"We Have a Moral Commitment to the Community to Sustain It": Exploring Determinants of Strategy Sustainment After the HEALing Communities Study.

BACKGROUND

Opioid overdoses are a pervasive public health crisis. Overdose education and naloxone distribution (OEND), and medications for opioid use disorder (MOUD) are evidence-based practices (EBPs) that can reduce opioid-related deaths. The HEALing Communities Study (HCS) worked with coalitions of community partner organizations during the Communities That HEAL (CTH) intervention to increase OEND and MOUD access. This study aims to explore how EBP strategies, or the mechanisms by which EBPs were delivered, were sustained after the study ended.

METHOD: Interviews with representatives from organizations who participated in the implementation of an OEND and/or MOUD EBP strategy were conducted 6-8 months after the HCS intervention period to understand how the EBP strategies had been adapted, maintained, or discontinued. A total of 135 interviews were transcribed, coded, and analyzed to identify the barriers and facilitators to sustainment.

RESULTS

We identified five themes related to the sustainment of EBP strategies after the end of the HCS intervention period. Our findings highlight the importance of (a) organizational capacity building, (b) collaboration and partnership between implementing organizations, (c) integration of EBP strategies into routine care during the study, (d) adaptation of services after the intervention to better respond to evolving community needs, and (e) community support for the implementation of EBP strategies.

CONCLUSION

Future studies should explore how explicit attention to capacity building, collaboration within and between community agencies, and opportunities for adapting EBPs to better fit the needs and contexts of communities may facilitate sustainment of effective EBP strategies in other public health contexts.

CLINICALTRIALSGOV IDENTIFIER: NCT0411939.