Abstract
BackgroundPublic 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.MethodsThis 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).ResultsThe 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.ConclusionsThe 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.
Highlights
Public health programs can only deliver benefits if they are able to sustain activities over time
Public health programs focused on areas such as tobacco control and injury prevention have been shown to deliver positive health outcomes [1,2], but it is often challenging to maintain programs over long periods of time
We propose in this paper that sustainability itself is the small set of organizational and contextual factors that build the capacity for maintaining a public health program over time
Summary
Public health programs can only deliver benefits if they are able to sustain activities over time. What keeps effective public health programs sustained over time? Financial resources may only be promised from a particular funder for a short period of time, after which the program is expected to find other sources of funding. The emergence of the new discipline of dissemination and implementation science has driven a rapid increase in studies of how new scientific discoveries are translated and developed into programs, policies, and practices [3]. Programs typically need time to reach a certain level of maturity and allow health benefits to accrue. If we as a society are to get the full benefit of the significant investment in public health research and subsequent program development, we need to better understand what factors can promote long-term program sustainability
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