Improving the Sustainability of Public Health Interventions: The INNOVATE Model

Abstract Introduction Improving the sustainability of public health interventions is a priority for policymakers and program implementers. However, existing theories, models, and frameworks focus on describing constructs, processes, and measures of sustainability. Models to guide the improvement of sustainability of public health interventions are currently lacking. Objective To develop an evidence-based model that can systematically guide the improvement of the sustainability of public health interventions. Methods We used a systematic and multi-stage approach to iteratively develop the model. A narrative review of the sustainability literature identified key constructs relevant to the improvement mechanisms of sustainability. Identified constructs were then developed into stages and activities. We applied the resulting model to guide development of improvement strategies in four public health interventions in Southeast Asia, verifying the applicability of the model to real-life contexts. Findings Evidence from 8 systematic reviews; 60 theories, models, and frameworks of sustainability; and 24 measures of sustainability, were used to develop the model. Expert review and real-world evaluation further refined the model. The resulting INNOVATE model has eight stages: Identify the mechanisms; Narrate determinants; Navigate strategies; Optimize the acquisition of resources; Validate strategies; Apply strategies; Tailor evaluation of the strategies; and Enhance the applied strategies and their implementation. Within each stage, there are five activities (IDEAL): Inform with quality evidence; Dedicate efforts to nurture local leaders/champions; Engage relevant stakeholders; Adapt to the local context; and Leverage tacit and local knowledge. The initial model was used to identify practical strategies for improving the sustainability of four public health interventions in Southeast Asia. Conclusion By applying the five activities within each of the eight stages, the INNOVATE model can systematically guide the improvement of the sustainability of public health interventions.