Review the Concept of Evidence-based Public Health Strategies

Abstract

Background

Sustainability of evidence-based interventions (EBI) remains a challenge for public wellness community-based institutions. The conceptual definition of sustainment is not universally agreed upon by researchers and practitioners, and strategies utilized to facilitate sustainment of EBI are not consistently reported in published literature. Given these limitations in the field, a systematic review was conducted to summarize the existing evidence supporting discrete sustainment strategies for public health EBIs and facilitating and hindering factors of sustainment.

Methods

We searched PsychINFO, Embase, ProQuest, PubMed, and Google Scholar. The initial search was run in March 2017 and an update was done in March 2019. Written report eligibility criteria included (a) public wellness evidence-based interventions, (b) conducted in the community or community-based settings, and (c) reported outcomes related to EBI sustainment. Details characterizing the study setting, design, target population, and type of EBI sustained were extracted.

Results

A total of 26 manufactures published from 2004 to 2019 were eligible for data extraction. Overall, the importance of sustainability was acknowledged across all of the studies. However, simply vii studies presented a conceptual definition of sustainment explicitly within the text. Six of the included studies reported specific sustainment strategies that were used to facilitate the sustainment of EBI. Only three of the studies reported their activities related to sustainment by referencing a sustainment framework. Multiple facilitators (i.e., accommodation/alignment, funding) and barriers (i.e., limited funding, express resources) were identified equally influencing EBI sustainment. The majority (n = 20) of the studies were conducted in high-income countries. Studies from low-income countries were by and large naturalistic. All of the studies from low-income countries reported lack of funding equally a hindrance to sustainment.

Implication for dissemination and implementation research

Literature focused on sustainment of public health EBIs should present an explicit definition of the concept. Better reporting of the framework utilized, steps followed, and adaptations fabricated to sustain the intervention might contribute to standardizing and developing the concept. Moreover, encouraging longitudinal dissemination and implementation (D&I) research especially in low-income countries might assist strengthen D&I research capacity in public health settings.

Peer Review reports

Groundwork

Sustaining the changes that consequence from bear witness-based public health interventions has become a topic of great interest among many researchers, donors, practitioners, and communities [1]. Show-based interventions (EBI) are divers as practices by which the provider'southward decision is backed by the most appropriate information [2]. EBIs originated from the evidence-based medicine motion. In recent years, additional fields that involve routine intervention and clinical decision making have embraced this movement [3]. This includes a range of EBIs in treatment research, prevention, policy, medicine, community-based public health, and overall healthcare [iv,five,6,7]. Although EBIs are conceptually highly-seasoned, our agreement of the implementation processes, including sustainment, that are necessary for delivering these practices over time in community-based settings remains unclear [i]. The field of dissemination and implementation (D&I) science has provided definitions for conceptually distinct terms, sustainability, and sustainment. Sustainability is defined as "the extent to which an evidence-based intervention can deliver its intended benefits over an extended period of time after external support… is terminated" [8] (p. 26), whereas sustainment is defined as "creating and supporting the structures and processes that will let an implemented innovation to be maintained in a system or organisation" [ix].

Research-to-practice gap

The past few decades have marked a meaning shift from traditional diffusion of interventions and research outcomes—"passive, untargeted, unplanned, and uncontrolled spread of new interventions" [10]—to a more than structured arroyo of EBI broadcasting, implementation, and sustainment in order to reduce the oft-noted research-to-practice gap [11]. Current estimates suggest that it takes about 17 years to implement only 14% of prove-based enquiry outcomes in real-world settings [12, 13]. This research-to-practice gap often translates to suboptimal care for patients, exposure to potentially avoidable harm, excessive healthcare spending, and other significant opportunity costs [14]. Multiple and mutually interacting factors are believed to contribute to this big research translation gap. Previous studies report that inadequate training, limited time, lack of infrastructure, and lack of feedback and incentives for the utilization of EBIs hinder timely adoption and sustainment of EBIs in real-world settings [fifteen]. Farther, of the EBIs that are adopted and implemented, many EBIs are not sustained after a sure amount of time [15].

Public health evidence-based interventions

Traditionally, the goal of intervention developers is to test the efficacy of the novel intervention in ideal settings with ideal participants and practitioners; however, this is not the typical end-point for public health researchers. For instance, effectiveness inquiry focuses on testing an individual-level intervention that is being delivered inside "real-world" settings past usual intendance providers to community patients. The outcome measures still remain at the individual or family level [eight]. Still, sustainment of EBIs within customs-based organizations requires the evaluation of the processes and factors that may facilitate or hinder the continuation of an EBI [nine]. For example, the field of health organization quality improvement emphasizes the comparative cess of the value of organizational or organization-level interventions that back up the sustainability of EBIs [16]. Thus, careful planning is necessary to ensure swift and sustained applications of findings from show-based enquiry into real-world settings [17]. Implementation studies in public health have emphasized the importance of developing sustainability strategies throughout the planning phase of an EBI to achieve its utmost benefits at the individual, client, and organizational level [18]. Yet, the sustainment of EBIs in community-based settings remains a major challenge [19].

In the past few years, sustainability has been a buzz word in various disciplines, including public health research. Despite its appeal, the concept has remained undefined or loosely divers in almost public health research, leading to underreported or vague findings [20]. The ambiguity in the conceptual and operational definition of sustainment has been identified equally one of the barriers contributing to the large translational gap in public health and healthcare in general [21].

Sustainment of EBIs presents many complexities. While planning for the sustainment of EBIs, researchers and practitioners oft face different unanticipated challenges pertaining to intervention characteristics, the organizational setting, and the broader policy surroundings [22]. For example, past overcoming these inner and outer contextual challenges, some public wellness interventions take been successfully sustained with fidelity. Yet, other EBIs may require adaptations over time to continue to work effectively in a complicated and dynamic real-world context [23, 24]. Effective sustainment strategies, outside of fidelity monitoring, for adapted interventions, are not well reported upon in implementation studies.

Sustainment efforts in low- and middle-income countries

Challenges to implementing EBIs in communities inside the US also bear over to low-income countries, where cultural differences, barriers to cost, accessibility and  quality are mutual. Given these barriers in adoption and broadcasting of EBIs in low-income countries, sustaining any programme efforts remains hard [25].

The limited evidence from depression- and eye-income countries (LMICs) reported that complexity of the intervention and inadequate program familiarity, limited man resources, and lack of workplace support for the new program and high staff turnover every bit barriers to sustainment [26,27,28]. Moreover, express wellness organisation capacity, poor awarding of show-based interventions, inadequate involvement of local implementers, and loftier staff turnover besides were reported to hinder the use of public health EBIs [28]. Yet, express evidence exists regarding the sustainment of EBIs in LMICs compared to high-income countries (HICs) [29]. The broader factors influencing the sustainment of EBIs in these settings remain underreported.

Given that little is known about how and nether what conditions sustainability occurs, it remains unclear equally to what strategies facilitate or hinder sustainability outcomes [thirty]. For instance, strategies to facilitate maintenance of wellness benefits activities or workforce capacity take non been recognized considering of the limited understanding to the developing procedure of sustainability [31, 32]. Therefore, in that location is a demand to identify and draw existing facilitators or barriers to sustainment outcomes to meliorate understand implementation processes, promote the use of impactful EBIs, and advance the field of dissemination and implementation science.

Objectives

The goal of this systematic review was to understand the state of the literature related to the sustainment of public health EBIs. Specifically, nosotros aimed to (1) describe how sustainability was divers; (2) identify and depict evidence-based sustainment strategies utilized in peer-reviewed public health literature; (iii) identify methods for evaluating sustainment outcomes; (iv) identify sustainment strategies utilized and with which specific stakeholder groups; (five) identify and describe reported sustainment outcomes; (half dozen) develop recommendations for (a) reporting sustainment efforts as well as (b) utilizing specific sustainment strategies with specific stakeholder groups, both initially and when sustainment seems to be failing; and (vii) sustainment efforts in depression -income settings.

Methods

Methods for the systematic followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We specified the methods in advance and documented every stride in an a priori protocol. The protocol was updated iteratively throughout the systematic review (the systematic review protocol is available upon asking from the first author).

Eligibility criteria

Eligible studies included articles that (1) were peer-reviewed, (two) written in the English linguistic communication, (3) reported the use of a specific EBI, (4) involved the implementation of an EBI in a community-based setting, and (five) provided a description of strategies used to sustain the EBI. Our search was not restricted to specific population or year of publication. Nosotros excluded articles that were (i) not based on original information, (two) generic reports that did not focus on a specific EBI, or (3) reviews of other published or unpublished prove. We did not include unpublished (ongoing) studies because these were not available on the databases we searched.

Data sources

Multiple electronic database indexes were searched for potentially eligible articles, including PsycINFO (1887–present), ProQuest including ERIC and CSA social sciences' abstracts (1971–present), PubMed (1946–present), Embase (1976-present), and Google Scholar (2004–present). Further, experts in the area of EBI sustainment were contacted by the senior author and asked to propose additional relevant articles that had not been included. Finally, reference lists of identified articles (including systematic reviews) were checked for potentially eligible articles. Duplicate articles were excluded at each stage of the search process. Nosotros conducted an initial search in March 2017, and additional time-restricted searches (March 2017–March 2019) were run to identify more recently published studies.

Search strategy

The post-obit keywords were searched in any combination: "sustainment," "sustainability," "scale-up," "continuation," "health," "providers," "community," "policy," "services," and "interventions." These search terms were identified during a preliminary search of the literature focused on discovering the various terms used in articles related to the sustainment of EBIs. A filter was used in all searches to exclude review manufactures, manufactures in other languages, or articles that are non peer-reviewed.

Report selection

The first and second authors reviewed the titles and abstracts identified by the searches. Articles were eligible for the total-text review if the title or abstract referenced equally follows: (1) utilize of any specified EBI, (2) if the EBI was delivered in a community-based arrangement, and (3) provided a description of sustainment procedure. If project members could not decide initial eligibility from the championship and abstract, the article passed to the next stage for a total-text review. Articles were excluded if the title and abstract did not pertain to EBI sustainment.

Two project members independently reviewed all of 4892 titles screened for inclusion. Inter-rater agreement for inclusion between the independent coders was 86%. Disagreements betwixt reviewers were resolved with discussions aimed to develop a consensus almost the eligibility of studies, with consultation from other co-authors, as needed.

Later the title and abstract review, members of the coding team were randomly assigned manufactures (10–15 articles each) to review. Two project members independently reviewed the full-text of each commodity to determine inclusion into or exclusion from the systematic review. Disagreements were resolved through discussion betwixt the two reviewers and a third independent reviewer until consensus was reached.

Information drove process

A information extraction course containing an initial coding scheme was adult a priori, based on the written report objectives and preliminary conceptualizations of sustainment strategies. Boosted codes were generated deductively past the data extraction team, which consisted of four reviewers. Training for the reviewers included a half-day didactic coding workshop involving an introduction to the PRISMA statement [33] and discussion of each variable definition using exercise articles. Raters reconvened to review how a second practice article was independently rated by each of the reviewers and to resolve any discrepancies or ambiguities about the coding process. All raters were asked to independently code and review iv additional articles to ensure clarity of the variables and consistency in the coding process. Raters were provided coding documents containing assignment sheets, training slides and notes, the survey, variable operational definitions, and printed articles for review. Twelve consensus meetings were held during the initial full-text review. The coding template was farther refined for the side by side level of the review. The new template was pilot-tested with x% of the manufactures, discussed, and endorsed to be used for the last total-text review. Additional ten consensus meetings were held for the final full-text review.

Data items

The extracted data comprised of 45 items focusing on (1) basic publication details almost the article (i.e., publication date, author), (2) study blueprint and methods, (3) reported EBI outcomes, (4) sustainment strategies, (five) targeted audience of sustainment strategies (e.g., organizational leaders, straight providers), (6) barriers and facilitators influencing sustainment outcomes, and (7) miscellaneous details on funding and comments/concerns about the articles. Data about the data items is available in the systematic review protocol.

Risk of bias

To establish the forcefulness of the body of evidence, we evaluated the risk of bias in individual studies and across studies. In individual studies, we checked validity and reliability of the measures used, report setting, appropriateness of the study pattern, methods of data collection, and how these interacted with reporting and outcomes [34]. We did non restrict our search to outcomes (positive/negative) to minimize the possibility of publication bias [35].

Data assay

All of the articles were independently double-coded by pairs of raters. Whenever disagreements emerged, the group of coders met to discuss coding disagreements until consensus was reached. All data were collected using the Qualtrics online survey programme [36]. Raters received a link to the online survey via email. All coding was starting time conducted on printed articles and then entered into the online survey to create the database. Data were after exported to SPSS V.14 [37] for analysis. The review team (MH, TB, RB, and BM) met to discuss emerging themes and to create a reporting structure based on the objectives of the report. Recurrent themes that were identified were thematically categorized to facilitate reporting. Moreover, we also compared studies from high-income countries and low- and middle-income countries (LMICs).

Results

Report choice

Searches generated 4892 articles published up to March 2019 (Fig. ane). After reviewing these articles' titles and abstracts, 274 manufactures were determined to see the criteria for a full-text review. After the initial full-text review, 45 articles met the criteria for terminal inclusion. During data extraction, 19 manufactures were excluded considering they did not fit the criteria of containing original data about sustainment strategies (n = 17) or because they were a study protocol or conceptual newspaper (n = 2), were of poor quality based on analysis of rigor and risk of bias (n = 2), or were a duplicate publication (northward = 1).

Fig. ane

Flow chart of the study

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Characteristics of the studies

A full of 26 manufactures published from 2004 to 2019 were included in the concluding assay. The report settings include wellness intendance facilities (north = 7), other customs-based organizations (n = 6), and communities (northward = 13). The EBIs beingness sustained covered a diversity of topics including physical health, behavioral health, prevention services, and life skills (Table 1).

Table i Types of EBIs included in the review

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Quality of included studies

We used the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) [38] to evaluate the quality of cross-sectional studies and the Consolidated Standards of Reporting Trials (CONSORT) guideline [39] for appraisement of RCTs. Overall, the studies included in this review rated from moderate to high. Written report design, objectives, and sampling were clearly presented in all of the studies.

Conceptualization of sustainability

In all of the studies, the importance of sustainability was acknowledged. Nevertheless, only x out of the 26 studies included an explicit definition of sustainability. For 16 of the 26 studies, sustainability was inadequately defined or was missing altogether. Specifically, these studies discussed outcomes and influences of sustainability without an explicit definition of sustainability referenced in the text. We reviewed the report objectives of these sixteen studies to determine how sustainability was conceptualized. In 17 of the studies, sustainability was conceptualized in relation to the continuity of a program sustained later the implementation phase. The concept of sustainability in these studies varied; yet, nosotros mapped these conceptualizations onto a consolidated list of definitions developed by Moore and colleagues [forty] (see Table 2).

Table two Defining sustainment

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The following provide examples of the variability in sustainment conceptualization across studies:

In the field of public health, sustainability has been divers as the capacity to maintain plan services at a level that will provide ongoing prevention and treatment for a health problem later on the termination of major financial, managerial, and technical assistance from an external donor. [41]

Another study used the definition of sustainability from Glasgow [42] at the individual and organizational level.

At the individual level, sustainability has been defined every bit the long-term effects of a plan every bit assessed after 6 or more months following the almost contempo intervention contact. [43]

Further, a study from Ghana defined sustainability as the "continuation of benefits" [44]. While another report [45] conceptualized sustainment in terms of retaining the human capacity of service providers and service users:

… a program is sustained if information technology continues to employ staff, maintains an active client caseload, and provides straight services. Programs sometimes continue in proper name only, without adhering to the plan model that they originally implemented. [45]

Specific efforts focusing on sustainment

Of the 26 studies included, vi studies [9, 46,47,48,49,50] reported purposefully building sustainment efforts into the EBI implementation. These studies reported the initiatives they took to ensure the sustainment of the program outcomes after the end of the implementation phase. Further, only five studies reported the utilise of a specific dissemination and implementation framework that guided the sustainment efforts (Tabular array 3). Notably, the remaining 21 studies described their sustainment activities without making any reference to a known a priori theoretical model or framework.

Table three Apply of sustainment frameworks

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Sustainment strategies used

Sustainment strategies extracted for the systematic review were guided past the conceptual model of factors that influence the sustainment of EBIs [3]. Nine sustainment strategies were identified among the 26 articles (Table iv). Funding and/or contracting for EBIs connected employ (n = 12) and maintenance of workforce skills through continued training, booster preparation sessions, supervision, and feedback (n = nine) were near ofttimes reported. Other sustainment strategies included organizational leader stakeholder prioritizing and supporting continued utilise (n = half-dozen), agency priorities, and/or plan needs are aligned with new EBI (n = iv), maintenance of staff buy-in (n = 3), accessing new or existing coin to facilitate sustainment (northward = 2), systematic adaptation of the EBI to increase continued fit/compatibility of the EBI with the organization (n = eight), mutual accommodation between the EBI and organisation (due east.chiliad., adaptation of the EBI to meliorate fit and alignment of the organizations' procedures) (north = vii), and monitoring EBI effectiveness (northward = ii). Ii of the remaining studies reported that a specific sustainment strategy was not used, and the final three studies described utilizing "positive implementation climate" and "community engagement/partnerships" as sustainment strategies.

Table 4 Sustainment strategies used to sustain EBIs

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Sustainment strategies and stakeholder groups

Of the 26 articles, merely 9 studies [46,47,48,49,fifty,51,52,53,54] provided information nigh the specific intended audition (east.g., stakeholder groups) of the sustainment efforts. Intended audiences for EBI sustainment efforts included direct providers (n = 6), supervisors of straight providers (n = 4), organizational leaders (n = v), and service users (due north = 3) (Table 5). No studies targeted policy-makers in their sustainment efforts.

Table 5 Target audition for EBI sustainment efforts

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Sustainment outcomes

Moreover, the nine manufactures that reported specific intended audiences for their sustainment efforts as well provided details on outcomes related to their sustainment strategy utilize. These details were grouped into two categories: (1) sustainment outcomes related to the implementation process and (two) sustainability outcomes directly related to the EBI. For the first category, details on sustainment outcomes included the moderating part of leadership styles (n = 1), the importance of tracking program activities to ensure continued use (n = 1), increased rates in initial and connected employ of the EBIs (northward = iii), and assessments related to degrees of institutionalization of EBIs (n = 1). Sustainability outcomes straight related to the EBI included increased usage of EBI components maintained over time (n = ii) and increased individual-level outcomes (e.g., asthma medication use and education) from EBI utilize (n = one).

Facilitating and hindering factors of EBI sustainment

Twenty-half-dozen facilitating and 23 hindering factors were reported to be of influence on the sustainment of EBIs (Table 6). Utilizing the influences on sustainability framework [20], nosotros mapped each reported facilitator and hindrance onto the framework, which proposes 4 major thematic areas, including (1) innovation characteristics, (two) context, (3) capacity, and (4) processes and interactions. Funding (n = 16), accommodation/alignment (north = fifteen) and organizational leadership (north = 12) were the near oftentimes reported facilitating factors for EBI sustainment. No or express funding (n = 13) was the near frequently reported hindering factor for EBI sustainment.

Table 6 Facilitating and hindering factors, definitions, and frequencies

Full size tabular array

Studies from LMICs

Of the eligible studies, only five of them [44, 46, 55,56,57] were conducted in LMICs according to the World Bank classification of countries [58]. 1 study did non report the study setting. All of these studies from LMICs followed a naturalistic approach with no longitudinal or RCT design reported. All but one [46] of the studies from LMICs was conducted in a facility-based setting. Regarding barriers to sustainment, all of the studies from LMICs reported that EBIs were non sustained afterward the termination of funding. Moreover, no study from LMICs reported actual targets of sustainment strategies.

Discussion

There is a growing interest to assess sustainment to promote EBIs in public health research. Despite this emerging emphasis, there remains a large research-to-practise gap [12, 13] that can be attributed to inconsistent definitions and underreporting of sustainability. To help address these gaps, this systematic review provides a detailed summary of the current evidence of sustainability in public health interventions across diverse customs-based settings and populations. To our knowledge, this is the showtime comprehensive systematic review that summarized definitions of sustainment and evidence-based intervention sustainment strategies targeting specific audiences inside public wellness literature.

Although the importance of sustainability was acknowledged across all the studies, the concept was inadequately divers with only seven studies presenting a definition of sustainability somewhere in the text. Merely nine of the included studies reported their sustainment efforts [9, 46,47,48,49,50]. Fifty-fifty fewer studies [nine, 46, 47, 52, 53] presented their activities related to sustainment by referencing a known sustainment framework.

Testify exists that various public health interventions are successfully implemented in bookish settings. Nevertheless, ensuring their transferability to community settings or customs-based organizations while besides maintaining fidelity has been a challenge [59, 60]. This claiming could be attributable to a lack of clarity or knowledge about the appropriate frameworks and the steps followed towards the sustainability of the intervention [61]. Consequent with these findings, in our systematic review, but five studies [9, 46, 47, 52, 53] reported a pre-existing framework used to ensure the sustainment of the EBI. Our findings support that studies evaluating sustainment strategies are limited. Therefore, information technology is believed that this underreporting may even farther lengthen the research-practice gap.

Understanding factors related to the implementation of prove-based public wellness interventions has been of significant scholarly attention in recent years [23, 62,63,64]. Yet, lack of proper conceptualization of sustainment from the outset seems to accept bandage a shadow over farther evolution of the field. In majorities of the included studies, sustainment was equated with the continuation of a program or an intervention later on a divers period of fourth dimension [9, 43, 44, 49,fifty,51,52,53]. Although sustainment is widely best-selling as relevant, consequent with what was reported earlier [20], efforts to explicitly define the concept take been found minimal in this systematic review, with only vii studies presenting a definition of sustainability somewhere in the text. This review underscores the apparent need for including a clear and unequivocal definition of the concept of sustainment in the context of public health evidence-based interventions.

Previous studies have identified multiple hindering factors to the sustainment of EBIs in customs-based settings. These include lack of funding, leadership challenges, unfavorable organizational climate, nature of the EBI, inadequate technical assistance, and fidelity monitoring [65, 66]. In this systematic review, 19 studies reported hindering factors related to the sustainment of EBIs. The challenges reported in those studies were also consistent with what was previously reported. Integrating a born machinery to accost leadership challenges and tailoring technical help to provide community stakeholders with the tools to adapt EBIs with or without the EBI developers may be relevant. Moreover, equipping community-based organizations with the skills to identify potential funding sources that can support the continuation of the plan after a certain flow might exist important for sustaining EBIs in these settings.

No RCTs or studies with the longitudinal blueprint were identified from low-income countries. At that place remains a need for more knowledge regarding sustainment efforts of EBIs across LMICs. In part, this could be attributable to the expensive nature of designing and conducting RCTs in resource-constrained settings. Most LMICs generally have express primary research, and most evidence-based interventions are resources intensive, requiring structural and financial provisions [67].

Limitations

While the reported results carry important implications for public health enquiry, we should consider limitations to our systematic review. The review only included studies of sustainability published in peer-reviewed literature. "Gray literature" and unpublished literature were excluded, presenting potential publication bias. We only reviewed studies focused on public health interventions. Studies related to contexts outside of public health interventions were not included, potentially overlooking further details to inform the concept of sustainability. Hereafter inquiry should consider reporting the sustainment of EBIs in settings outside public health interventions.

Conclusions

Studies reporting sustainment-related outcomes might benefit from presenting an explicit definition of the concept from the commencement. Amend reporting of the steps followed, frameworks used and adaptations made to sustain the intervention might contribute to standardizing and developing the concept. Moreover, encouraging longitudinal D&I research specially in low-income countries might help strengthen D&I inquiry capacity in these settings.

Availability of data and materials

Systematic review protocol is available from the first author up on request.

Abbreviations

CONSORT:

Consolidated Standards of Reporting Trials

D&I:

Dissemination and implementation

EBI:

Evidence-based interventions

HIC:

High-income countries

LMICs:

Low- and middle-income countries

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RCT:

Randomized controlled trial

STROBE:

Strengthening the Reporting of Observational Studies in Epidemiology

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Acknowledgements

Not applicable.

Funding

This work was supported past the National Institute of Minority Health and Wellness Disparities Middle grant U54MD011227 (PI: C. Debra Furr-Holden).

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Affiliations

1. Higher of Human being Medicine, Partitioning of Public Health, Michigan State Academy, Flint, MI, USA

   Maji Hailemariam, Barrett Montgomery, Rolando Barajas & Luther B. Evans

2. Department of Psychology, Michigan State University, East Lansing, MI, Usa

   Tatiana Bustos & Amy Drahota

3. Community-Based Organizational Partners (CBOP), Flint, MI, USA

   Luther B. Evans

4. Child & Adolescent Services Enquiry Center (CASRC), San Diego, CA, USA

   Amy Drahota

Contributions

Advertizement drafted the systematic review protocol. MH and TB contributed to the protocol. MH and TB did the search, merged the information, removed the duplicates, and reviewed the championship and abstracts of the studies. MH, AD, LE, and TB did the initial full-text review. MH, Ad, TB, BM, and RB conducted the second round of the review and coding of the themes. MH drafted the manuscript. All authors reviewed, contributed, and approved the last manuscript.

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Correspondence to Maji Hailemariam.

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Hailemariam, M., Bustos, T., Montgomery, B. et al. Testify-based intervention sustainability strategies: a systematic review. Implementation Sci 14, 57 (2019). https://doi.org/ten.1186/s13012-019-0910-6

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• Received: xv January 2019

• Accepted: 27 May 2019

• Published: 06 June 2019

• DOI : https://doi.org/10.1186/s13012-019-0910-6

Keywords

• Sustainment
• Sustainability
• Evidence-based interventions
• Sustainment outcomes

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