Dimensions of sustainability for a health communication intervention in African American churches: a multi-methods study

Abstract

BackgroundSustainability of evidence-based health promotion interventions has received increased research attention in recent years. This paper reports sustainability data from Project HEAL (Health through Early Awareness and Learning) a cancer communication implementation trial about early detection, based in African American churches. In this paper, we used a framework by Scheirer and Dearing (Am J Publ Health 101:2059-2067, 2011) to evaluate multiple dimensions of sustainability from Project HEAL.MethodsWe examined the following dimensions of sustainability: (a) continued benefits for intervention recipients, (b) continuation of intervention activities, c) maintaining community partnerships, (d) changes in organizational policies or structures, (e) sustained attention to the underlying issues, (f) diffusion to additional sites, or even (g) unplanned consequences of the intervention. Project HEAL provided a three-workshop cancer educational series delivered by trained lay peer community health advisors (CHAs) in their churches. Multiple sources of sustainability were collected at 12 and 24 months after the intervention that reflect several levels of analysis: participant surveys; interviews with CHAs; records from the project’s management database; and open-ended comments from CHAs, staff, and community partners.ResultsOutcomes differ for each dimension of sustainability. For continued benefit, 39 and 37% of the initial 375 church members attended the 12- and 24-month follow-up workshops, respectively. Most participants reported sharing the information from Project HEAL with family or friends (92% at 12 months; 87% at 24 months). For continuation of intervention activities, some CHAs reported that the churches held at least one additional cancer educational workshop (33% at 12 months; 24% at 24 months), but many more CHAs reported subsequent health activities in their churches (71% at 12 months; 52% at 24 months). No church replicated the original series of three workshops. Additional data confirm the maintenance of community partnerships, some changes in church health policies, and continued attention to health issues by churches and CHAs.ConclusionsThe multiple dimensions of sustainability require different data sources and levels of analysis and show varied sustainability outcomes in this project. The findings reinforce the dynamic nature of evidence-based health interventions in community contexts.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-017-0576-x) contains supplementary material, which is available to authorized users.

The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care

“…Researchers may also want to examine any negative unintended consequences that arise. Recent research suggests that multiple aspects of sustainability may 62 Shelton · Cooper · Stirman require different data sources and levels of analysis, and sustainability outcome indicators may vary (120). Ideally, multiple sustainability outcomes should be measured (113), and researchers should work with stakeholders in determining and prioritizing indicators.…”

“…There has been a growing literature on the sustainability of interventions implemented in a wide range of public health and community settings (e.g., schools, worksites, community organizations, health departments, churches) (18,29,44,120,124,127,141). Whereas many studies have investigated stakeholder perspectives on barriers and facilitators, several studies have begun empirically testing multilevel predictors of sustainability (27, 108).…”

Web-based versus in-person methods for training lay community health advisors to implement health promotion workshops: participant outcomes from a cluster-randomized trial

“…Examination of the means over the study period suggests that knowledge about cancer continued to increase over time even though workshops occurred relatively early in the study period. It is possible that the CHAs in both groups continued discussions around cancer and conducted cancer educational activities in their churches, as suggested by sustainability activities reported in Scheirer et al [36]. In addition, 92% of participants reported talking to family or friends about the program by 12 months.…”

National Working Group on the RE-AIM Planning and Evaluation Framework: Goals, Resources, and Future Directions

“…Specifically, the framework has been used to guide the development and assessment of interventions that expand beyond simply improving effectiveness-to include an explicit focus on improving individual and organizational-level dissemination (34,35) of evidence-based approaches (i.e., reach and adoption, respectively) and improving implementation quality, costs, and likelihood of organizational sustainability (36,37). It is also possible to categorize publications by different levels on a translational research spectrum from efficacy (38), to effectiveness (39), to dissemination (35), to sustainability (40) across a variety of intervention types-program, policy, systems, and environmental changes (41)(42)(43). Indeed, the accumulation of literature demonstrating the utility of the framework matches the promise to improve planning, evaluation, and scientific advancement in health promotion of early RE-AIM articles (44)(45)(46).…”