Background: Failure to sustain implementation of health interventions has implications on cost and patient care, and diminishes trust and support for future implementation. Even if implementation has a small benefit, sustained implementation can have significant potential impact.
Objectives:To determine if projects funded through National Institutes of Health (NIH) Dissemination and Implementation Research in Health Study Section (DIRH) of the Research Project Grants (R01) considered or planned for sustainability.
Methods: Phase 1: We conducted a document review of all active and completed RO1 grants within the DIRH section in October 2016 using the publicly accessible NIH RePORTER Database. Data including focus of the project, mention of sustainability planning and use of frameworks were abstracted on funded projects and related publications by 2 independent raters. Phase 2: Semi-structured interviews were held with a sample of these funded investigators to explore their understanding of, and how they planned for sustainability, as well as challenges to considering sustainability.
Results:76 implementation science projects were funded between 2004 and 2016. Of these, 26% mentioned sustainability in their NIH RePORTER abstract, 15% mentioned sustainability in their published results, 9% mentioned sustainability in their NIH RePORTER profile and published results, and 50% did not mention sustainability. No project included a definition of sustainability and only one project included a sustainability framework. Eleven investigators were interviewed and all described challenges with considering sustainability in their projects including lack of: clarity on the definition of sustainability; awareness of appropriate frameworks and how to measure sustainability; and, organisational awareness of its importance.
Conclusions: While interest in conducting implementation science has grown, there is a lack of work to advance the science and practice of sustainability of implementation. Addressing this gap is critical to inform implementation practice across health systems.