title: Assessing Capacity for Sustainability of Effective Programs and Policies in Local Health Departments.
abstract: BACKGROUND
  Sustainability has been defined as the existence of structures and processes that allow a program to leverage resources to effectively implement and maintain evidence-based public health and is important in local health departments (LHDs) to retain the benefits of effective programs.
  
  
  OBJECTIVE
  Explore the applicability of the Program Sustainability Framework in high- and low-capacity LHDs as defined by national performance standards.
  
  
  METHODS
  Case study interviews from June to July 2013. Standard qualitative methodology was used to code transcripts; codes were developed inductively and deductively.
  
  
  METHODS
  Six geographically diverse LHD's (selected from 3 of high and 3 of low capacity)
  
  
  METHODS
  : 35 LHD practitioners.
  
  
  METHODS
  Thematic reports explored the 8 domains (Organizational Capacity, Program Adaptation, Program Evaluation, Communications, Strategic Planning, Funding Stability, Environmental Support, and Partnerships) of the Program Sustainability Framework.
  
  
  RESULTS
  High-capacity LHDs described having environmental support, while low-capacity LHDs reported this was lacking. Both high- and low-capacity LHDs described limited funding; however, high-capacity LHDs reported greater funding flexibility. Partnerships were important to high- and low-capacity LHDs, and both described building partnerships to sustain programming. Regarding organizational capacity, high-capacity LHDs reported better access to and support for adequate staff and staff training when compared with low-capacity LHDs. While high-capacity LHDs described integration of program evaluation into implementation and sustainability, low-capacity LHDs reported limited capacity for measurement specifically and evaluation generally. When high-capacity LHDs described program adoption, they discussed an opportunity to adapt and evaluate. Low-capacity LHDs struggled with programs requiring adaptation. High-capacity LHDs described higher quality communication than low-capacity LHDs. High- and low-capacity LHDs described strategic planning, but high-capacity LHDs reported efforts to integrate evidence-based public health.
  
  
  CONCLUSIONS
  Investments in leadership support for improving organizational capacity, improvements in communication from the top of the organization, integrating program evaluation into implementation, and greater funding flexibility may enhance sustainability of evidence-based public health in LHDs.
authors.affiliation: Prevention Research Center in St Louis (Drs Tabak and Brownson and Mss Duggan, Smith, and Aisaka), George Warren Brown School at Washington University in St Louis (Drs Tabak, Moreland-Russell, and Brownson), and Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine (Dr Brownson), St Louis, Missouri.
authors.forename: Rachel G
authors.initials: RG
authors.lastname: Tabak
authors.forename: Katie
authors.initials: K
authors.lastname: Duggan
authors.forename: Carson
authors.initials: C
authors.lastname: Smith
authors.forename: Kristelle
authors.initials: K
authors.lastname: Aisaka
authors.forename: Sarah
authors.initials: S
authors.lastname: Moreland-Russell
authors.forename: Ross C
authors.initials: RC
authors.lastname: Brownson
mesh_terms: D016022:Case-Control Studies; D006291:Health Policy / Q000639:trends; D006801:Humans; D009111:Local Government; D017063:Outcome Assessment, Health Care / Q000379:methods*; D015397:Program Evaluation / Q000379:methods*; D011634:Public Health / Q000379:methods / Q000592:standards*