Abstract

BackgroundSustaining health promotion programs (HPP) is critical to maintain their intended health benefits, community capacity, and to optimize resources and investment. However, not all programs are sustained beyond their initial implementation period. This is partly due to uncertainty regarding sustainability: lack of a clear definition; infrequent use of a sustainability framework; and lack of understanding of the factors that influence sustainability. The aim of this systematic review is to identify barriers and facilitators that promote or inhibit the sustainability of HPP, particularly those that can be considered in program planning.MethodsTwo search strategies were used: 1) electronic database searching; and 2) grey literature searching. Inclusion criteria included papers published since 1998, in English, focusing on the sustainability of HPP that explicitly used a sustainability framework and specifically reported on facilitators and barriers to sustainability. Exclusion criteria included papers that addressed environmental, system or sector sustainability. Quality assessment was conducted on all included papers and a quality assessment tool was developed for grey literature. Data analysis included a thematic analysis, using an a priori framework to initially code barriers and facilitators, which were then grouped into factors for HPP sustainability. Factors were then analyzed for frequency, importance, and relevance, and categorized into one of three tiers.ResultsSixteen papers were included in this review. Eleven definitions of sustainability and 13 sustainability frameworks were used. A total of 83 barriers and 191 facilitators were identified and categorized into 14 factors: nine from the a priori framework, and five additional ones based on the results of our analysis. Tier 1 factors were the most important for sustainability with organizational capacity scoring the highest; tier 3, the least important.ConclusionThis review provides clarity regarding existing definitions of sustainability and sustainability frameworks. It identifies fourteen factors that influence program sustainability, which practitioners can consider when planning, developing and implementing HPP. In addition, it is important for practitioners to clearly articulate program elements that should be sustained, define sustainability as it relates to the context of their program, select a sustainability framework to guide their work, and consider these factors for sustainability.

Highlights

  • Sustaining health promotion programs (HPP) is critical to maintain their intended health benefits, community capacity, and to optimize resources and investment

  • This review provides health promotion and public health practitioners with an updated and practical inventory of factors that impact HPP sustainability based on a comprehensive and systematic review of published and grey literature

  • This systematic review identifies 14 factors that influence the sustainability of HPP

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Summary

Introduction

Sustaining health promotion programs (HPP) is critical to maintain their intended health benefits, community capacity, and to optimize resources and investment. Health Promotion Programs (HPP) “improve population health outcomes by reducing preventable disease, injury or death, and taking action on health inequities” [2]. The health promotion field faces a predicament: to provide quality services that reduce disease burden and improve quality of life, while under budgetary constraints. This gives rise to the necessity for HPP to be sustained, so that health benefits do not end when the program does [5,6,7]

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