title: Program Sustainability: Hearing Loss and Tinnitus Prevention in American Indian Communities.
abstract: BACKGROUND
  An important goal of any health promotion effort is to have it maintained in delivery and effectiveness over time. The purpose of this study was to establish a community-based noise-induced hearing loss and tinnitus prevention program in three different types of American Indian communities and evaluate them for evidence of long-term sustainability.
  
  
  METHODS
  The target population was fourth- and fifth-grade students from three different models of American Indian communities. The evidenced-based Dangerous Decibels®program was adapted to include local media, classroom education, family and community outreach, and web-based activities. Sustainability was attempted by promoting funding stability, political support, partnerships, organizational capacity, program adaptation, program evaluation, communications, public health impacts, and strategic planning.
  
  
  RESULTS
  Currently, there is evidence suggesting that the hearing health promotion program is self-sustaining in all three American Indian communities. The intervention was effective at changing knowledge, attitudes, beliefs, and behaviors in the target population, but program adoption and self-sustenance faced challenges that required patience, persistence, and creativity by the program team. Components of the intervention continue to be delivered by local members of each community.
  
  
  CONCLUSIONS
  Critical factors that led to self-sustaining programs included approval of community leaders and engagement of community members in the design, administration, and evaluation of the effort; use of a well-developed, evidence-based intervention; and high-level training of local participants who could confidently and effectively continue delivering the program following a gradual transition to independence.
authors.affiliation: Oregon Health and Science University, Center for Healthy Communities, School of Public Health, Portland, Oregon; Department of Otolaryngology, National University of Singapore, Singapore. Electronic address: entwhm@nus.edu.sg.
authors.forename: William Hal
authors.initials: WH
authors.lastname: Martin
authors.affiliation: Portland State University School of Community Health, Portland, Oregon.
authors.forename: Judith L
authors.initials: JL
authors.lastname: Sobel
authors.affiliation: Oregon Health and Science University, Center for Healthy Communities, School of Public Health, Portland, Oregon; National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System (VAPORHCS), Portland, Oregon;; Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University (OHSU), Portland, Oregon.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Griest
authors.affiliation: Oregon Health and Science University, Center for Healthy Communities, School of Public Health, Portland, Oregon.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Howarth
authors.affiliation: Oregon Health and Science University, Center for Healthy Communities, School of Public Health, Portland, Oregon.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Becker
mesh_terms: D006317:Hearing Loss, Noise-Induced / Q000517:prevention & control*; D006801:Humans; D007198:Indians, North American; D011314:Preventive Health Services; D015397:Program Evaluation; D014012:Tinnitus / Q000517:prevention & control*