ArticleImplementation science : IS2013
The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change.
Article in Implementation science : IS, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 7 registered trials, which are not on this map. Cited by 949 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Compassion Intervention: A Pilot Study of Enhanced Integrated Care for People With Severe Memory Problems
Building and Sustaining Interventions for Children (BASIC): Task-sharing Mental Health Care in Low-resource Settings
Leveraging Routine Clinical Materials and Mobile Technology to Assess CBT Quality
Effectiveness and Implementation of mPATH-CRC: a Mobile Health System for Colorectal Cancer Screening
Participatory System Dynamics vs Audit and Feedback: A Cluster Randomized Trial of Mechanisms of Implementation Change to Expand Reach of Evidence-based Addiction and Mental Health Care
Fulfillment Center Intervention Study as Part of The Harvard T.H. Chan School of Public Health Center for Work, Health and Wellbeing
Leveraging Social Media to Increase Lung Cancer Screening Awareness, Knowledge and Uptake in High-Risk Populations
Who cites it
949 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Implementation Outcomes and Their Determinants for Hospital-Led Care Coordination Interventions Targeting Patients With Complex Care Needs: A Qualitative Systematic Review.Journal of clinical nursing · 2026Pooled it
- Effectiveness and economic impact of interventions targeting healthcare personnel: a systematic review of return on investment.Public health reviews · 2026Pooled it
- Exploring long-term follow-up of effective implementation trials in schools: a secondary review.Frontiers in public health · 2026Pooled it
- What makes community-based, multilevel physical activity promotion last? A systematic review with narrative synthesis on factors for sustainable implementation.Perspectives in public health · 2025Pooled it
- What is fidelity? A systematic review of provider fidelity and its associations with engagement and outcomes in parenting programs.Clinical psychology review · 2025Pooled it
- An analysis of National Cancer Institute-funded scale-up research.Frontiers in health services · 2025Pooled it
- Sustainability of implementation of health-promotion practice in primary healthcare: a non-randomized parallel group study.BMC health services research · 2026Trial
- Sustainment of Four Evidence-Based Treatments for Patients with Psychosis: A Prospective Cohort Study in Norway.Administration and policy in mental health · 2026Trial
- Using co-design to develop actionable strategies to identify and follow-up on breast cancer survivors in primary care.BMC health services research · 2026Trial
- Effectiveness of the Systems Analysis and Improvement Approach to optimise outpatient mental, neurological, and substance-use disorder treatment cascades in Mozambique: a cluster-randomised trial.The lancet. Psychiatry · 2026Trial
- mHealth to support resistance training using outdoor gyms: the ecofit hybrid type 3 implementation-effectiveness trial.Translational behavioral medicine · 2026Trial
- Getting to Implementation: applying data-driven implementation strategies to improve guideline concordant surveillance for hepatocellular carcinoma.Implementation science : IS · 2025Trial
- Effectiveness of Multilevel Implementation Strategies for Autism Interventions: Outcomes of Two Linked Implementation Trials.Journal of the American Academy of Child and Adolescent Psychiatry · 2025Trial
- Scalable physical activity intervention for youth with disability: Burn 2 Learn adapted cluster randomized controlled trial.The international journal of behavioral nutrition and physical activity · 2025Trial
- An Examination of Training Quality and Provider Outcomes Across Two Generations of Train-the-Trainer.Administration and policy in mental health · 2025Trial
- The Content of Usual Clinical Care for Youth with Primary Anxiety Problems.Administration and policy in mental health · 2025Trial
- A randomized trial of adapted versus standard versions of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction implemented via facilitation and delivered by community mental health providers: improving the "fit" of psychological treatments by adapting to context.Implementation science : IS · 2025Trial
- Technology-assisted cognitive-behavioral therapy for perinatal depression delivered by lived-experience peers: a cluster-randomized noninferiority trial.Nature medicine · 2025Trial
- Long-term health conditions and their impact on people with sleep disturbances and dementia.BMC geriatrics · 2025Trial
- Collaborative tailoring of the Reach Out, Stay Strong Essentials (ROSE) program for pregnant veterans in the U.S. Veterans Health Administration: a qualitative case study of contextual conditions and adaptations.BMC health services research · 2025Trial
889 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDespite growth in implementation research, limited scientific attention has focused on understanding and improving sustainability of health interventions. Models of sustainability have been evolving to reflect challenges in the fit between intervention and context. DISCUSSION: We examine the development of concepts of sustainability, and respond to two frequent assumptions -'voltage drop,' whereby interventions are expected to yield lower benefits as they move from efficacy to effectiveness to implementation and sustainability, and 'program drift,' whereby deviation from manualized protocols is assumed to decrease benefit. We posit that these assumptions limit opportunities to improve care, and instead argue for understanding the changing context of healthcare to continuously refine and improve interventions as they are sustained. Sustainability has evolved from being considered as the endgame of a translational research process to a suggested 'adaptation phase' that integrates and institutionalizes interventions within local organizational and cultural contexts. These recent approaches locate sustainability in the implementation phase of knowledge transfer, but still do not address intervention improvement as a central theme. We propose a Dynamic Sustainability Framework that involves: continued learning and problem solving, ongoing adaptation of interventions with a primary focus on fit between interventions and multi-level contexts, and expectations for ongoing improvement as opposed to diminishing outcomes over time. SUMMARY: A Dynamic Sustainability Framework provides a foundation for research, policy and practice that supports development and testing of falsifiable hypotheses and continued learning to advance the implementation, transportability and impact of health services research.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.