Leaders' Decisions to Sustain a Peer-Led Healthy Lifestyle Intervention for People with Serious Mental Illness in Supportive Housing

Background & Purpose. Healthy lifestyle interventions that increase physical activity and healthy dietary habits can help improve the physical health of people with serious mental illness. Yet, little is known about how to sustain these interventions in routine practice settings outside of research studies. This study examined the decision-making process of leaders from three supportive housing agencies participating in a clinical trial of a peer-led healthy lifestyle intervention for people with serious mental illness as they began planning for sustaining this intervention after the end of the study. We also explored the mechanisms leaders discussed for helping move these choices into actions.

Methods. Twelve organization leaders participated in this study. A simultaneous mixed methods design was used in which a survey instrument, the Program Sustainability Assessment Tool, was embedded within semi-structured qualitative interviews. Participants were also asked to rank-order the top three sustainability dimensions and top three intervention attributes that would influence their decisions to sustain the healthy lifestyle intervention at their agencies and to explain their choices. Directed content analysis informed our analytical approach.

Results. The intervention attributes most valued by participants suggest that a combination of implementation strategies that address cost concerns, generate local evidence of the intervention’s benefits, and provide ongoing training were important for sustainability. A sustainability model emerged from our analysis illustrating the implementation strategies and their respective mechanisms for supporting the three sustainability domains (funding, organizational capacity and adaptation) prioritized by participants. The model captures leaders’ decisions, priorities and processes for how to best sustain the healthy lifestyle intervention at their agencies.

Conclusions & Implications. Helping organizations close the gap between research and practice is an important priority for reducing health disparities in people with serious mental illness. Our findings provide initial evidence that could inform future studies testing strategies and mechanisms to support the sustainability of interventions in routine practice settings to improve the health of people with serious mental illness.