How is the sustainability of chronic disease health programmes empirically measured in hospital and related healthcare services?—a scoping review
Open accessAbstract
Objectives: Programmes to address chronic disease are a focus of governments worldwide. Despite growth in ‘implementation science’, there is a paucity of knowledge regarding the best means to measure sustainability. The aim of this review was to summarise current practice for measuring sustainability outcomes of chronic disease health programmes, providing guidance for programme planners and future directions for the academic field. Settings: A scoping review of the literature spanning 1985–2015 was conducted using MEDLINE, CINAHL, PsychINFO and The Cochrane Library limited to English language and adults. Main search terms included chronic disease, acute care, sustainability, institutionalisation and health planning. A descriptive synthesis was required. Settings included primary care, hospitals, mental health centres and community health. Participants: Programmes included preventing or managing chronic conditions including diabetes, heart disease, depression, respiratory disease, cancer, obesity, dental hygiene and multiple chronic diseases. Primary and secondary outcome measures: Outcome measures included clarifying a sustainability definition, types of methodologies used, timelines for assessment, criteria levels to determine outcomes and how methodology varies between intervention types. Results: Among 153 abstracts retrieved, 87 were retained for full article review and 42 included in the qualitative synthesis. Five definitions for sustainability outcome were identified with ‘maintenance of programme activities’ most frequent. Achieving sustainability was dependent on inter-relationships between various organisational and social contexts supporting a broad scale approach to evaluation. An increasing trend in use of mixed methods designs over multiple time points to determine sustainability outcomes was found. Conclusions: Despite the importance and investment in chronic disease programmes, few studies are undertaken to measure sustainability. Methods to evaluate sustainability are diverse with some emerging patterns in measurement found. Use of mixed methods approaches over multiple time points may serve to better guide measurement of sustainability. Consensus on aspects of standardised measurement would promote the future possibility of meta-analytic syntheses.
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There was a clear dependence on the measure of maintenance of programme activities, which has been previously observed in the literature.
“Although multiple definitions were found (continuation of the health benefits from an initiative, capacity built in the workforce or community, further development or adaptation and the ability to recover costs), there was a clear dependence on this one measure which has been previously observed in the literature [76].”
From Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare (2018) · cites this paper as [76]
Relying solely on measuring continuation of programme activities may risk other key sustainability variables being missed.
“It is important to note that while measuring continuation of programme activities is important to assessing sustainability, relying solely on this measure may risk other key sustainability variables being missed [18, 76].”
From Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare (2018) · cites this paper as [76]
Until recently, the field lacked a common set of definitions, research questions, measures, and conceptual frameworks.
“Most notably, until recently, the field has lacked a common set of definitions, research questions, measures, and conceptual frameworks (39, 42, 118).”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [42]
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The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care
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- Authors
- Francis, L., Dunt, D., & Cadilhac, D. A.
- Affiliations
- The University of Melbourne (AU)
- Florey Institute of Neuroscience and Mental Health (AU)
- Corresponding author
- Francis, Linda
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2016-05
- Volume
- 6
- Issue
- 5
- Pages
- e010944
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC4893855
- OpenAlex
- W2408892160
- Cited by
- 24
- References
- 71
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 5 · 2017: 4
- FWCI
- 0.64
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc)
- Monash University Research Portal (Monash University) (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Medical Research Council
- National Health and Medical Research Council (1001216, 1063761)
- National Medical Research Council
- Health and Medical Research Fund
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Decision Sciences › Management Science and Operations Research › Evaluation and Performance Assessment
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- sustainability measurement, health program evaluation, implementation science, mixed methods evaluation, outcome measures
- MeSH terms
- Chronic Disease, Health Education, Health Promotion, Hospitals, Humans, Terminology as Topic, Organizational Affiliation, Program Evaluation, Outcome Assessment, Health Care
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