Along with a recent upsurge in interest across implementation research generally, there has been a particular emphasis on scale-up or large-scale dissemination. This focus on ‘going to scale’ has become a theme across knowledge translation, dissemination and implementation discussions, and in issues involving international development. In many ways, this renewed focus takes us back to the pioneering work of Everett Rogers on diffusion of innovations.
There is one problem with this emphasis, however, as illustrated by the now classic studies of providing pets for nursing home residents: if the development, innovation, program or policy (e.g., presence of pets) cannot be maintained or sustained, the long-term impact may actually make the situation worse than it was prior to intervention. We also know that sustainability does not just happen; it needs to be planned for from the beginning.
This issue of sustainability, how it is conceptualized and approached, and how sustainability interventions are implemented is the topic of this month’s editorial and the related Advanced Topics in IS Webinar to be held on July 23, 2:00-3:00pm ET. The issues involved include, but are not limited to:
- Planning for sustainability from the outset: Long-term sustainability – of either outcomes or resources/programs - needs to be planned for from the outset. One approach to facilitate such planning might be similar to the evaluability analyses used by the Robert Wood Johnson Foundation and championed by Laura Leviton and colleagues. This approach might involve asking a series of questions related to the likelihood of sustainability prior to funding or initiation of programs intended to produce long-term benefits.
- Cost and resource issues: Often programs and policies, whether evidence-based or not, require levels of money, expertise, training and supervision, time commitments and other resources that are not possible to maintain once the initial funding for initiation/research/evaluation is withdrawn. Potential adopting settings would be able to make more informed choices if a greater proportion of outcome studies and evaluations included standard, transparent reporting on the costs and resources required to deliver a program successfully.
- Conceptualization of sustainability. Possibly the greatest challenge has to do with conceptualizations of sustainability. Often sustainability is assumed to mean continued delivery of the same intervention components in the same perpetual way. The numerous problems with this conceptualization and alternative, and more dynamic conceptualizations of sustainability as a process that has to evolve over time to fit changing context (both internal and external) is the subject of the July Advanced Topics in Implementation Science, which will be led by Dr. David Chambers, NIMH.
For those who cannot participate in the webinar, an archive will be made available right here on this discussion forum after the session.
As always, I appreciate your reactions and feedback on these thoughts. Please share your point of view on this and other D&I issues.