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      Developing an evidence-based program sustainability training curriculum: a group randomized, multi-phase approach

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          Abstract

          Background

          The emergence of dissemination and implementation (D&I) science has driven a rapid increase in studies of how new scientific discoveries are translated and developed into evidence-based programs and policies. However, D&I science has paid much less attention to what happens to programs once they have been implemented. Public health programs can only deliver benefits if they reach maturity and sustain activities over time. In order to achieve the full benefits of significant investment in public health research and program development, there must be an understanding of the factors that relate to sustainability to inform development of tools and trainings to support strategic long-term program sustainability. Tobacco control programs, specifically, vary in their abilities to support and sustain themselves over time. As of 2018, most states still do not meet the CDC-recommended level for funding their TC program, allowing tobacco use to remain the leading cause of preventable disease and death in the USA. The purpose of this study is to empirically develop, test, and disseminate training programs to improve the sustainability of evidence-based state tobacco control programs and thus, tobacco-related health outcomes.

          Methods

          This paper describes the methods of a group randomized, multi-phase study that evaluates the empirically developed “Program Sustainability Action Planning Training” and technical assistance in US state-level tobacco control programs. Phase 1 includes developing the sustainability action planning training curriculum and technical assistance protocol and developing measures to assess long-term program sustainability. Phase 2 includes a group randomized trial to test the effectiveness of the training and technical assistance in improving sustainability outcomes in 24 state tobacco control programs (12 intervention, 12 comparison). Phase 3 includes the active dissemination of final training curricula materials to a broader public health audience.

          Discussion

          Empirical evidence has established that program sustainability can improve through training and technical assistance; however, to our knowledge, no evidence-based sustainability training curriculum program exists. Therefore, systematic methods are needed to develop, test, and disseminate a training that improves the sustainability of evidence-based programs.

          Trial registration

          NCT03598114. Registered 25 July 2018—retrospectively registered.

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          Most cited references24

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          The Learning Way: Meta-cognitive Aspects of Experiential Learning

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            The impact of tobacco control programs on adult smoking.

            We examined whether state tobacco control programs are effective in reducing the prevalence of adult smoking. We used state survey data on smoking from 1985 to 2003 in a quasi-experimental design to examine the association between cumulative state antitobacco program expenditures and changes in adult smoking prevalence, after we controlled for confounding. From 1985 to 2003, national adult smoking prevalence declined from 29.5% to 18.6% (P<.001). Increases in state per capita tobacco control program expenditures were independently associated with declines in prevalence. Program expenditures were more effective in reducing smoking prevalence among adults aged 25 or older than for adults aged 18 to 24 years, whereas cigarette prices had a stronger effect on adults aged 18 to 24 years. If, starting in 1995, all states had funded their tobacco control programs at the minimum or optimal levels recommended by the Centers for Disease Control and Prevention, there would have been 2.2 million to 7.1 million fewer smokers by 2003. State tobacco control program expenditures are independently associated with overall reductions in adult smoking prevalence.
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              Correlates of the sustainability of community-based heart health promotion interventions.

              This study investigated factors related to the perceived sustainability of 189 heart health promotion interventions initiated by a public health department or research initiative and implemented in a variety of organizations across Canada. Data were collected in a telephone survey of key informants from schools, restaurants, grocery stores, health care facilities, and sports facilities that had implemented a heart health promotion intervention (risk factor screening, courses for smoking cessation, healthy eating or physical activity, support groups to promote healthy lifestyles, environmental modification, dissemination of information) in the past 8 years. Overall, 43.6% of 189 interventions were perceived to be very permanent, 34.8% were somewhat permanent, and 21.5% were not permanent. Independent correlates of perceived sustainability included intervention used no paid staff (odds ratio (OR) 95% confidence interval (95% Cl) = 3.7 (1.8, 7.5)), intervention was modified during implementation (OR (95% Cl) = 2.7 (1.4, 5.0)), there was a good fit between the local provider and the intervention (OR (95% Cl) = 2.4 (1.2, 5.0)), and there was the presence of a program champion (OR (95% Cl) = 2.3 (1.2, 4.4)). Consideration of these factors by health promotion program planners could increase the potential for sustainability of health promotion interventions implemented in the community. Copyright 1998 American Health Foundation and Academic Press.
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                Author and article information

                Contributors
                rebecca.vitale@wustl.edu
                tblaine@wustl.edu
                ezofkie@wustl.edu
                smoreland-russell@wustl.edu
                tcombs@wustl.edu
                rbrownson@wustl.edu
                dluke@wustl.edu
                Journal
                Implement Sci
                Implement Sci
                Implementation Science : IS
                BioMed Central (London )
                1748-5908
                26 September 2018
                26 September 2018
                2018
                : 13
                : 126
                Affiliations
                [1 ]ISNI 0000 0001 2355 7002, GRID grid.4367.6, Prevention Research Center in St. Louis, , Brown School at Washington University in St. Louis, ; 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
                [2 ]ISNI 0000 0001 2355 7002, GRID grid.4367.6, Center for Public Health System Science, , Brown School at Washington University in St Louis, ; St Louis, MO USA
                [3 ]ISNI 0000 0001 2355 7002, GRID grid.4367.6, Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, , Washington University School of Medicine, Washington University in St. Louis, ; St. Louis, MO USA
                Author information
                http://orcid.org/0000-0003-2325-8357
                Article
                819
                10.1186/s13012-018-0819-5
                6158899
                30257695
                6b526ea9-74dd-4229-8de7-57cab0d620e0
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 9 August 2018
                : 12 September 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000054, National Cancer Institute;
                Award ID: R01CA203844
                Award Recipient :
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2018

                Medicine
                sustainability,organizational sustainability,dissemination and implementation,tobacco control,evidence-based practice,institutionalization,experiential learning,action-oriented,technical assistance

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