Table 1 Definitions/operationalisations of emerging factors in the Integrated Sustainability Framework
Constructs and emerging factors | Definitions/operationalisations | Source |
|---|---|---|
Outer setting | The external contextual factors that may influence the sustainability of interventions | Adapted from Shelton et al. [12] |
Policy and legislation | External policy and legislation (governmental or other central entity) to spread interventions | Adapted from CFIR [18] (External Policies and Incentives) |
Socio-political context | The influence of the local context in which the intervention is delivered | Adapted from Shelton et al. [12] |
Funding environment | The availability and stability of additional external or on-going funding necessary to deliver an intervention beyond the implementation period | Definition developed by authors |
Leadership | The influence of external leadership (e.g., government, senior manager/executives of health services or hospitals) to the setting in which the intervention is delivered | Definition developed by authors |
Values, priorities, needs | The degree of fit between intervention activities and the values, priorities, and needs of stakeholders (e.g., policymakers, health departments, communities/society and populations) | Definition developed by authors |
Community ownership | Levels of community support and trust in the intervention | Adapted from Shelton et al. [12] |
Inner setting | Organisational factors that may influence the sustainability of interventions | Adapted from Shelton et al. [12] |
Funding/resources | The availability of resources dedicated to intervention delivery, e.g., funding for staff, equipment, consumables, staff training | Adapted from CFIR [18] (Available resources) |
Leadership/support | Active participation in and accountability to intervention delivery by leaders and managers | Adapted from CFIR [18] (Leadership engagement) |
Climate/culture | Climate: “The absorptive capacity for change, shared receptivity of involved individuals to an intervention, and the extent to which use of that intervention will be rewarded, supported, and expected within their organisation.” Culture: “Norms, values, and basic assumptions of a given organisation” | Direct quotation from CFIR [18] (Implementation climate and Culture) |
Staffing/turnover | The degree of stability of the organisation’s workforce as it relates to the delivery of the intervention | Definition developed by authors |
Structural characteristics | The social and functional characteristics of an organisation | Adapted from CFIR [18] |
Capacity | The organisational availability of resources necessary to deliver an intervention (additional to cost of the intervention – see below) | Definition developed by authors |
Champion | An individual who commits themselves to steering the implementation of an intervention and overcoming organisational resistance | Adapted from CFIR [18] |
Policy (alignment) | The degree of fit between intervention activities and internal organisational policy | Definition developed by authors |
Intervention Characteristics | The key attributes of interventions that may influence the sustainability of interventions | Adapted from CFIR [18] |
Adaptability | “The degree to which an intervention can be adapted, tailored, refined, or reinvented to meet local needs” | Direct quotation from CFIR [18] |
Fit with population and context | “The degree of tangible fit between meaning and values attached to the intervention by involved individuals, how those align with individuals’ own norms, values, and perceived risks and needs, and how the intervention fits with existing workflows and systems” | Direct quotation from CFIR [18] (Compatibility) |
Benefits/need | “Perceived benefit/need” of the intervention | Adapted from Shelton et al. [12] |
Burden/complexity | “Perceived difficulty of implementation, reflected by duration, scope, radicalness, disruptiveness, centrality, and intricacy, and number of steps required to implement” | Direct quotation from CFIR [18] |
Trialability | “The ability to test the intervention on a small scale in the organisation, and to be able to reverse course (undo implementation) if warranted” | Direct quotation from CFIR [18] |
Cost | “Costs of the intervention and costs associated with implementing and sustaining the intervention including investment, supply, and opportunity costs” | Direct quotation from CFIR [18] |
Processes | Key components of the processes that may influence the sustainability of interventions | Definition developed by authors |
Partnership/engagement | The use of collaborative partnerships and stakeholder engagement to support the implementation and sustainability of an intervention | Adapted from Shelton et al. [12] |
Training/support/supervision | Provision of staff and implementer training, support and supervision to facilitate implementation and sustainment | Definition developed by authors |
Fidelity | “The degree to which an intervention or program is delivered as intended” | Direct quote from Carroll et al. [19] |
Adaptation | “The degree to which an evidence-based intervention is changed to fit the setting or to improve fit to local conditions” | Direct quote from Shelton et al. [12] |
Planning | “The degree to which a scheme or method of behaviour and tasks for implementing and sustaining an intervention are developed in advance, and the quality of those schemes or methods” | Direct quotation from CFIR [18] |
Team/board functioning | The extent and quality of collaborative and functioning relationships of the teams and boards involved in implementation and sustainment of interventions | Definition developed by authors |
Program evaluation/data | The use of evaluation and data to provide feedback on performance and outcomes to be used to support processes for implementation and sustainability | Definition developed by authors |
Communication | The extent and quality of communication about the intervention and its implementation among involved stakeholders | Definition developed by authors |
Technical assistance | Availability of technical assistance to support the implementation and sustainment of interventions | Definition developed by authors |
Capacity building | “Activities that build durable resources and enable the recipient community to continue the delivery of an evidence-based intervention” | Direct quotation from Shelton et al. [12] |
Implementer and population characteristics | Attributes of implementers and population that may influence the sustainability of interventions | Definition developed by authors |
Provider/implementer characteristics | Attributes of the provider/implementer of the intervention | Definition developed by authors |
Implementation skills/expertise | The implementation skills and expertise of the individuals involved in the implementation | Definition developed by authors |
Implementer attitudes | General attitudes of the implementing group towards the intervention | Definition developed by authors |
Implementer motivation | The degree to which implementers are motivated (willing) to implement and sustain the intervention. This construct relates to organisational readiness for change which refer to organisational members’ motivation and capability (i.e., being willing and able) to implement intentional organisational change | Adapted from Weiner et al. [17] |
Population characteristics | Attributes of the population which the intervention targets | Definition developed by authors |