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Assessing capacity for sustainability of effective programs and policies in local health departments

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Tabak, Rachel G., Duggan, Katie, Smith, Carson, Aisaka, Kristelle, Moreland-Russell, Sarah, Brownson, Ross C.·2016·Journal of Public Health Management and Practice
DOI 10.1097/phh.0000000000000254PMC PMC4635064
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Abstract

CONTEXT: Sustainability has been defined as the existence of structures and processes that allow a program to leverage resources to effectively implement and maintain evidence-based public health and is important in local health departments (LHDs) to retain the benefits of effective programs. OBJECTIVE: Explore the applicability of the Program Sustainability Framework in high- and low-capacity LHDs as defined by national performance standards. DESIGN: Case study interviews from June to July 2013. Standard qualitative methodology was used to code transcripts; codes were developed inductively and deductively. SETTING: Six geographically diverse LHD's (selected from 3 of high and 3 of low capacity) PARTICIPANTS: : 35 LHD practitioners. MAIN OUTCOME MEASURES: Thematic reports explored the 8 domains (Organizational Capacity, Program Adaptation, Program Evaluation, Communications, Strategic Planning, Funding Stability, Environmental Support, and Partnerships) of the Program Sustainability Framework. RESULTS: High-capacity LHDs described having environmental support, while low-capacity LHDs reported this was lacking. Both high- and low-capacity LHDs described limited funding; however, high-capacity LHDs reported greater funding flexibility. Partnerships were important to high- and low-capacity LHDs, and both described building partnerships to sustain programming. Regarding organizational capacity, high-capacity LHDs reported better access to and support for adequate staff and staff training when compared with low-capacity LHDs. While high-capacity LHDs described integration of program evaluation into implementation and sustainability, low-capacity LHDs reported limited capacity for measurement specifically and evaluation generally. When high-capacity LHDs described program adoption, they discussed an opportunity to adapt and evaluate. Low-capacity LHDs struggled with programs requiring adaptation. High-capacity LHDs described higher quality communication than low-capacity LHDs. High- and low-capacity LHDs described strategic planning, but high-capacity LHDs reported efforts to integrate evidence-based public health. CONCLUSIONS: Investments in leadership support for improving organizational capacity, improvements in communication from the top of the organization, integrating program evaluation into implementation, and greater funding flexibility may enhance sustainability of evidence-based public health in LHDs.

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  • Funding is often identified as the major barrier to program sustainment.

    “Funding is often identified as the major barrier to program sustainment [20, 31, 55].”

    From Using qualitative comparative analysis to uncover multiple pathways to program sustainment: implications for community-based youth substance misuse prevention (2022) · cites this paper as [31]

    The Results (Funding Stability; page unavailable) report that funding limitations impeded sustainability in the local health departments studied and that limited flexibility in using funds was seen as a major barrier, particularly in low-capacity departments. The Discussion (page unavailable) calls funding a major issue for all departments interviewed, but the paper does not establish it as the single major barrier to program sustainment generally. (LLM, conf=0.86)

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  • The PSAT has been employed in several sustainability studies, but these studies have been primarily descriptive and seldom examined predictive strength between PSAT domains and program sustainment.

    “Since its inception, the PSAT has been employed in several sustainability studies, though the studies have been primarily descriptive, seldom examining the predictive strength between the PSAT domains and program sustainment [30, 31].”

    From Using qualitative comparative analysis to uncover multiple pathways to program sustainment: implications for community-based youth substance misuse prevention (2022) · cites this paper as [31]

    The Methods (Summary Table; page unavailable) describe a thematic comparison using eight sustainability-framework domains, and the Discussion (Limitations; page unavailable) says the study could not assess actual program sustainment or cause and effect. This supports describing this study as non-predictive, but it does not establish that several studies employed the PSAT itself or that such studies were primarily descriptive. (LLM, conf=0.79)

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  • Findings are consistent with previous research using the PSAT showing higher levels of environmental support are reported by programs with greater sustainment success.

    “Our findings are consistent with previous research using the PSAT showing higher levels of environmental support are reported by programs with greater sustainment success [31, 32, 42].”

    From Using qualitative comparative analysis to uncover multiple pathways to program sustainment: implications for community-based youth substance misuse prevention (2022) · cites this paper as [31]

    The Results (Environmental Support; page unavailable) say staff at high-capacity local health departments described having environmental support, while staff at low-capacity departments said it was lacking. But the Methods (Case Study Sample Selection; page unavailable) define capacity using performance scores, not program sustainment success, and describe interviews rather than use of the PSAT instrument. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Tabak et al. found both sites with high and low sustainment capacity reporting limited funding stability.

    “This finding appears to be in line with a study by Tabak and colleagues [31] that found both sites with high and low sustainment capacity reporting limited funding stability.”

    From Using qualitative comparative analysis to uncover multiple pathways to program sustainment: implications for community-based youth substance misuse prevention (2022) · cites this paper as [31]

  • Empirical research shows organizational capacity, such as having adequate resources and staff to deliver the program, is integral to a program's success and continued delivery.

    “and that organizational capacity, such as having adequate resources and staff to deliver the program [19, 24, 31, 53] is integral to a program’s success and continued delivery.”

    From Using qualitative comparative analysis to uncover multiple pathways to program sustainment: implications for community-based youth substance misuse prevention (2022) · cites this paper as [31]

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Authors
Tabak, R. G., Duggan, K., Smith, C., Aisaka, K., Moreland-Russell, S., & Brownson, R. C.
Affiliations
Washington University in St. Louis (US)
Corresponding author
Tabak, Rachel G.
ORCID
Venue
Journal of Public Health Management and Practice
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2016-03
Volume
22
Issue
2
Pages
129-137
ISSN
1078-4659 (ISSN-L)
DOI
10.1097/phh.0000000000000254
PMC
PMC4635064
OpenAlex
W2414013503
Cited by
40
References
31
Citations by year
2025: 3 · 2024: 5 · 2023: 4 · 2022: 10 · 2021: 5 · 2020: 6 · 2019: 1 · 2018: 2 · 2017: 4
FWCI
3.65
Type
journal article
Language
en
Open access
Locations
  • Journal of Public Health Management and Practice (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR000448)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092950)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
  • Health Sciences › Health Professions › General Health Professions › Community Health and Development
Keywords
program sustainability, local health departments, organizational capacity, evidence-based public health, program adaptation, program evaluation, partnership, strategic planning, environmental support, employee training
MeSH terms
Health Policy, Humans, Local Government, Public Health, Program Evaluation, Case-Control Studies, Outcome Assessment, Health Care

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