Prioritizing Core Factors Needed to Sustain Hospital-Based Violence Intervention Programs: A Delphi Study

Hospital-based violence intervention programs (HVIP) are a public-health approach to violence that seek to intervene with victims in the hospital and break the cycle of violence. While there are published blueprints for launching an HVIP, limited evidence and guidance exist about how to sustain HVIPs. To fill this gap, we conducted a three-round Delphi study (June 2024-March 2025) with leaders and founders of established HVIPs to prioritize factors critical for achieving long-term program sustainability. Participants (n = 32) submitted 108 candidate factors influencing their program's sustainability in Round 1. These submissions were synthesized into 28 unique factors in Round 2 through an iterative refinement process between the research team and study participants. In Round 3, we used maximum-difference (MaxDiff) scaling with hierarchical Bayes estimation to rank the 28 factors in order of priority for achieving long-term HVIP sustainability based on their relative importance to study participants. Factors related to support for frontline violence prevention professionals represented six of the top nine factors. Funding sources (e.g., government) and funding allocation (e.g., general operating support) received moderate to above average priority. Administrative factors (e.g., hospital leadership) and factors related to community stakeholders (e.g., community champions) received lower priority, with those related to external systems and institutions (e.g., law enforcement) prioritized lowest for program sustainability. Sustainability priorities differ from those in existing blueprints for launching a program. These results indicate the likely need for programs to adapt during their implementation journey. HVIP leaders may need to recalibrate priorities over time and acquire new skills.