Wong Dylan Randall, Schaper Holle, Saldana Lisa
Oregon Social Learning Center, Eugene, OR, USA.
Implement Sci Commun. 2022 Jan 5;3(1):2. doi: 10.1186/s43058-021-00250-6.
Sustainment is a desirable outcome of implementation, but its precise definition remains unclear, contributing to the difficulty of identifying a generalized rate of sustainment. Several studies and reviews on the topic differ on both definition and levels of analysis. Furthermore, methodological limitations might have influenced the results, including the unknown quality with which some interventions were delivered. The Universal Stages of Implementation Completion (UniSIC) is a standardized measurement tool that tracks the implementation process and milestone completion across a wide range of real-world implementations-this provides a unique opportunity to identify a generalized rate of sustainment.
UniSIC data was captured from the SIC website on 27 September 2020 and included data from all sites (n = 1778) that had been tracked to date. Data were restricted to sites that achieved competency in program delivery, and thus had a newly adopted program worthy of sustainment. Dates and indicator variables of implementation activities were combined to form two alternate definitions of sustainment: sustained (start-up) was achieved if sites continued to deliver services 2 years past their program start-up date; sustained (competent) was achieved if sites continued to deliver services 2 years past their competence and/or certification date. Of sites eligible for inclusion based on these definitions (N = 208), descriptive analyses were conducted to determine a rate of sustainment for all programs that successfully started a program. These definitions were also applied to a combined sample for a general rate of sustainment among all sites. Rates of competency among both a sample of sites that started up and a combined sample were also identified.
The rate of competence was 58.5% and the rate of sustained (start-up) was 37.1%, while the rate of sustained (competent) was 25.1%. The rates of competence and sustainment among the combined samples were far lower: 15.6% for competence, 6.8% for sustained (start-up), and 4.4% for sustained (competent).
These identified rates of sustainment are accurate initial estimates of sustainment of community-based practices, or in general. Future research on rates of sustainment should carefully define measures of sustainment and be transparent about the real-world conditions on which analyses are centered.
可持续性是实施工作所期望达成的结果，但其确切定义仍不明确，这导致难以确定一个普遍适用的可持续率。关于该主题的多项研究和综述在定义及分析层面上存在差异。此外，方法学上的局限性可能影响了研究结果，包括某些干预措施实施质量的未知性。通用实施完成阶段（UniSIC）是一种标准化测量工具，可跟踪广泛的实际实施过程及里程碑的完成情况——这为确定一个普遍适用的可持续率提供了独特契机。
2020年9月27日从SIC网站获取了UniSIC数据，其中包括截至当时已被跟踪的所有站点（n = 1778）的数据。数据仅限于那些在项目实施方面达到能力要求、因而有一个新采用且值得维持的项目的站点。实施活动的日期和指标变量被合并起来，形成了可持续性的两种替代定义：如果站点在其项目启动日期之后持续提供服务达2年，则实现了持续（启动）；如果站点在其达到能力和/或获得认证日期之后持续提供服务达2年，则实现了持续（胜任）。对于基于这些定义符合纳入条件的站点（N = 208），进行了描述性分析，以确定所有成功启动项目的可持续率。这些定义也应用于一个综合样本，以确定所有站点的总体可持续率。还确定了启动站点样本和综合样本中的胜任率。
胜任率为58.5%，持续（启动）率为37.1%，而持续（胜任）率为25.1%。综合样本中的胜任率和可持续率要低得多：胜任率为15.6%，持续（启动）率为6.8%，持续（胜任）率为4.4%。
这些确定的可持续率是对基于社区的实践或总体实践可持续性的准确初步估计。未来关于可持续率的研究应仔细定义可持续性的衡量标准，并对分析所基于的实际情况保持透明。
