Keys to Unlocking Prevention Program Sustainment: A Mixed Method Study of the Strengthening Families Program

Introduction: For prevention efforts to effectively scale-up within public systems of care, we need a clear understanding of the multifaceted nature of program sustainment. Program sustainment is defined as the continued delivery of program activities in order to achieve continued impact, and is viewed as the final stage of effective implementation. This mixed-method study explores the community, organizational, and program factors associated with sustainment in a sample of Strengthening Families Programs (SFP) implemented under natural conditions as part of a 15-year dissemination effort in Washington State.

Methods: Fifty-nine SFP coordinators completed the Program Sustainability Assessment Tool (PSAT; Luke et al., 2014) and reported sustainment level in an online survey. Twenty of these coordinators also participated in semi-structured interviews. The coding manual includes constructs from the PSAT and the Consolidated Framework for Implementation Research (Damschroder et al., 2009). The qualitative analysis strategy is modeled after Damschroder & Lowery (2013): (1) a double-consensus, case-analysis approach, (2) valence coding of each identified construct, and (3) matrix analysis to identify patterns, and compare and contrast sites within and across sustainment levels (high, medium, and low).

Results: Results from the quantitative analysis determined that a supportive internal and external climate for the program (environmental support), in combination with strong internal support and resources needed to effectively manage the program (organizational capacity) were conditions consistently present in those sites with high levels of reported sustainment. These results will be compared with results from the qualitative analysis currently underway. Thus far, data obtained from six interviews (two interviews at each level of sustainment) indicate that positive beliefs about the program are not sufficient. It also suggests that while organizational capacity and partnerships positively contribute to sustainment, intervention cost and external policy and incentives appear to negatively influence sustainment. The coding process will be completed for six additional interviews and the full results will be available for the conference.

Conclusions: Few sustainment studies capture the multiple, intersecting factors associated with effective, long-term implementation in real-world conditions. This study addresses that gap by using a mixed methods approach to uncover the combinations of factors that distinguish between sites with high and low sustainment success. This information is critical to supporting program scale-up and ultimately improving public health.