Sustainable Change Research Articles

To CRT (in your Dissertation) or not CRT? That is the Question!

Recently the notion of Critical Race Theory (CRT) has come under fire by those with a limited knowledge of the theoretical underpinnings surrounding the intersection of education, law, and race in American society. To support those students eager to incorporate CRT as a framework within their research, the authors analyzed the dissertations of students receiving Education Doctorates (EdD). The researchers set out to determine how EdD students used CRT, how they framed problems of practice (POP), how they operationalized CRT, and to understand how those former students interrogated their findings in the pursuit of truth. The authors intend for this work to expand the knowledge base on CRT and inform scholarly practitioners on how to operationalize CRT to create sustainable change in the American education system.

Young adult Latino testicular cancer survivors: a pilot study of Goal-focused Emotion regulation Therapy (GET)

PurposeYoung adult Latino testicular cancer survivors experience adverse impacts after treatment. We developed Goal-focused Emotion regulation Therapy (GET) to improve distress symptoms, goal navigation skills, and emotion regulation. This open pilot trial extended GET to Latino young adult survivors of testicular cancer and assessed feasibility and tolerability as well as changes in anxiety and depressive symptoms. Secondary outcomes included goal navigation, emotion regulation, and components of hope-related goal processes (i.e., agency and pathway mapping). To assess the extent to which GET is culturally congruent or in need of adaptation, the influence of simpatía and acculturative stress were also examined.MethodsThirty-five eligible young adult (age 18–39) survivors treated with chemotherapy were enrolled and assessed at baseline. Study acceptability, tolerability, and therapeutic alliance were examined. Preliminary efficacy was evaluated for changes in anxiety and depressive symptoms as well as psychological processes (goal navigation, agency, goal pathway skill, and emotion regulation) from baseline to immediate post- and 3-month post-intervention.ResultsAmong the 35 men assessed at baseline, 54% initiated intervention sessions. Among these, 94.7% completed all study procedures. Helpfulness ratings of intervention components and therapeutic alliance scores were strong. Repeated measures ANOVA revealed significant reductions in anxiety and depressive symptoms from pre- to post-intervention with sustained change at the 3-month follow-up. Favorable patterns of change were also observed in GET-related psychological processes. Simpatía was associated with less depressive symptoms at post-intervention, but not change in anxiety. Acculturative stress was associated with increased anxiety and depressive symptoms over time.ConclusionGET is a feasible and acceptable intervention for reducing adverse outcomes after testicular cancer for young adult Latino men. Results should be considered preliminary but suggest meaningful changes in emotional and psychological outcomes.

Intra-articular knee injections in patients with primary osteoarthritis in a tertiary clinical setting: a best practice implementation project.

This project aimed to improve physicians' adherence to evidence-based practices regarding the selection and administration of intra-articular knee injections for patients with osteoarthritis. The project also aimed to empower patients by increasing their awareness of these evidence-based practices. In the management of knee osteoarthritis, intra-articular injections are commonly used when initial treatments prove inadequate. However, issues such as patients' demand for rapid relief and variability in physicians' familiarity with optimal practices often lead to suboptimal treatment decisions and potential adverse outcomes. This project followed the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit process. Initially, physicians were surveyed on the topic under consideration, and hospital records were reviewed. Subsequently, targeted interventions were implemented, including briefings and the distribution of informative flyers. The baseline audit indicated low adherence with all audit criteria. Various parameters, such as adherence to best clinical practices, informed decision-making by patients, and the recommendation of alternative treatment modalities, were significantly lacking. Following the interventions, substantial improvements were observed, including higher rates of adherence to best clinical practices by physicians for multiple criteria, such as stepwise referral to conservative therapy options and the content of intra-articular injections. Adherence to best clinical practices can be improved through educational briefings for physicians on the most current evidence-based treatment practices for injectable substances in knee osteoarthritis. The active engagement of patients, facilitated by informative flyers and physician assistance, contributed to better involvement in their treatment choices. However, the participation of health care institutions and providers as well as lifelong education practices may be necessary for more comprehensive and sustainable changes. http://links.lww.com/IJEBH/A277.

Building an Inclusive Work Environment: Challenges and Opportunities in HR Management

An inclusive work environment is crucial in enhancing the workforce well-being and organizational performance. The research in this paper conducted by the researcher is a critical analysis of some kind of challenges and solutions for management facing towards an inclusive work environment completely implemented I out there. The effectiveness of various policies and strategic steps in achieving inclusivity is assessed from a human resource management perspective by the researcher. The author reviews in Ms the different paths designed from an analysis of scientific approaches implemented in various sectors and institutions, details how legal regulations made these programs more challenging to include. The results of this study suggest that significant institutional biases are omnipresent, there remains a paucity of conceptual understanding and minimal adequate training in HR but also indicates opportunities to overcome these barriers. These findings suggest that some organizational policies may be inadvertently breeding subtle forms of discrimination while keeping in place continuining biases, which are harmful for particular groups as our societies converge toward artificial intelligence-led recruitment. Therefore, the method should not be one-size-fits-all there are different strategic approaches which can help create sustainable and lasting changes in building a truly inclusive work environment.

A 6-month Randomised Controlled Trial to Compare the Effectiveness of Telenutrition Versus Telenutrition Supported by Telemonitoring and Health Coaching in a Weight Loss Program: A Study Protocol.

One of the main challenges in weight loss programs is compliance with diet and achievement of sustainable changes in eating habits and lifestyles. Most clients desire to lose weight quickly, rather than looking at long-term changes. The literature suggests applying telenutrition, owing to its convenience and easy access in combination with both telemonitoring and health coaching, where confounding factors in the diet are tackled. A 6-month randomised controlled trial will be conducted to compare the effectiveness of Telenutrition Versus Telenutrition supported by weekly telemonitoring and monthly health coaching in a weight loss program. Participants are obese and overweight adults of both sex groups, aged 20-50 years who will be randomized to join a control or an intervention group. A total of three visits will be scheduled for all participants: at baseline, after three months, and after six months. This study aims to answer the question of whether participants following a weight loss program supported by telemonitoring and health coaching will increase their weight loss and compliance to the diet in comparison with the control group. This will be the first trial to assess the impact of integrating telemonitoring and health coaching in weight loss programs, including the evaluation of associated confounding factors such as general nutrition education, eating behaviour, Sensory modalities and hunger, and stress. This trial will support dietary weight loss programs, contribute to the emerging field of telenutrition, and provide advice for clinical dietitians and health coaches to work together to help individuals lose and maintain weight.

Accounting for change: the impact and implications of using the intervention-based research method GenderLAB at a big four accounting firm

PurposeThis article shows how qualitative interventions can engender both an immediate impact and the possibility of sustained change at the research site. We investigate this by assessing the impact generated from a research project that utilized the GenderLAB method. In doing so, we expand the notion of impact to include the changes that intervention-based research can initiate at a research site.Design/methodology/approachWe illustrate the impact of qualitative intervention-based research by exploring GenderLAB, which is a diversity and inclusion (D&I) intervention method that combines norm-critical approaches with design thinking to change norms and attitudes and to produce hands-on local solutions.FindingsThe GenderLAB intervention had immediate, medium-term and long-term impact in different participating organizations. As the intervention was aimed at participants’ attitudes and norms, the local impact it created resists numerical measurements. Nevertheless, we note how the organization’s leaders recreated exercises with their own staff and utilized ideas generated during the intervention to, for example, foster more inclusive working conditions for working parents, accommodate a broader spectrum of religious groups and cater to a larger variety of dietary needs. While we are currently in the process of publishing our theoretical findings from the research project to create research impact, the intervention itself has already had – and continues to have – practical impact on the D&I practices of the organizations in which we applied this methodology.Originality/valueThe intervention-based research method that we report on distinguishes itself from traditional qualitative methods, as it is designed to impact the research site as much as possible while gathering data. In contrast to quantitative approaches to interventions, it does not aim to generate quantifiable impact. Instead, we show how this research method pushes our definition of impact from a researcher-centered perspective to a perspective that emphasizes sustained change at the research site. Thus, we contribute to the growing literature on participatory methods, particularly the streams arguing for non-extractive methods that not only aim to take data but also to give knowledge to research sites.

Health coaching: the node of health literacy & health promotion

Abstract Introduction To achieve sustainable health behaviors and outcomes to move from a precarious health situation to good health, people need to be supported in health literacy in behavior change that ensure interventions’ success. As a non-clinical approach, health coaching aims to increase a person’s levels of self-efficacy, confidence and resilience, by promoting the sense of coherence. This communication aims to identify the benefits that health coaching as a salutogenic approach can trigger. Methods The work is structured in a narrative review of literature and the lived experience of the authors in health coaching. Results The published research on health coaching and the systematic professional experience of the authors highlight: (1) the anchoring of health coaching in the salutogenic model and in the person-centered approach focused on individual characteristics and needs in driving healthy behaviors; (2) health coaching as a collaborative relationship with chronically ill people and people at risk of developing illness; (3) the role of health coaching as a sense of coherence (SOC) promoter; (4) health coaching as a new profession in the healthcare ecosystem (e.g. NHS, UK), cooperating with multidisciplinary teams. Discussion From A.Antonovsky’s model approach to health, the SOC stands out and constitutes one of the basic theories in health coaching interventions, by strengthening the person’s capabilities of comprehensibility, manageability, and meaningfulness. As an emerging profession, with ethical and a growing research foundation, it is facilitated by trained professionals in managing and monitoring health behavior change. Conclusions Health coaching aims to bring relevance, meaning and strategy to a person’s behavioral change. Health coaching demonstrates positive effects on several health parameters by supporting the implementation of health literacy development and empowering people to trigger sustainable changes that lead to healthier lifestyles.

Equity and diversity maturity matrix for structured diversity inclusion in the EU JACARDI project

Abstract Issue There is increasing awareness on the importance of integration of cultural and ethnic diversity perspectives to reduce prevailing health inequities effectively and sustainably. There is, however, limited experience and practical tools for systematic integration of these perspectives in public health. Description of the problem The EU Joint Action for Cardiovascular Diseases and Diabetes (JACARDI) project, conducted 11/2023-10/2027 has developed a structured and systematic approach for integrating equity and diversity perspectives in all its 142 pilots across 21 European countries. Results Equity and diversity perspectives are embedded in the harmonized stepwise methodology for pilots, supported with a practical Equity and diversity maturity matrix. The maturity matrix is based on the JACARDI 4Cs Equity and diversity explanatory framework (Critical reflection; Context and data; Co-design; inclusive and accessible Communications). The content of the matrix is divided into concrete steps related to pilot’s planning and implementation, each with three levels of maturity that aim at gauging how equity and diversity perspectives are applied in practice: Approaching, Meeting, Exceeding. Pilots are encouraged to strive for any of these three levels, considering their available resources and previous experiences in diversity inclusion. Lessons Effective and sustainable change toward more equitable and diversity inclusive practice requires seamless integration of these perspectives in other routine activities. Training and continued practical and motivational support are key for adherence to novel approaches. In addition to being a practical tool, the Equity and diversity matrix acts as a structured self-evaluation tool to monitor how equity and diversity principles are translated into practice.

Effectiveness of the educational training program for Japanese chief residents: A one‐year pilot study

AbstractBackgroundMulti‐institutional faculty development programs for chief residents were lacking in Japan. This study evaluated the effectiveness of the program for enhancing the knowledge and behaviors of chief residents at the national level.MethodsSix participants completed self‐assessment questionnaires at three points: before, immediately after, and 6 months post‐program. Knowledge and behavior changes were compared using the Mann–Whitney U test.ResultsSignificant improvements in knowledge were observed and maintained at 6 months. However, behavioral changes were limited, with significant improvements only in counseling skills.ConclusionThe program effectively increased knowledge but faced challenges in translating it into sustained behavioral change.

Establishment of Healthy Tolam Community (KOTOS): Community Empowerment Strategy in Improving Environmental Health Quality in Kuala Tolam Village

The establishment of Komunitas Tolam Sehat (KOTOS) in Kuala Tolam Village is a community empowerment initiative that aims to improve health and environmental quality through a participatory approach. This article explores the process of community formation, the strategies used in community empowerment, as well as its impact on the health and environment of the village. Through a participatory approach, the community successfully engaged various elements of the community, including the village government, community leaders, and local residents, in designing and implementing health and environmental programs. The results show that this approach not only increases community awareness about the importance of health and environmental hygiene, but also strengthens social solidarity and community capacity to manage health issues independently and sustainably. This article highlights the importance of community empowerment in creating sustainable positive change at the local level.

Physical activity promotion in Aged care: a participatory approach

Abstract Introduction Aged care facilities (ACF) constitute an increasingly important, yet challenging setting for health promotion - given it is a highly sedentary pseudo-total institution characterized by structured daily routines within a paradigm of care for residents perceived as fragile and vulnerable. A participatory approach with residents, significant others, staff, and management might be a promising pathway to address intrapersonal, sociocultural, organizational, environmental, and political determinants of physical activity in this specific context. We will present processes and results from a research project, funded by the German Ministry of Health (2019-2023), on physical activity promotion in ACFs. Methods Our co-creation approach involved residents, significant others, staff, and management from seven nursing homes in Southern Germany. Methods included 800hrs on-site observations, semi-structured interviews (n = 31), Photovoice (n = 27 participants, n = 169 photos), as well as future workshops (n = 14) for intervention co-development (n = 14) and co-evaluation workshops (n = 7). Data analysis used reflexive thematic analysis with MaxQDA20. Results Implemented interventions (n = 57) addressed individual, social, environmental, and organizational factors. Activity promotion was integrated into care concepts and mission statements, staff work descriptions, as well as informal internal routines. Of the interventions implemented, 33% were rated as more successful, 43% as successful, and 19% as less successful than anticipated. Conclusions Participation can initiate structural and cultural change towards physical activity. However, the analyses also emphasized the critical role of staff training, along with the involvement of significant others and external service providers, as essential components for achieving sustainable change. Key messages • Participatory approaches integrate physical activity into aged care, fostering cultural shifts for resident well-being. • Success requires staff training, engaging residents’ support networks, balancing empowerment with protection.

Understanding barriers and facilitators to lifestyle management in people with polycystic ovary syndrome: A mixed method systematic review.

Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting 10-13% of reproductive-aged women. Lifestyle management through diet and physical activity changes can improve reproductive, metabolic, and psychological comorbidities. The aim of this systematic review is to understand the barriers and facilitators to lifestyle changes from the perspective of people with PCOS and health care professionals (HCP) using the theoretical domains framework and capability, opportunity, motivation, and behavior model. Six databases were systematically searched for qualitative, quantitative, and mixed-methods studies to 22nd September 2022. Quantitative outcomes from quantitative and mixed-methods studies were narratively synthesized and all studies were thematically analyzed. Sixty-eight papers met the eligibility criteria. HCP education on lifestyle management in PCOS was viewed by all to be inadequate, impacting the quality of care and health outcomes. Lifestyle advice delivered by a multidisciplinary team, including dietitians, was identified as a key component for change. All agreed that there was a need for individualized and PCOS-specific lifestyle advice. Weight stigma was identified as negatively impacting both those in larger and smaller bodies with PCOS, reducing the quality of care and affecting self-perception and mental health. People with PCOS perceived that lifestyle management was overly focused on weight loss and fertility, independent of their own personal motivations and goals. Systemic changes, including increasing HCP education on lifestyle management and multidisciplinary collaboration, focusing on lifestyle advice that meets individual needs, and reducing the use of weight-centric care are necessary for long-term sustainable changes and improvements in health outcomes in people with PCOS.

Chronic interferon-stimulated gene transcription promotes oncogene-induced breast cancer.

The MRE11 complex (comprising MRE11, RAD50, and NBS1) is integral to the maintenance of genome stability. We previously showed that a hypomorphic Mre11 mutant mouse strain (Mre11 ATLD1/ATLD1 ) was highly susceptible to oncogene-induced breast cancer. Here we used a mammary organoid system to examine which MRE11-dependent responses are tumor-suppressive. We found that Mre11 ATLD1/ATLD1 organoids exhibited an elevated interferon-stimulated gene (ISG) signature and sustained changes in chromatin accessibility. This Mre11 ATLD1/ATLD1 phenotype depended on DNA binding of a nuclear innate immune sensor, IFI205. Ablation of Ifi205 in Mre11 ATLD1/ATLD1 organoids restored baseline and oncogene-induced chromatin accessibility patterns to those observed in WT. Implantation of Mre11 ATLD1/ATLD1 organoids and activation of the oncogene led to aggressive metastatic breast cancer. This outcome was reversed in implanted Ifi205 -/- Mre11 ATLD1/ATLD1 organoids. These data reveal a connection between innate immune signaling and tumor development in the mammary epithelium. Given the abundance of aberrant DNA structures that arise in the context of genome instability syndromes, the data further suggest that cancer predisposition in those contexts may be partially attributable to chronic innate immune transcriptional programs.

Lessons Learned from Offering Video Visits as an Alternative to Phone Visits: A Case Study from a Safety-Net Obstetrics Clinics.

Before the Covid-19 pandemic, human-centered design work in San Francisco found video visits promising for Medicaid-insured pregnant individuals. They were deemed likely better than phone at addressing concerns about remoteness. We describe our experience with introducing video visits within a safety net clinic that had rapidly adopted phone visits as the standard telemedicine option early in the pandemic. By utilizing Kotter's change framework, providing an equity-focused vision, and supporting the implementation with a skilled, on-the-ground project manager, temporary uptake of offering video visits was achieved. However, competing priorities, staffing structure, and institutional culture were barriers to creating sustained change once grant funding ended, even after improvement of digital infrastructure. Efforts to increase video visit uptake in systems where telephone visits are the norm-as is in many safety net systems-may have limited success without leadership-driven prioritization and culture change at all levels.

Exploring the influence of green growth and energy sources on “carbon-dioxide emissions”: implications for climate change mitigation

Climate change is a global concern driven by greenhouse gas emissions. Bangladesh, being densely populated and a significant carbon emitter, must urgently reduce its “carbon-dioxide emissions”. The primary objectives of this research are to meticulously examine the impact of green growth, non-renewable energy, renewable energy, and technological innovations on carbon dioxide emissions in Bangladesh from 1990 to 2020, with the goal of informing policies for effective and sustainable climate change mitigation in Bangladesh. The analysis using advanced econometric methods, including autoregressive distributed lag, fully modified ordinary least squares, and canonical cointegration regression, reveals that green growth and technological innovations have adverse long-term but positive short-term effects on carbon emissions in Bangladesh. Additionally, it is noteworthy that both non-renewable and renewable energy sources significantly contribute to long-term and short-term carbon emissions. The study confirms the Environmental Kuznets Curve, showing a “∩” shaped relationship between green development and carbon emissions. Policymakers should prioritize green growth, incentivize technological innovation, promote sustainable economic practices, and implement comprehensive energy transition strategies. The insights from this study inform policy formulation to address the complex relationships between green growth, energy sources, and carbon-dioxide emissions for sustainable climate change mitigation in Bangladesh. Bangladesh’s efforts contribute to global emission reduction and foster a resilient future.

Application of Interactive Learning Methods and Character Strengthening in Aisyiyah Penatarsewu Kindergarten

This research aims to explore the role of Real Work Lecture (KKN) students in supporting learning activities at the Aisyiyah Kindergarten in Penatarsewu Village and their contribution in increasing awareness of children's dental health. Using a qualitative descriptive approach, this research assesses the impact of KKN on educational learning, social and cultural introduction, and children's health. The research results show that KKN students have succeeded in applying creative and innovative methods, introducing local social and cultural values, and increasing children's understanding of dental health, including the importance of limiting consumption of sweet foods. The involvement of KKN students makes a significant contribution to improving the quality of education, social knowledge, culture and children's health. This program shows the potential for synergy between higher education and local communities in creating sustainable positive change.

Operationalization of ESG-Integrated Strategy Through the Balanced Scorecard in FMCG Companies

The increasing focus on sustainability and climate change mitigation necessitates that corporate strategies not only build competitive advantage but also contribute to the creation of sustainable operations. The purpose of the article is to present, based on the analyses of the development of the strategic targets of leading Fast-Moving Consumer Goods (FMCG) companies, a method for operationalizing an ESG-adapted corporate strategy within FMCG companies using the Balanced Scorecard (BSC). ESG, encompassing environmental, social, and governance factors, requires a shift in both strategic management theory and practice. The author explores how ESG metrics can be integrated into the traditional BSC framework alongside financial, customer, and business processes and learning and growth perspectives to align with the growing importance of sustainability. The study identifies specific measures that contribute to a successful transition toward sustainable business practices. The findings demonstrate that the BSC, when adapted to incorporate ESG considerations, is an effective tool for strategy implementation and operational management in FMCG companies. While the proposed framework focuses on the FMCG sector, it has potential applications across other industries. The article makes important theoretical contributions, though it would benefit from further empirical research, sector-specific comparisons, and a more detailed examination of external ESG factors that impact corporate strategy.

Eye of the Beholder: Prevalence of Binge Eating Disorder among Youth in Urban Coastal Karnataka, India

Abstract Introduction: Eating disorders (EDs) are on the rise and can result in medical and psychiatric morbidities in children, adolescents as well as during adulthood. It is crucial to understand the disease burden for its early diagnosis, intervention, and prevention. Our study was thus conducted over 5 months to estimate the prevalence of binge ED (BED) among adolescents and young adults in Mangalore, Karnataka. Materials and Methods: A total of 300 participants between the ages of 15 and 24 years were administered the Questionnaire on Eating and Weight Patterns - 5. Responses were categorized into “possible diagnosis of BED” and “possible diagnosis of bulimia nervosa (BN).” Results: The mean age of the participants was 19.4 ± 3.1 years and their mean body mass index was 22.7 ± 3.9 kg/m2. Among 300 participants, 15 (5.0%) had a possible diagnosis of BN, while 4 (1.3%) had a probable diagnosis of BED, both were found to be more among females than males. Sixty participants reported having loss of control over their food intake, of which only 26 (43.3%) reported being upset about it. However, on multivariate logistic regression, none of the sociodemographic factors were found to be significant in our study. Conclusion: It is essential to encourage healthy eating habits and physical activity at an early age along with the inclusion of screening for EDs in school health programs. Raising awareness among parents and children is crucial in bringing about sustained behavior change.

Unlocking innovation and sustainability: lessons from Dubai Expo 2020 for business transformation

Research methodology The data used in the case are collected through both primary and secondary sources. The interview method was used to collect data on the experience of the protagonist on visiting the expo and details about the Expo was collected using secondary sources. Case overview/synopsis The case study examines the success factors of initiatives implemented by the Dubai Expo 2020 team, with a focus on sustainable transportation, energy efficiency, people-centric spaces, biodiversity preservation, water efficiency, waste management, green building and communication. Even though not all objectives were met, the overall progress demonstrates a strong commitment to sustainability and positive effects on environmental, social and economic aspects. In addition, the case study demonstrates how businesses can incorporate social and environmental factors into their decision-making processes, supply chain management and responsible procurement practices. It highlights the significance of sustainability in business operations, stakeholder collaboration and continuous improvement. In addition, the case study provides innovative business models and practices that promote circular economy principles, waste reduction, resource efficiency and inclusivity. This case provides business students with valuable insights into successful sustainability initiatives and strategies for creating a more inclusive and equitable economy. Complexity academic level This case study is appropriate for intermediate undergraduate students in their third year or postgraduate students in their first year, particularly those enrolled in courses on sustainability, operations management, strategic management, supply chain management and corporate social responsibility. The case study is designed to enhance cognitive skills by analyzing and evaluating real-world examples of successful initiatives in sustainability, energy efficiency, people-centric spaces, biodiversity preservation, water efficiency, waste management, green building and open communication. It also aims to develop affective skills by fostering a commitment to sustainable practices and psychomotor skills through practical applications and projects. By analyzing these initiatives, students can comprehend how businesses can integrate social and environmental factors into their decision-making processes, supply chain management and responsible procurement practices to create a more inclusive and equitable economy. In addition, the case study introduces innovative business models and practices that promote circular economy principles, waste reduction and resource efficiency while fostering economic inclusion and equity. Overall, the case study equips students with the knowledge and motivation necessary to drive sustainable change within organizations and contribute to a more sustainable and equitable future.

Is community-led total sanitation programme ending open defecation? A sustainability perspective from stakeholders in Ghana

Community-led total sanitation (CLTS) is an intervention widely employed by developing countries to end open defecation (OD) in line with SDG Target 6.2. Following its adoption in Ghana, many communities have been declared open defecation-free (ODF), but little is known about their sustainability. This study sought to determine the sustainability of the ODF status of communities after 2 to 10 years of certification across eight regions in Ghana. Qualitative data were collected using semi-structured interviews with 26 practitioners and implementers, focus group discussions and direct observations in 22 communities. The data were manually transcribed and thematically analysed. The results revealed four major sustainability factors: motivational, behavioural change, leadership and financial. While motivational factors included improved health, pride, comfort and convenience, leadership factors involved supportive traditional and active natural leaders, and behavioural change entailed understanding the consequences of OD and latrine rebuilding. Financial factors encompassed access to sanitation funds. Regional and district league tables were found to be influencing the sustainability factors of the programme. Based on the findings, policymakers and implementers of the CLTS programme should intensify persuasive education focusing on sustainable behavioural change towards OD and post-ODF follow-ups alongside league tables to motivate sustained ODF communities while providing a friendly loan schedule for communities willing to pay.