Factors contributing to the sustainability of alcohol and other drug interventions in Australian community health settings
Sarah MacLean A B D , Lynda Berends A C and Janette Mugavin AA Turning Point Alcohol and Drug Centre, 54–62 Gertrude Street, Fitzroy, Vic. 3065, Australia.
B Centre for Health and Society, School of Population Health, University of Melbourne, Vic. 3010, Australia.
C Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Vic. 3168, Australia.
D Corresponding author. Email: sarah.maclean@turningpoint.org.au
Australian Journal of Primary Health 19(1) 53-58 https://doi.org/10.1071/PY11136
Submitted: 3 November 2011 Accepted: 28 December 2011 Published: 30 January 2012
Abstract
This study identifies factors that support the sustainability of interventions implemented to enhance responses to alcohol and other drug misuse in Australian community health settings. Eight completed projects that had received time-limited funding were sampled to reflect a mix of project types, contexts and success in meeting funding objectives. Projects were investigated using a case study approach involving thematic analysis. Project records were analysed and interviews were conducted with stakeholders to identify intervention elements that continued after funding ceased, and factors that supported this sustainability. Key factors identified were: embedding changes in the operations of the agency; filling a critical gap in the sector; building support from key individuals and agencies; and planning realistically for future ownership. We argue that complexity theory provides a framework to understand both the context-bound nature of intervention sustainability and differences within the literature as to how sustainability is typologised. Each factor associated with intervention sustainability identified in this study reflects an astute understanding of project context and a capacity to adapt. These factors could assist people designing interventions with time-limited funding to maximise ongoing impact of interventions. They should optimally be implemented within an overall approach of flexibility and sensitivity to context.
Additional keywords: complexity theory, prevention, substance misuse, treatment.
References
Baum F, Jolley G, Hicks R, Saint K, Parker S (2006) What makes for sustainable Healthy Cities initiatives? – a review of the evidence from Noarlunga, Australia after 18 years. Health Promotion International 21, 259–265.| What makes for sustainable Healthy Cities initiatives? – a review of the evidence from Noarlunga, Australia after 18 years.Crossref | GoogleScholarGoogle Scholar | 16849380PubMed |
Brinkerhoff RO (2003) ‘The success case method.’ (Berrett Koehler: San Francisco, CA)
Byrne D (2003) Complexity theory and planning theory: a necessary encounter. Planning Theory 2, 171–178.
| Complexity theory and planning theory: a necessary encounter.Crossref | GoogleScholarGoogle Scholar |
Harvey G, Hurworth R (2006) Exploring program sustainability: identifying factors in two educational initiatives in Victoria. Evaluation Journal of Australasia 1, 36–44.
Higgins JW, Naylor PJ, Day M (2008) Seed funding for health promotion: sowing sustainability or skepticism? Community Development Journal 43, 210–221.
| Seed funding for health promotion: sowing sustainability or skepticism?Crossref | GoogleScholarGoogle Scholar |
Holder HD, Moore RS (2000) Institutionalization of community action projects to reduce alcohol-use related problems: systematic facilitators. Substance Use & Misuse 35, 75–86.
| Institutionalization of community action projects to reduce alcohol-use related problems: systematic facilitators.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c7kt1eltA%3D%3D&md5=d9755956a9fe64fd3e3f36694fbca97cCAS |
Hunter B, MacLean S, Berends L (2012) Using realist synthesis to develop an evidence base from an identified data set on enablers and barriers for alcohol and drug program implementation. The Qualitative Report 17, 131–142.
Innes JE, Booher DE (2000) Indicators for sustainable communities: a strategy building on complexity theory and distributed intelligence. Planning Theory & Practice 1, 173–186.
| Indicators for sustainable communities: a strategy building on complexity theory and distributed intelligence.Crossref | GoogleScholarGoogle Scholar |
Johnson K, Hays C, Center H, Daley C (2004) Building capacity and sustainable prevention innovations: a sustainability planning model. Evaluation and Program Planning 27, 135–149.
| Building capacity and sustainable prevention innovations: a sustainability planning model.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2cXmsVKgtro%3D&md5=39bdecb50cd96ec50de5dbd0369e9ab7CAS |
MacLean S, Berends L, Hunter B, Roberts B, Mugavin J (2012) Factors that enable and hinder implementation of projects in the alcohol and other drug field. Australian and New Zealand Journal of Public Health
| Factors that enable and hinder implementation of projects in the alcohol and other drug field.Crossref | GoogleScholarGoogle Scholar | 22313708PubMed |
Miles MB, Huberman AM (1994) ‘Qualitative data analysis: an expanded sourcebook. 2nd edn.’ (Sage: Newbury Park, CA)
Mitleton-Kelly E (2011) A complexity theory approach to sustainability: a longitudinal study in two London NHS hospitals. The Learning Organization 18, 45–53.
| A complexity theory approach to sustainability: a longitudinal study in two London NHS hospitals.Crossref | GoogleScholarGoogle Scholar |
Pluye P, Potvin L, Denis J-L (2004) Making public health programs last: conceptualizing sustainability. Evaluation and Program Planning 27, 121–133.
| Making public health programs last: conceptualizing sustainability.Crossref | GoogleScholarGoogle Scholar |
Savaya R, Elsworth G, Rogers P (2009) Projected sustainability of innovative social programs. Evaluation Review 33, 189–205.
| Projected sustainability of innovative social programs.Crossref | GoogleScholarGoogle Scholar | 18708528PubMed |
Scheirer MA (2005) Is sustainability possible? A review and commentary on empirical studies of program sustainability. American Journal of Evaluation 26, 320–347.
| Is sustainability possible? A review and commentary on empirical studies of program sustainability.Crossref | GoogleScholarGoogle Scholar |
Shediac-Rizkallah MC, Bone LR (1998) Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. Health Education Research 13, 87–108.
| Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c3jvVKitA%3D%3D&md5=878d619977795a7fd9330f30a774a54bCAS | 10178339PubMed |
Spooner C, Dadich A (2008) ‘Non-government organisations in the alcohol and other drugs sector. Issues and options for sustainability.’ (Australian National Council on Drugs: Canberra)
Stake RE (1998) Case studies. In ‘Strategies of qualitative inquiry’. (Eds YS Lincoln, NK Denzin) pp. 86–106. (Sage Publications: Thousand Oaks, CA)
Swerissen H, Crisp BR (2004) The sustainability of health promotion interventions for different levels of social organization. Health Promotion International 19, 123–130.
| The sustainability of health promotion interventions for different levels of social organization.Crossref | GoogleScholarGoogle Scholar | 14976180PubMed |
Taylor J, Blue I, Misan G (2001) Approach to sustainable primary health care service delivery for rural and remote South Australia. The Australian Journal of Rural Health 9, 304–310.
| Approach to sustainable primary health care service delivery for rural and remote South Australia.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD383lvVaksw%3D%3D&md5=4291ed2d8b6de18123f202e23a8f917eCAS | 11998266PubMed |
