title: A Mixed-Method Application of the Program Sustainability Assessment Tool to Evaluate the Sustainability of 4 Pediatric Asthma Care Coordination Programs.
abstract: BACKGROUND
  As part of a cross-site evaluation of the implementation of an evidence-based intervention for pediatric asthma care coordination into low-income communities, we sought to understand the factors that influenced the programs' expected sustainability of the programs after external funding ended.
  
  
  METHODS
  We administered the Center for Public Health Systems Science's Program Sustainability Assessment Tool, a 40-item instrument assessing 8 domains of sustainability capacity, to 12 key informants across 4 program sites. We developed open-ended probes for each domain. We examined patterns in site-specific and overall domain scores, and coded qualitative data to identify challenges and strategies in each domain.
  
  
  RESULTS
  Across sites, the domains of program evaluation (cross-site mean, 5.4 on a scale of 1-7) and program adaptation (mean, 5.2) had the highest ratings (indicating a strong finding during program evaluation) and funding stability had the lowest rating (mean, 2.7). Scores varied most across sites in the domains of strategic planning (SD, 0.9) and funding stability (SD, 0.9). Qualitative data revealed key challenges, including how implementation difficulties and externally led implementation can impede planning for sustainability. Program leaders discussed multiple strategies for enhancing capacity within each domain, including capitalizing on the interconnectedness of all domains, such as using evaluation and communication strategies to bolster internal political support throughout the implementation process.
  
  
  CONCLUSIONS
  Findings indicating weak and strong domains were consistent with previous findings of studies that used the Program Sustainability Assessment Tool. The addition of qualitative probes yielded detailed data describing capacity strengths, weaknesses, and strategies to increase the likelihood that programs are sustained.
authors.affiliation: 1415 Washington Heights, HBHE, Ann Arbor, MI 48109-2029. Email: scstoll@umich.edu.
authors.forename: Shelley
authors.initials: S
authors.lastname: Stoll
authors.affiliation: University of Michigan School of Public Health, Ann Arbor, Michigan.
authors.forename: Mary
authors.initials: M
authors.lastname: Janevic
authors.affiliation: RAND Corporation, Santa Monica, California.
authors.forename: Marielena
authors.initials: M
authors.lastname: Lara
authors.affiliation: University of Puerto Rico School of Public Health, San Juan, Puerto Rico.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Ramos-Valencia
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Tyra Bryant
authors.initials: TB
authors.lastname: Stephens
authors.affiliation: University of Illinois at Chicago School of Public Health, Chicago, Illinois.
authors.forename: Victoria
authors.initials: V
authors.lastname: Persky
authors.affiliation: Los Angeles Unified School District, Los Angeles, California.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Uyeda
authors.affiliation: Merck Childhood Asthma Network, Washington, DC.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Ohadike
authors.affiliation: Merck Childhood Asthma Network, Washington, DC.
authors.forename: Floyd
authors.initials: F
authors.lastname: Malveaux
mesh_terms: D001249:Asthma / Q000628:therapy*; D057191:Capacity Building; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D019058:Community Networks; D055317:Evidence-Based Practice; D006801:Humans; D011203:Poverty; D015397:Program Evaluation; D036301:Qualitative Research; D014481:United States