A comprehensive theory to guide organizational success at adapting and sustaining evidence-based programs to promote healthy aging

Older Americans are disproportionately affected by chronic diseases and conditions. In the last decades, significant attention is being given to expanding the implementation of evidence-based programs, those proven to work, to promote healthy aging. Although federal agencies encourage communities to adapt evidence-based programs, studies on how organizations learn about, adapt, and sustain such programs are limited. Our purpose is to describe the development of a theory-driven framework that can guide organizational adoption of evidence-based programs, as well as the evaluation of an organization's efforts to adopt evidence-based programs. The development of this framework was informed by 5 years of experience with the Hawai'i Healthy Aging Partnership (HHAP), a statewide coalition devoted to replicating evidence-based health promotion programs for older adults, including the Chronic Disease Self-Management Program (CDSMP). We reviewed relevant organizational change theories, as well as the literature on sustainability. We combined elements to develop a comprehensive theoretical model that portrays the process from initiation (identifying programs, making modifications to fit your community, assessing organizational readiness, training) to delivery (coordinating offerings, monitoring fidelity, collecting data, realizing perceived benefits) to sustainment (examining whether the organization sustains, discontinues, or replaces the program). The model also prompts evaluators to investigate factors that support organizational movement from one stage to the next. This framework works well in understanding, guiding, and evaluating adoption and sustainment of healthy aging programs, and may be useful to public health practitioners working in other areas.