Sustainment has been comparatively less examined than other implementation phases. The concept has also been referred to by varying terms including sustainability, maintenance, continued use, and long-term implementation. In this session, we focus on the concept of “sustainment,” defined as an outcome indicating that an intervention was continued over time. From this definition, we provide an overview of a recent narrative review of sustainment measures, highlight the gaps and opportunities in sustainment measurement, and describe the development and validation of a new 3-item, provider-report scale of evidence-based practice sustainment. The session will close with an interactive exercise that invites audience members to critically evaluate an implementation case study and discuss key considerations for selecting sustainment measures.

Despite many important global public health successes, for many public health problems there is a continued lack of interventions that have been sufficiently scaled up to achieve sustainable and equitable population health improvement. Implementation science approaches have dominated the scale up literature, which typically promote a sequential and mechanistic spread of interventions. Systems change plays a major role in the relation between implementation processes and institutionalization of public health interventions; yet systems approaches remain underutilized in scaling up. This presentation will present evidence from scaled up physical activity and nutrition interventions, to illustrate why reorientating the scale-up discourse to embrace a complex systems perspective has the potential to improve sustainable implementation and impact of population interventions.

Changing the built environment to facilitate active transportation and increase access is recommended to increase physical activity levels. Yet, implementing these complex interventions in community settings is challenging. This session will detail methods to assess barriers and facilitators to built environment approaches and select relevant implementation strategies in two state Cooperative Extension Systems, and next steps for scaling out to additional community organizations through rapid methods.