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Sustainment - Detailed Guidance

Why Is This Important?

Sustainment decisions are ultimately based on whether an intervention continues to provide value. The priorities that matter during implementation may change once an intervention becomes part of routine practice. Leaders may focus on efficiency and resource use, while staff, patients, and community partners may prioritize usability, access, or outcomes. Revisiting what stakeholders value most helps define what successful sustainment should look like in the future.

Action Steps

Ask stakeholders what success looks like now. Explore whether priorities have changed since implementation began.

Identify the outcomes that matter most. Focus on the measures and benefits stakeholders use when making continuation decisions.

Discuss intervention fit. Determine whether the intervention still aligns with organizational and community needs.

Explore necessary adaptations. Ask what changes may be needed to support long-term use while preserving core functions.

Example

A diabetes prevention program found that staff valued flexibility more than strict adherence to the original delivery model. By incorporating virtual sessions and reducing scheduling burdens, the program maintained participation while becoming more feasible to sustain.

Impact Summary

Clarifying stakeholder priorities creates a shared definition of sustainment success. This helps organizations focus resources on the aspects of an intervention that matter most and avoid investing in activities that no longer provide value.

Why Is This Important?

Evidence of effectiveness helps stakeholders justify continued investment in a program. Consider what is important to your partners and tailoring the results to the audience.  Costs and resources are often one of the most important factors for a site’s decision to sustain. Types of costs (e.g., time, money, resource allocation, etc.) and their importance may differ based on your partner’s values. Well-designed summaries can transform data into a compelling case for sustainment.

Action Steps

Highlight outcomes that matter most. Focus on clinical, operational, financial, or community impacts that influence decision-making.

Use audience-specific summaries. Tailor information for leaders, staff, patients, or community partners.

Combine data with stories. Include participant quotes and real-world examples that bring findings to life.

Use visuals strategically. Present key findings through simple graphics, dashboards, or infographics.

Example

A hypertension program paired blood pressure improvement data with participant stories and cost summaries. Health system leaders used the data to support continued funding, while clinicians found the patient stories particularly motivating.

Impact Summary

Clear communication of results builds confidence in the value of an intervention. Tailored summaries help stakeholders understand why a program deserves continued attention and resources.

Why Is This Important?

Sustainment rarely happens without someone actively advocating for it. As competing priorities emerge, programs can lose visibility even when they are effective. A sustainment champion helps keep the intervention on the agenda, communicates its value, and navigates organizational barriers. Keep in mind, the champion to keep the project going may differ from the person who originally led implementation.

Action Steps

Identify influential individuals. Look for respected leaders or staff members who can advocate for the intervention over time.

Assess whether champions should change. Determine whether a different champion may be better suited for the sustainment phase.

Provide supporting evidence. Equip champions with outcome data, cost information, and success stories that help build buy-in.

Create opportunities for advocacy. Encourage champions to present results and lessons learned to leadership and stakeholders.

Plan for succession. Develop backup champions to reduce disruptions caused by staff turnover.

Example

A medical director used outcome data and patient success stories to advocate for continued support of a care coordination program after grant funding ended. Their leadership helped secure resources and maintain visibility among senior administrators.

Impact Summary

Effective champions help interventions remain a priority during times of change. Their advocacy can increase buy-in, secure resources, and maintain organizational commitment.

 

Why Is This Important?

What gets measured is more likely to be maintained and improved. Tracking systems provide ongoing information about whether interventions continue to reach intended populations, produce desired outcomes, and remain feasible to deliver. The RE-AIM framework highlights the importance of monitoring Reach, Effectiveness, Implementation, and Maintenance over time. Sustainment measures should be pragmatic and rely on data that organizations can realistically collect and use for decision-making.

Action Steps 

Monitor reach. Track whether eligible individuals continue to participate.

Measure key outcomes. Focus on practical indicators that reflect intervention effectiveness.

Track implementation burden. Monitor staffing demands, costs, and resource requirements.

Document adaptations. Record what changed, why it changed, and whether it improved fit or performance.

Review findings regularly. Use data to support continuous improvement and decision-making.

Example

Tracking systems can reveal emerging problems before they become major barriers. A primary care program monitored enrollment, blood pressure outcomes, and staffing time through routine reports. When participation began to decline, the team identified workflow challenges and adjusted outreach strategies before outcomes were affected.

Impact Summary

Routine monitoring supports continuous improvement and sustainment. Tracking key outcomes allows organizations to identify challenges early, justify ongoing investment, and make adaptations that improve long-term success.

Why Is This Important?

A sustainment guidebook helps future users understand not only what to do, but how to respond when challenges arise. Unlike a protocol or operations manual, a sustainment guidebook captures practical lessons learned, common adaptations, and real-world experiences from implementation. It also offers practical tools to aid sustainment. A sustainment guidebook serves as a resource for training, problem-solving, and knowledge transfer while reducing dependence on individual staff members.

Action Steps

Begin with orientation information. Clearly describe the purpose of the guide, intended audience, and how it should be used.

Use stories and examples. Include participant quotes, completed worksheets, and examples of successful adaptations.

Provide practical tools. Offer checklists, FAQs, worksheets, and troubleshooting resources.

Consider multiple formats for interactivity. Use PDFs, videos, quick-reference guides, or other formats that match user needs.

Treat the guide as a living document. Update content regularly based on user feedback and real-world experience.

Decide upon the level of technical assistance you are able to provide and clearly communicate this.  Consider recommending R2P2 resources.

Example

A community health worker program created a handbook containing workflow diagrams, adaptation examples, participant quotes, and completed planning worksheets. New sites reported that these practical examples helped them implement and sustain the program more quickly than written instructions alone.

Impact Summary

Guidebooks preserve institutional knowledge and accelerate learning across sites. By documenting lessons learned and practical solutions, they make sustainment more achievable for both current and future users.

• Program Sustainability Assessment Tool (PSAT) helps organizations assess overall readiness and capacity for sustaining evidence-based programs across key domains such as funding, partnerships, organizational capacity, evaluation, and strategic planning.
• Clinical Sustainability Assessment Tool (CSAT) provides a structured assessment of factors that influence the long-term sustainability of clinical practices and interventions within healthcare settings, helping teams identify strengths and areas for improvement.
• Shorter Versions of the Program Sustainability Assessment Tool (PSAT) and Clinical Sustainability Assessment Tool (CSAT) (Malone et al., 2024) introduces validated abbreviated versions of the PSAT and CSAT, reducing respondent burden while maintaining reliable assessment of sustainability capacity.
• RE-AIM Maintenance Tools provide guidance and practical resources for planning, measuring, and monitoring the long-term maintenance of interventions at both the individual and organizational levels.
• Dynamic Sustainability Framework provides a framework for continuously adapting interventions, implementation strategies, and health systems over time to improve long-term fit, effectiveness, and sustainability.
• Designing for Dissemination and Sustainability (D4DS) Toolkit offers planning tools, worksheets, and guidebooks to help researchers design interventions that are more likely to be disseminated, implemented, and sustained in real-world settings.
• Designing for Dissemination and Sustainability (Kwan et al., 2022) provides an overview of principles and strategies for designing interventions, implementation approaches, and partnerships that increase the likelihood of successful dissemination and long-term sustainability.
• IM4Equity: An Implementation Science Meta-Framework for Community-Engaged Partnerships to Advance Health Equity integrates implementation science and community engagement principles to help researchers design, implement, and sustain interventions that promote health equity across diverse settings.
• An Extension of RE-AIM to Enhance Sustainability (Shelton, Chambers, & Glasgow, 2020) expands the RE-AIM framework by emphasizing sustainability planning, adaptation, and long-term maintenance throughout the implementation process.
• Scale-up and Sustainment (Wolfenden et al., 2023) summarizes evidence and practical strategies for scaling effective interventions and sustaining them over time, including considerations for adaptation, system capacity, policy, and long-term implementation in real-world settings. In Dissemination and Implementation Research in Health: Translating Science to Practice (3rd ed., pp. 618–643). Oxford University Press.