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Evidence-Based Disability and Disease Prevention for Elders

Making New Programs Last


Marcia G. Ory, Ph.D., M.P.H., Professor, Social and Behavioral Health, School of Rural Public Health, Texas A&M University, College Station, TX.

What Factors Influence Whether a Community-based Program for Older Adults Can Be Sustained Over Time?

The following factors were cited:

  • Planning upfront for sustainability.
  • Creating realistic time frames.
  • Including participant cost sharing as part of the grant.
  • Tapering funding over the life of the grant.
  • Partnering with other agencies to leverage resources.
  • Identifying decisionmakers who may control resources both within and outside the partner organizations.

Which Innovative Programs Emanating From Community-based Organizations Will Become Institutionalized and Why?

The Archstone Study examined factors associated with sustainability. Interviews were conducted with leaders of award winning programs to ascertain the status of the program over time. The study found that most programs were still functioning four years after the grant award, that innovative programs needed an organizational infrastructure to survive, and that programs dependent on external grants were the most tenuous.

The study identified the following lessons learned:

  • Seek strong leadership.
  • Involve communities and key stakeholders.
  • Build on a supporting organizational infrastructure.
  • Engage in active outreach and informal marketing.
  • Gather outcome data.
  • Redefine financial self-sufficiency.
  • Recognize and employ principles of behavioral and organizational change.

Another model considers sustainability of innovative projects as a process that includes:

  • Preparation:
    • Thinking about sustainability before the project begins and developing a sustainability plan.
    • Confirming a commitment by the organization to sustaining the project.
    • Establishing shared ownership and partnerships.
    • Obtaining current knowledge of the societal and organizational contexts in which the project exists.
    • Finding a champion to shepherd the project.
  • Application:
    • Ensuring ongoing access to information and supporting resources such as funding opportunities and human resources skills.
    • Addressing intellectual property ownership, use of data, and communications strategies.
  • Resource utilization (both internal and external): ensuring adequate investment and management of both financial and human resources (staff and volunteers).
  • Demonstration of project value: conducting research and data collection to enable proper evaluation of the project.
  • Knowledge transfer:
    • Communicating evaluation findings and success stories to enhance the image of the project and to illustrate who can benefit.
    • Developing effective strategies for communicating this information to key stakeholders, including government officials.

One Model: Sustaining Evidence-based Physical Activity Programs

Dr. Ory discussed the Active for Life® program, which introduces research-based behavioral programs related to physical activity into community settings, provides structured social marketing support, and conducts independent evaluation to measure effectiveness.

Active for Life® grantees are encouraged to develop a sequential sustainability plan that is flexible to individual site preferences and circumstances but that is designed to result in a higher likelihood of the programs becoming institutionalized following the completion of initial grant funding. These plans are designed to include the following steps:

  • Step 1: Address the factors that could influence the sustainability of the program.
  • Step 2: Examine the current and future resources available for program delivery and identify changes that could make the program more sustainable.
  • Step 3: Detail specific action plans to ensure sustainability.

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