Prevention Research Center, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA.
Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
Implement Sci. 2024 Feb 2;19(1):9. doi: 10.1186/s13012-024-01340-4.
Public health programs are charged with implementing evidence-based interventions to support public health improvement; however, to achieve long-term population-based benefits, these interventions must be sustained. Empirical evidence suggests that program sustainability can be improved through training and technical assistance, but few resources are available to support public health programs in building capacity for sustainability.
This study sought to build capacity for sustainability among state tobacco control programs through a multiyear, group-randomized trial that developed, tested, and evaluated a novel Program Sustainability Action Planning Model and Training Curricula. Using Kolb's experiential learning theory, we developed this action-oriented training model to address the program-related domains proven to impact capacity for sustainability as outlined in the Program Sustainability Framework. We evaluated the intervention using a longitudinal mixed-effects model using Program Sustainability Assessment (PSAT) scores from three time points. The main predictors in our model included group (control vs intervention) and type of dosage (active and passive). Covariates included state-level American Lung Association Score (proxy for tobacco control policy environment) and percent of CDC-recommended funding (proxy for program resources).
Twenty-three of the 24 state tobacco control programs were included in the analyses: 11 received the training intervention and 12 were control. Results of the longitudinal mixed-effects linear regression model, where the annual PSAT score was the outcome, showed that states in the intervention condition reported significantly higher PSAT scores. The effects of CDC-recommended funding and American Lung Association smoke-free scores (proxy for policy environment) were small but statistically significant.
This study found that the Program Sustainability Action Planning Model and Training Curricula was effective in building capacity for sustainability. The training was most beneficial for programs that had made less policy progress than others, implying that tailored training may be most appropriate for programs possibly struggling to make progress. Finally, while funding had a small, statistically significant effect on our model, it virtually made no difference for the average program in our study. This suggests that other factors may be more or equally important as the level of funding a program receives.
gov, NCT03598114. Registered on July 26, 2018.
公共卫生计划承担着实施循证干预措施以支持公共卫生改善的任务；然而，为了实现基于人群的长期效益，这些干预措施必须得到持续实施。实证证据表明，培训和技术援助可以提高计划的可持续性，但很少有资源可用于支持公共卫生计划建立可持续性能力。
本研究通过一项多年期、分组随机试验，旨在为州级烟草控制计划建立可持续性能力，该试验开发、测试和评估了一种新颖的“计划可持续性行动计划规划模型”和培训课程。我们利用科尔布的体验式学习理论，制定了这个面向行动的培训模式，以解决计划可持续性框架中确定的与可持续性能力相关的计划领域。我们使用三个时间点的计划可持续性评估（PSAT）分数，采用纵向混合效应模型评估干预措施。我们的模型中的主要预测因子包括组（对照组与干预组）和剂量类型（主动和被动）。协变量包括州级美国肺协评分（代表烟草控制政策环境）和疾控中心建议资金的百分比（代表计划资源）。
24 个州级烟草控制计划中有 23 个参与了分析：11 个接受了培训干预，12 个为对照组。纵向混合效应线性回归模型的结果显示，干预组的州报告的 PSAT 得分显著更高。疾控中心建议资金和美国肺协无烟评分（代表政策环境）的影响较小，但具有统计学意义。
本研究发现，“计划可持续性行动计划规划模型”和培训课程在建立可持续性能力方面是有效的。培训对政策进展不如其他州的计划最有益，这表明针对可能难以取得进展的计划进行量身定制的培训可能是最合适的。最后，尽管资金对我们的模型有较小但具有统计学意义的影响，但对我们研究中的平均计划几乎没有影响。这表明其他因素可能比一个计划收到的资金水平更重要或同等重要。
gov，NCT03598114。2018 年 7 月 26 日注册。
