Assessment of the Sustainability Capacity of a Coordinated Approach to Chronic Disease Prevention.

OBJECTIVE: This article outlines some factors that influenced the sustainability capacity of a coordinated approach to chronic disease prevention in state and territory health departments. DESIGN: This study involved a cross-sectional design and mixed-methods approach. Quantitative data were collected using the Program Sustainability Assessment Tool (PSAT), a 40-item multiple-choice instrument that assesses 8 domains of sustainability capacity (environmental support, funding stability, partnerships, organizational capacity, program evaluation, program adaptation, communications, and strategic planning). Qualitative data were collected via phone interviews. PARTICIPANTS: The PSAT was administered to staff and stakeholders from public health departments in 50 US states, District of Columbia, and Puerto Rico, who were involved in the implementation of coordinated chronic disease programs. Phone interviews were conducted with program coordinators in each state. MAIN OUTCOME MEASURE(S): Sustainability score patterns and state-level categorical results, as well as strengths and opportunities for improvement across the 8 program sustainability domains, were explored. RESULTS: On average, programs reported the strongest sustainability capacity in the domains of program adaptation, environmental support, and organizational capacity, while funding stability, strategic planning, and communications yielded lowest scores, indicating weakest capacity. Scores varied the most by state in environmental support and strategic planning. CONCLUSION: The PSAT results highlight the process through which states approached the sustainability of coordinated chronic disease initiatives. This process included an initial focus on program evaluation and partnerships with transfer of priority to long-term strategic planning, communications, and funding stability to further establish coordinated chronic disease efforts. Qualitative interviews provided further context to PSAT results, indicating that leadership, communications, partnerships, funding stability, and policy change were perceived as keys to success of the transition. Integrating these findings into future efforts may help those in transition establish greater sustainability capacity. The PSAT results and interviews provide insight into the capacity for sustainability for programs transitioning from traditional siloed programs to coordinated chronic disease programs.

Assessing the sustainability capacity of evidence-based programs in community and health settings.

Background: Within many public health settings, there remain large challenges to sustaining evidence-based practices. The Program Sustainability Assessment Tool has been developed and validated to measure sustainability capacity of public health, social service, and educational programs. This paper describes how this tool was utilized between January 2014 and January 2019. We describe characteristics of programs that are associated with increased capacity for sustainability and ultimately describe the utility of the PSAT in sustainability research and practice. Methods: The PSAT is comprised of 8 subscales, measuring sustainability capacity in eight distinct conceptual domains. Each subscale is made up of five items, all assessed on a 7-point Likert scale. Data were obtained from persons who used the PSAT on the online website (https://sustaintool.org/), from 2014 to 2019. In addition to the PSAT scale, participants were asked about four program-level characteristics. The resulting dataset includes 5,706 individual assessments reporting on 2,892 programs. Results: The mean overall PSAT score was 4.73, with the lowest and highest scoring subscales being funding stability and program adaptation, respectively. Internal consistency for each subscale was excellent (average Cronbach's alpha = 0.90, ranging from 0.85 to 0.94). Confirmatory factor analysis highlighted good to excellent fit of the PSAT measurement model (eight distinct conceptual domains) to the observed data, with a comparative fit index of 0.902, root mean square error of approximation equal to 0.054, and standardized root mean square residual of 0.054. Overall sustainability capacity was significantly related to program size (F = 25.6; p < 0.001). Specifically, smaller programs (with staff sizes of ten or below) consistently reported lower program sustainability capacity. Capacity was not associated with program age and did not vary significantly by program level. Discussion: The PSAT maintained its excellent reliability when tested with a large and diverse sample over time. Initial criterion validity was explored through the assessment of program characteristics, including program type and program size. The data collected reinforces the ability of the PSAT to assess sustainability capacity for a wide variety of public health and social programs.

Development of a bioluminescent ATP assay to quantify mammalian and bacterial cell number from a mixed population.

Modification of biomaterial surfaces is one approach aimed at improving cellular interactions and the subsequent integration of medical devices into the body. However, by optimising surfaces to enhance mammalian cell adhesion there is the potential risk that adhesion of bacteria will also be increased. Bacterial colonisation of biomaterials can be problematic as infection often results in morbidity and the consequent removal of the failing device from the body. Currently, quantifying cellular adhesion from a mixed population of bacterial and mammalian cells can only be determined by slow and laborious methods such as microscopy. ATP is a key molecule in the metabolism of both mammalian and bacterial cells and can be used to quantify cell numbers. In this study, we have modified a bioluminescence-based ATP assay to enable the differential measurement of both mammalian and bacterial cell ATP levels within the same culture. Mixed populations of Staphylococcus epidermidis and 3T3 fibroblasts were assessed both in suspension and adhered to a surface. ATP levels from cultures in suspension were selectively extracted and measured from both cell types, revealing a linear trend that would enable the differentiation of cell numbers from a mixed population. The application of the assay to adhered mixed cultures also allowed differences in ATP levels from both cell types to be distinguished. The data presented reveals that this assay would be useful for the rapid screening of cellular adhesion to modified surfaces although, its use in detecting subtle differences in ATP levels may be limited due to natural interactions between the two cell types.