Measuring sustainability in several health services interventions: An application and expansion of the Levels of Institutionalization (LoIn) Scales

This presentation addresses the issue of sustainability, that is, many interventions are disseminated but very few actually become part of the functioning of an organization. To address this concern, the presentation provides an analysis of the use of the Level of Institutionalization (LoIn) Scales (Goodman, McLeroy, Steckler, and Hoyle, 1993) and recommendations for changes in its structure and implementation. The LoIn Scales for health promotion programs was used to assess the sustainability of asthma interventions in primary care centers, schools, pharmacies, and community outreach organizations. The application was part of the five year Controlling Asthma in St. Louis project, which was one of seven components of the Controlling Asthma in American Cities program sponsored by the CDC. The validity of the scales is assessed with regard to the conceptualization of institutionalization (passage, routinization, and saturation), the aspects of the four subsystems measured by the scale (production, maintenance, supportive, and managerial), implementation sites and interventions, and the number of years that the implementation was in place. Employing a translation and dissemination model for health interventions (Brownson, 2006) and Rogers (1995) diffusion of innovation theory, the LoIn scales were reconceptualized to include additional indicators that measure changes in the processes of organizational change and improvement, which are believed to be influential in the continued adoption of the intervention and hence, its sustainability.