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Evidence-based intervention sustainability strategies: a systematic review
Open accessAbstract
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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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
Experimental — accuracy not yet measuredIn the citing paper
“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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Metadata
- Authors
- Hailemariam, M., Bustos, T., Montgomery, B., Barajas, R., Evans, L. B., & Drahota, A.
- Affiliations
- Michigan State University (US)
- Corresponding author
- Hailemariam, Maji
- Venue
- Implementation Science
- Published
- 2019-06-06
- Volume
- 14
- Issue
- 1
- Pages
- 57-57
- ISSN
- 1748-5908 (ISSN-L)
- 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
- gold
- doi.org
- 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 › Medicine › Public Health, Environmental and Occupational Health › Public Health Policies and Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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