This paper presents a review of the empirical literature for studies evaluating factors that facilitate and create barriers to sustained program implementation in disadvantaged communities. It outlines study methodology and sustainment outcomes and proposes a conceptual model that involves implementation sustainment support for providers delivering evidence-based health and family services in disadvantaged communities. Sustained program implementation in the community setting is a significant issue as only 43% of studies reported successfully sustained programs. The review identified 18 factors that facilitate success and create barriers to program sustainment. The factors are synthesized into three themes; program characteristics, workplace capacity, and process and interaction factors. The majority of factors map onto commonly cited sustainability influences in implementation science. However, there was an additional focus for studies included in this review on the importance of factors such as program burden, program familiarity and perceived competence in program skills, workplace support for the program, staff mobility and turnover, supervision and peer support, and ongoing technical assistance. The need to use a conceptual framework and develop measures to guide and evaluate capacity building in EBP implementation and sustainment in low-resource community settings is highlighted.

Behavioural parenting programs are an effective intervention for behavioural and emotional problems in children, however these programs have low utilisation rates by culturally diverse parents. We examined the cultural acceptability of program materials, preferences for delivery methods, and barriers to use of the Triple PPositive Parenting Program. One hundred and thirty seven parents watched a video outlining the 17 strategies in Triple P and read through a tip sheet before completing a series of questionnaires. Results revealed that parents found the strategies highly acceptable, highly useful, were very likely to use the strategies and reported currently using the strategies often. They also rated the program materials as very culturally appropriate and identified group, seminar, television, and individual as the most preferred delivery methods. Parents identified location and timing of services, financial cost, and competing work commitments as the most frequently cited barriers to accessing a parenting intervention. The findings of this study suggest that elements of parenting programs may not be contributing to the low rates of access among culturally diverse parents. These findings highlight the need for more research addressing variables that may contribute to increasing culturally diverse parents' access of behavioural parenting programs.

An evaluation measure of enablers and inhibitors to sustained evidence-based program (EBP) implementation may provide a useful tool to enhance organizations' capacity. This paper outlines preliminary validation of such a measure. An expert informant and consumer feedback approach was used to tailor constructs from two existing measures assessing key domains associated with sustained implementation. Validity and reliability were evaluated for an inventory composed of five subscales: Program benefits, Program burden, Workplace support, Workplace cohesion, and Leadership style. Exploratory and confirmatory factor analysis with a sample of 593 Triple P-Positive Parenting Program-practitioners led to a 28-item scale with good reliability and good convergent, discriminant, and predictive validity. Practitioners sustaining implementation at least 3 years post-training were more likely to have supervision/peer support, reported higher levels of program benefit, workplace support, and positive leadership style, and lower program burden compared to practitioners who were non-sustainers.

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