Evidence-based intervention sustainability strategies: a systematic review

Area of Science:

• Public Health
• Implementation Science
• Health Services Research

Background:

• Sustainability of evidence-based interventions (EBIs) is a critical challenge for community-based public health institutions.
• Lack of a universal conceptual definition for sustainment and inconsistent reporting of strategies hinder progress in the field.
• Existing literature often fails to detail the specific methods used to ensure the long-term viability of public health programs.

Purpose of the Study:

• To systematically review and summarize evidence on discrete sustainment strategies for public health EBIs.
• To identify facilitating and hindering factors impacting the sustainment of EBIs in community settings.
• To address the limitations in conceptual clarity and reporting practices within the field of intervention sustainment.

Main Methods:

• Conducted a systematic literature search across multiple databases (PsychINFO, Embase, ProQuest, PubMed, Google Scholar) from March 2017 to March 2019.
• Included studies focused on public health EBIs implemented in community or community-based settings that reported sustainment outcomes.
• Extracted data on study settings, design, target population, EBI type, and sustainment-related details.

Main Results:

• Analyzed 26 articles published between 2004 and 2019, noting the universal acknowledgment of sustainability's importance.
• Observed limited explicit conceptual definitions of sustainment (7 studies) and inconsistent reporting of specific sustainment strategies (6 studies) or frameworks (3 studies).
• Identified key facilitators (e.g., adaptation, funding) and barriers (e.g., limited funding, resources), with funding being a significant hindrance in low-income countries.

Conclusions:

• Future literature on public health EBI sustainment should explicitly define the concept and clearly report utilized frameworks, steps, and adaptations.
• Standardizing reporting practices can contribute to the conceptual development of intervention sustainment.
• Promoting longitudinal dissemination and implementation research, particularly in low-income countries, is crucial for strengthening research capacity.