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Cited by 398Health Policy Implementation SciencePublic Health Policies and EducationCommunity Health and Development

Evidence-based intervention sustainability strategies: a systematic review

Open access
Hailemariam, Maji, Bustos, Tatiana, Montgomery, Barrett, Barajas, Rolando, Evans, Luther B., Drahota, Amy·2019·Implementation Science
DOI 10.1186/s13012-019-0910-6PMC PMC6554955
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Abstract

BACKGROUND: Sustainability of evidence-based interventions (EBI) remains a challenge for public health community-based institutions. The conceptual definition of sustainment is not universally agreed upon by researchers and practitioners, and strategies utilized to facilitate sustainment of EBI are not consistently reported in published literature. Given these limitations in the field, a systematic review was conducted to summarize the existing evidence supporting discrete sustainment strategies for public health EBIs and facilitating and hindering factors of sustainment. METHODS: We searched PsychINFO, Embase, ProQuest, PubMed, and Google Scholar. The initial search was run in March 2017 and an update was done in March 2019. Study eligibility criteria included (a) public health evidence-based interventions, (b) conducted in the community or community-based settings, and (c) reported outcomes related to EBI sustainment. Details characterizing the study setting, design, target population, and type of EBI sustained were extracted. RESULTS: A total of 26 articles published from 2004 to 2019 were eligible for data extraction. Overall, the importance of sustainability was acknowledged across all of the studies. However, only seven studies presented a conceptual definition of sustainment explicitly within the text. Six of the included studies reported specific sustainment strategies that were used to facilitate the sustainment of EBI. Only three of the studies reported their activities related to sustainment by referencing a sustainment framework. Multiple facilitators (i.e., adaptation/alignment, funding) and barriers (i.e., limited funding, limited resources) were identified as influencing EBI sustainment. The majority (n = 20) of the studies were conducted in high-income countries. Studies from low-income countries were mostly naturalistic. All of the studies from low-income countries reported lack of funding as a hindrance to sustainment. IMPLICATION FOR DISSEMINATION AND IMPLEMENTATION RESEARCH: Literature focused on sustainment of public health EBIs should present an explicit definition of the concept. Better reporting of the framework utilized, steps followed, and adaptations made to sustain the intervention might contribute to standardizing and developing the concept. Moreover, encouraging longitudinal dissemination and implementation (D&I) research especially in low-income countries might help strengthen D&I research capacity in public health settings.

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  • The health benefits of the intervention may not last over an extended period after the intervention is terminated.

    “However, the health benefits of the intervention may not last over an extended period after the intervention is terminated, raising concerns about sustainability [63].”

    From Effectiveness of an Internet-Based Acceptance and Commitment Therapy Intervention for Reducing Psychological Distress in Health Care Professionals: Randomized Controlled Trial (2024) · cites this paper as [63]

    The Background (page unavailable) says sustaining evidence-based interventions in community settings remains a major challenge, and the Results’ conceptualization of sustainability considers benefits months after the last intervention contact. But the paper does not directly say that health benefits may fade after the intervention itself is terminated; its termination example concerns external support. (LLM, conf=0.78)

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  • Extensive implementation research suggests that even when challenges of implementing evidence-based practices with fidelity have been surmounted, it is difficult to maintain consistent use, as well as intended effects, over longer periods of time.

    “Extensive implementation research suggests that even when the challenges of implementing EBPs with fidelity have been surmounted, it is difficult to maintain consistent use, as well as intended effects, over longer periods of time (56).”

    From The Renfrew Unified Treatment for Eating Disorders and Comorbidity: Long-Term Effects of an Evidence-Based Practice Implementation in Residential Treatment (2021) · cites this paper as [56]

    The Background (Research-to-practice gap; page not provided) says many evidence-based interventions are not sustained after adoption and implementation. The Background also defines sustainability in terms of intended benefits over time and notes that some interventions need adaptation to remain effective. It does not establish the more specific claim that consistent use and intended effects are difficult to maintain even after implementation with fidelity has been achieved. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Reported influences on sustainability include characteristics of the innovation and the individuals involved, leadership, capacity, processes, and context.

    “Reported influences on sustainability include characteristics of the innovation and the individuals involved, leadership, capacity, processes, and context [2, 9, 13, 14].”

    From Factors influencing sustainability and scale-up of rural primary healthcare memory clinics: perspectives of clinic team members (2022) · cites this paper as [9]

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1 of the 66 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [37]Inc S. SPSS Base 14.0 user’s guide: Prentice Hall; 2005.

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Authors
Hailemariam, M., Bustos, T., Montgomery, B., Barajas, R., Evans, L. B., & Drahota, A.
Affiliations
Michigan State University (US)
Corresponding author
Hailemariam, Maji
ORCID
Venue
Implementation Science
Publisher
Springer Science and Business Media LLC
Published
2019-06-06
Volume
14
Issue
1
Pages
57-57
ISSN
1748-5908 (ISSN-L)
DOI
10.1186/s13012-019-0910-6
PMC
PMC6554955
OpenAlex
W2948464760
Cited by
398
References
66
Citations by year
2026: 43 · 2025: 70 · 2024: 72 · 2023: 73 · 2022: 59 · 2021: 47 · 2020: 25 · 2019: 5
FWCI
6.25
Type
journal article
Language
en
Open access
Licence
Locations
  • Implementation Science (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Institute on Minority Health and Health Disparities (U54MD011227)
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
evidence-based interventions, intervention sustainability, public health interventions, community-based intervention, barriers and facilitators, financial constraints, low-income countries, dissemination and implementation research
MeSH terms
Health Plan Implementation, Humans, Public Health, Evidence-Based Medicine

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