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Assessment of the Sustainability Capacity of a Coordinated Approach to Chronic Disease Prevention

Moreland-Russell, Sarah, MPH, PhD; Combs, Todd, PhD; Polk, LaShaun, MPH; Dexter, Sarah, MSW

Journal of Public Health Management and Practice: July/August 2018 - Volume 24 - Issue 4 - p E17–E24
doi: 10.1097/PHH.0000000000000663
Research Reports: Research Full Report

Objective: This article outlines some factors that influenced the sustainability capacity of a coordinated approach to chronic disease prevention in state and territory health departments.

Design: This study involved a cross-sectional design and mixed-methods approach. Quantitative data were collected using the Program Sustainability Assessment Tool (PSAT), a 40-item multiple-choice instrument that assesses 8 domains of sustainability capacity (environmental support, funding stability, partnerships, organizational capacity, program evaluation, program adaptation, communications, and strategic planning). Qualitative data were collected via phone interviews.

Participants: The PSAT was administered to staff and stakeholders from public health departments in 50 US states, District of Columbia, and Puerto Rico, who were involved in the implementation of coordinated chronic disease programs. Phone interviews were conducted with program coordinators in each state.

Main Outcome Measure(s): Sustainability score patterns and state-level categorical results, as well as strengths and opportunities for improvement across the 8 program sustainability domains, were explored.

Results: On average, programs reported the strongest sustainability capacity in the domains of program adaptation, environmental support, and organizational capacity, while funding stability, strategic planning, and communications yielded lowest scores, indicating weakest capacity. Scores varied the most by state in environmental support and strategic planning.

Conclusion: The PSAT results highlight the process through which states approached the sustainability of coordinated chronic disease initiatives. This process included an initial focus on program evaluation and partnerships with transfer of priority to long-term strategic planning, communications, and funding stability to further establish coordinated chronic disease efforts. Qualitative interviews provided further context to PSAT results, indicating that leadership, communications, partnerships, funding stability, and policy change were perceived as keys to success of the transition. Integrating these findings into future efforts may help those in transition establish greater sustainability capacity. The PSAT results and interviews provide insight into the capacity for sustainability for programs transitioning from traditional siloed programs to coordinated chronic disease programs.

Washington University in St Louis, St Louis, Missouri (Drs Moreland-Russell and Combs and Dexter); and Coordinated States Support Branch, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Polk).

Correspondence: Sarah Moreland-Russell, MPH, PhD, George Warren Brown School of Social Work, Washington University in St Louis, 1 Brookings Dr, Campus Box 1196, St Louis, MO 63130 (

This project was supported in part by an appointment to the Research Participation Program at the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the US Department of Energy and the Centers for Disease Control and Prevention.

This project was funded by the Centers for Disease Control and Prevention, Division of Population Health. The authors thank Annaliese Calhoun for her work administering the PSAT and conducting qualitative interviews.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

The authors declare no conflicts of interest.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.