Is Sustainability Possible? A Review and Commentary on Empirical Studies of Program Sustainability
Abstract
An important final step in the life cycles of programs and their evaluation involves assessing new programs’ or innovations’ sustainability. This review and synthesis of 19 empirical studies of the sustainability of American and Canadian health-related programs examines the extent of sustainability achieved and summarizes factors contributing to greater sustainability. Three definitions for measuring sustainability were examined: continued program activities (18 studies), continued measured benefits or outcomes for new clients (2 studies), and maintained community capacity (6 studies). Methods of studying sustainability were also assessed. In 14 of 17 studies covering the continuation of program activities, at least 60% of sites reported sustaining at least one program component. Although these studies’ methods had substantial limitations, cross-study analysis showed consistent support for five important factors influencing the extent of sustainability: (a) A program can be modified over time, (b) a “champion” is present, (c) a program “fits” with its organization’s mission and procedures, (d) benefits to staff members and/or clients are readily perceived, and (e) stakeholders in other organizations provide support.
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Sustainability is rarely included in CbP planning, with immediate outcomes prevailing instead.
“However, sustainability is rarely included in CbP planning [15], with items like program immediate outcomes prevailing instead [16,17,18].”
From Community-Based Healthcare Programs Sustainability Impact on the Sustainability of Host Organizations: A Structural Equation Modeling Analysis (2019) · cites this paper as [18]
Many promising improvement initiatives fail to sustain and do not produce long-term benefits.
“Despite the significant investment of staff time and other resources, many promising initiatives fail to sustain and do not produce long term benefits [1–6].”
From Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare (2018) · cites this paper as [5]
A review on the continuation of programme activities found that only 60% of sites reported sustaining at least one programme component.
“Similar results were found in a review on the continuation of programme activities where only 60% of sites reported sustaining at least one programme component [5].”
From Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare (2018) · cites this paper as [5]
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 [116]
Scheirer reviewed 19 health-related programs and found that one to six years after program adoption, 40-60% of the programs reported continuing in the community to some extent.
“In one of the first articles to examine systematically the sustainability of public health programs, Scheirer reviewed 19 health-related programs and found that one to six years after program adoption, 40–60% of the programs reported continuing in the community to some extent (116).”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [116]
Several methodological issues have hampered the sustainability literature and the broader development of the field.
“Several methodological issues have hampered the sustainability literature and the broader development of the field (16, 116, 118, 135).”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [116]
Effectively engaging staff, and in our case, clients, establishes a sense of empowerment that they are a part of the change process, enhances staff motivation to participate in the change process, and leads to more actionable steps by staff to promote sustainment of the change.
“Effectively engaging staff, and in our case, clients, establishes a sense of empowerment that they are a part of the change process, enhances staff motivation to participate in the change process, and leads to more actionable steps by staff to promote sustainment of the change [40,44-48].”
From Successful Organizational Strategies to Sustain Use of A-CHESS: A Mobile Intervention for Individuals With Alcohol Use Disorders (2015) · cites this paper as [48]
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References 43 · Cited by 710
- Authors
- Scheirer, M. A.
- Affiliations
- Scheirer Consulting,
- Corresponding author
- Scheirer, Mary Ann
- Venue
- American Journal of Evaluation
- Publisher
- SAGE Publications
- Published
- 2005-09
- Volume
- 26
- Issue
- 3
- Pages
- 320-347
- ISSN
- 1098-2140 (ISSN-L)
- 1557-0878
- OpenAlex
- W2043887666
- Cited by
- 710
- References
- 43
- Citations by year
- 2026: 13 · 2025: 26 · 2024: 29 · 2023: 50 · 2022: 40 · 2021: 56 · 2020: 57 · 2019: 43 · 2018: 45 · 2017: 49 · 2016: 41 · 2015: 46 · 2014: 36 · 2013: 51 · 2012: 36
- FWCI
- 17.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Evaluation (publishedVersion)
- Topics
- Social Sciences › Decision Sciences › Management Science and Operations Research › Evaluation and Performance Assessment
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Public Administration › Public Policy and Administration Research
- Keywords
- program sustainability, program evaluation, health programs, program continuation, community capacity, software modification, champions, organizational fit, stakeholder support, program life cycle
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