Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy
Abstract
Attention to the sustainability of health intervention programs both in the US and abroad is increasing, but little consensus exists on the conceptual and operational definitions of sustainability. Moreover, an empirical knowledge base about the determinants of sustainability is still at an early stage. Planning for sustainability requires, first, a clear understanding of the concept of sustainability and operational indicators that may be used in monitoring sustainability over time. Important categories of indicators include: (1) maintenance of health benefits achieved through an initial program, (2) level of institutionalization of a program within an organization and (3) measures of capacity building in the recipient community. Second, planning for sustainability requires the use of programmatic approaches and strategies that favor long-term program maintenance. We suggest that the potential influences on sustainability may derive from three major groups of factors: (1) project design and implementation factors, (2) factors within the organizational setting, and (3) factors in the broader community environment. Future efforts to develop sustainable health intervention programs in communities can build on the concepts and strategies proposed here.
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Unexpected termination of CbPs leads to negative effects for targeted communities and host organizations because initiation costs are high.
“Unexpected termination of CbPs leads to negative effects for the targeted communities, since they may lose trust in similar such initiatives in the future, but also for the host organizations, since the initiation costs for a community-based program are usually high [14].”
From Community-Based Healthcare Programs Sustainability Impact on the Sustainability of Host Organizations: A Structural Equation Modeling Analysis (2019) · cites this paper as [14]
Initiatives that fail to sustain are extremely wasteful of human and monetary investments.
“Initiatives that fail to sustain are extremely wasteful of human and monetary investments [7, 8].”
From Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare (2018) · cites this paper as [8]
Large variation in practices and care can be seen across similar services when initiatives that initially demonstrate improved patient outcomes fail to maintain their gains.
“Large variation in the practices and care can be seen across similar services when initiatives which initially demonstrate improved patient outcomes fail to maintain their gains [7, 8].”
From Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare (2018) · cites this paper as [8]
Sustainability is often viewed as an outcome where health benefits, activities or workforce capacity are maintained.
“Sustainability is often viewed as an ‘outcome’ where health benefits, activities or workforce capacity are maintained [8].”
From Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare (2018) · cites this paper as [8]
The ability of an initiative to share resources with partners and other organisations, seek out alternative and supplemental resources and/or uncover multiple funding sources were highlighted across some approaches as important to overall sustainability.
“The ability of an initiative to share resources with partners and other organisations [41, 46], seek out alternative and supplemental resources [18, 47–49] and/or uncover multiple funding sources [8, 36, 49, 50] were also highlighted across some approaches as important to overall sustainability.”
From Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare (2018) · cites this paper as [8]
A selection of approaches looked at whether the initiative benefits were perceived by staff and other stakeholders as valuable.
“A selection of approaches took a wider perspective and looked at whether the initiative benefits were perceived by staff and other stakeholders as valuable [8, 30, 42, 51, 61-63].”
From Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare (2018) · cites this paper as [8]
Value is seen in both views, but depending on what theoretical perspective is taken, planning, measurement and monitoring is significantly different.
“Value is seen in both views, but depending on what theoretical perspective is taken, planning, measurement and monitoring is significantly different [8, 13, 61, 74, 75].”
From Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare (2018) · cites this paper as [8]
Among studies that provided definitions, sustainability was the most commonly used term.
“Among those studies that did provide definitions, sustainability was the most commonly used term (116, 122, 135).”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [122]
Discontinuing or abandoning programs in community settings may result in low levels of community support and trust in research and public health/medical institutions.
“Furthermore, discontinuing or abandoning programs in community settings may result in low levels of community support and trust in research and public health/medical institutions (122).”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [122]
Scholars have developed an overarching multilevel framework of recognized influences on sustainability, including intervention characteristics, organizational setting factors, and the broader context/community environment.
“In recent years, scholars have developed an overarching multilevel framework of recognized influences on sustainability (118, 122), which includes the categories of intervention characteristics, organizational setting factors, and the broader context/community environment.”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [122]
Some researchers assert that the factors that influence the initial adoption of evidence-based interventions may differ from those that influence sustainability.
“They assert that the factors that influence the initial adoption of EBIs may differ from those that influence sustainability (115, 122), and that different factors might be more influential at different time points (2).”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [122]
Having a gold standard for measuring sustainability as an outcome is challenging because of wide variability in program components and across health outcomes, settings, and behaviors.
“In measuring sustainability as an outcome, having a gold standard can be challenging, given the wide variability in the program components of individual interventions (122) as well as the variability across health outcomes, settings, and behaviors studied.”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [122]
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- Authors
- Shediac-Rizkallah, M. C., & Bone, L. R.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Bone, L. R.
- Venue
- Health Education Research
- Publisher
- Oxford University Press (OUP)
- Published
- 1998-03-01
- Volume
- 13
- Issue
- 1
- Pages
- 87-108
- ISSN
- 0268-1153 (ISSN-L)
- 1465-3648
- OpenAlex
- W2148850812
- Cited by
- 1,129
- References
- 69
- Citations by year
- 2026: 24 · 2025: 41 · 2024: 49 · 2023: 65 · 2022: 66 · 2021: 67 · 2020: 68 · 2019: 53 · 2018: 124 · 2017: 67 · 2016: 52 · 2015: 58 · 2014: 56 · 2013: 65 · 2012: 47
- FWCI
- 10.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Education Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Community Health and Development
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Keywords
- sustainability of health programs, community health programs, program planning, sustainability indicators, institutionalization, capacity building, organizational factors, community environment
- MeSH terms
- Community Health Services, Community Participation, Health Plan Implementation, Health Planning, Health Policy, Health Services Research, Humans, Organizational Innovation, United States
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