Cited by 823Health Policy Implementation ScienceEvaluation and Performance AssessmentPublic Health Policies and Education

The DOI matches its Crossref record; 144 of the 144 references it cites were found in a registry or an index; 11 of the 139 sources its claims cite were checked for support.

The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care

Open access

Abstract

There is strong interest in implementation science to address the gap between research and practice in public health. Research on the sustainability of evidence-based interventions has been growing rapidly. Sustainability has been defined as the continued use of program components at sufficient intensity for the sustained achievement of desirable program goals and population outcomes. This understudied area has been identified as one of the most significant translational research problems. Adding to this challenge is uncertainty regarding the extent to which intervention adaptation and evolution are necessary to address the needs of populations that differ from those in which interventions were originally tested or implemented. This review critically examines and discusses conceptual and methodological issues in studying sustainability, summarizes the multilevel factors that have been found to influence the sustainability of interventions in a range of public health and health care settings, and highlights key areas for future research.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review synthesizes conceptual, methodological, and empirical work on the sustainability of evidence-based interventions (EBIs) in public health and health care, arguing that sustainability is an understudied translational problem and an increasingly dynamic construct that permits adaptation. It proposes an Integrated Sustainability Framework of multilevel factors and lays out a research agenda for measurement, design, and sustainment strategies.

Key findings

  • Rates of sustainability are variable and variably reported: in Scheirer's review of 19 health-related programs, 40–60% reported continuing in the community to some extent one to six years after adoption; in Stirman and colleagues' systematic review of 125 empirical studies, partial sustainability was much more common than continued implementation of the entire intervention, and fewer than half of programs continued at high levels of fidelity.
  • Measurement and definitional problems are pervasive: 65% of studies in Stirman et al.'s review did not define sustainability, only 45% of the 125 studies measured continued delivery of program components among sites or providers, and only 22% reported information about health behaviors or outcomes.
  • Empirical evidence supports dynamic, multilevel influences on sustainability, categorized as outer contextual factors, inner contextual/organizational factors, processes, intervention characteristics, and implementer characteristics (presented in the Integrated Sustainability Framework and Table 1).
  • Setting-specific findings include: in a study of 110 Communities That Care sites in Pennsylvania, 90% of coalitions continued after the three-year initial funding period, with 3–8% of sites terminating each year after; in Cooper et al.'s study of 77 EBIs in a statewide youth substance-use and delinquency initiative, sustained programs more often reported stakeholder connection/communication, fit with organizational capacity, program knowledge, communication with the trainer/developer, and sustainability planning; a review of 41 studies across 26 countries in sub-Saharan Africa highlighted community engagement, community resources, and mobilization.

Methods

  • Narrative critical review (published in the Annual Review of Public Health symposium on Implementation Science and Public Health), not a primary study; it examines conceptual and methodological issues, summarizes multilevel influencing factors, and identifies future research directions.
  • Evidence base is the published sustainability literature across community, health care/social service, low- and middle-income country, and whole-systems settings, including prior systematic reviews (e.g., 125 studies; 19 programs; 41 studies across 26 countries).
  • The authors synthesize this literature into an Integrated Sustainability Framework (Figure 1) and a table of emerging factors associated with sustainability across settings (Table 1).

Limitations

  • Stated in the paper: the sustainability literature has been naturalistic, descriptive, exploratory, retrospective, and shaped by short-term funding cycles; few studies are guided by conceptual frameworks with clear operational definitions or rigorous outcome measures; follow-up periods are variable; most studies rely on self-report with few independent observations or fidelity assessments; there is no consensus on measures and psychometric properties are unreported for most; most conceptual frameworks have not been empirically tested; and there are gaps regarding which factors are most critical, how they interact, and whether importance differs by context or intervention type.
  • Stated in the paper: the underlying evidence base for EBIs often prioritizes internal over external validity, is drawn from well-resourced settings and unrepresentative populations, and reports short-term effectiveness metrics.
  • Evident from the text: as a narrative review rather than a systematic review with a stated search strategy, the synthesis is selective and does not report formal quality appraisal or quantitative pooling of the cited studies.

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Integrity signals

Registry

Crossref · 10.1146/annurev-publhealth-040617-014731

Cites

144 of 144 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

73 Not checked yet · 16 Own interpretation · 12 No basis given · 6 Partly supported · 1 Supported · accuracy not yet measured

Verify all 128 references — free account

Show all 43 claims

  • Probably not a substantial claim. 50
  • It may state two separate claims as one. 35
  • The quote only partly states this claim. 1
65 of 65
  • The paper relies on this without support.

    Medical interventions are highly standardized and may require closer adherence to protocols.

    “which are highly standardized and may require closer adherence to protocols.”
  • The paper relies on this without support.

    Public health programs evolve over time in response to changes in and input from the community, the maturation of program staff, and increased skills and refinement in delivery.

    “as public health programs evolve over time in response to changes in (and input from) the community, the maturation of program staff, and increased skills and refinement in delivery”
  • The paper relies on this without support.

    Some intervention elements may be necessary for some populations but not others.

    “For example, some elements may be necessary for some populations but not others.”
  • The paper relies on this without support.

    Homogenous implementation is difficult across systems.

    “given that homogenous implementation is difficult across systems.”
4 of 4

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Citations

Cites

Show all 144 references

Research works printed but not linked: 4

  1. 55. Green LW, Kreuter MW. 2005. Health Program Planning: An Educational and Ecological Approach . New York: McGraw-Hill Co.
  2. 85. Minkler M, Wallerstein N. 2011. Community-Based Participatory Research for Health: From Process to Outcomes . New York: Wiley
  3. Moore JE, 2016, Healthc. Policy, 11, 27
  4. Stirman SW, Optimizing the Cancer Control Continuum: Advancing Implementation Research, 2018

Cited by

Sorted by citations

Items 401–500 of 823

Metadata

Authors
Shelton, R. C., Cooper, B. R., & Stirman, S. W.
Affiliations
  • Columbia University (US)
  • Washington State University (US)
  • National Center for Post Traumatic Stress Disorder (US)
Venue
Annual Review of Public Health
Published
2018-04-01
Volume
39
Issue
1
Pages
55-76
ISSN
  • 0163-7525 (ISSN-L)
  • 1545-2093
OpenAlex
W2783052600
Cited by
806
References
144
Citations by year
2026: 89 · 2025: 124 · 2024: 130 · 2023: 115 · 2022: 118 · 2021: 107 · 2020: 83 · 2019: 30 · 2018: 9
FWCI
10.40
Type
journal article
Language
en
Open access
Locations
  • Annual Review of Public Health (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
National Institutes of Health
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Public Administration › Evaluation and Performance Assessment
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Public Health Policies and Education
Keywords
intervention sustainability, evidence-based interventions, implementation science, research-practice gap, translational research, intervention adaptation, multilevel factors, public health programs, health interventions
MeSH terms
Implementation Science, Humans, Public Health, Research, Public Health Practice, Evidence-Based Practice, Capacity Building

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