conducted, including appraising measures in the Society of Implementation Research Collaboration (SIRC) instrument review project (IRP) and the Dissemination and Implementation Grid-Enabled Measures database initiative (GEM-D&I). The narrative review used a snowballing strategy by searching the reference sections of literature reviews and definitions of sustainability and sustainment. Measures used frequently and judged to be comprehensive and/or validated by a team of implementation scientists were extracted for analysis.ResultsEleven measures were evaluated. Three of the included measures were found in the SIRC-IRP, three in the GEM-D&I database, (one measure was in both databases) and six were identified in our additional searches. Thirteen constructs relating to sustainment were coded from selected measures. Measures covered a range of determinants for sustainment (i.e., construct of sustainability) as well as constructs of sustainment as an outcome. Strengths of the measures included, development by expert panels knowledgeable about particular interventions, fields or contexts, and utility in specific scenarios. A number of limitations were found in the measures analyzed including inadequate assessment of psychometric characteristics, being overly intervention or context specific, being lengthy and/or complex, and focusing on outer context factors.ConclusionThere is a lack of pragmatic and psychometrically sound measures of sustainment that can be completed by implementation stakeholders within inner context settings (e.g., frontline providers, supervisors).
Highlights
Sustainment, an outcome indicating an intervention continues to be implemented over time, has been comparatively less studied than other phases of the implementation process
Eleven measures targeting or that included sustainment were identified across the Grid-Enabled Measures database initiative (GEM-dissemination and implementation (D&I)), Society of Implementation Research Collaboration (SIRC)-instrument review project (IRP), and other sources as described above
Three of the measures were found in the GEM-D&I database, three in the SIRC-IRP, and six came from other sources
Summary
Sustainment, an outcome indicating an intervention continues to be implemented over time, has been comparatively less studied than other phases of the implementation process. A common thread or goal amongst the derivations is a culminating phase wherein the intervention is “sustained” and integrated as routine practice This final phase has been included as part of the implementation process and as an implementation outcome. A multitude of other terms have been used including adhere [9], penetration [10, 11], niche saturation [11], institutionalization [12], routinization [13], normalization [14], integration [15, 16], and community ownership [17] These terms largely relate to the integration of an intervention into routine practice, their operationalization differs. The number of recipients of the intervention (similar to RE-AIM concept of reach) [18] or the providers delivering/using the intervention (similar to RE-AIM concept of adoption) [18] are used as measures of penetration
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
