Table 2.

Themes and illustrative quotes identified from each of the eight domains from the Program Sustainability Framework

Sustainability Domain	Description	High-capacity LHDs	Low-Capacity LHDs
Environmental Support	Having a supportive internal and external climate for your program	“Public health is whatever the legislature says it is. So if they want us sampling beach water and give us money to do that, then that's what we will do. Whether there's any benefit to that or not, is not our decision, if that makes sense.”	“We've mostly received a lot of opposition in the political climate for our programs, and even though we're able to show that they are evidence-based, and what we're trying to do really does help in the long run, people find it as intruding on their personal rights.”
Funding Stability	Establishing a consistent financial base for your program (meeting long-term needs, adjusting to changing trends, having a plan)	“So we’re not the best paying agency in the world. I hate to say that. And I don’t have a lot of control over that. Not the best paying agency in the world, so we have to take what we can get, sometimes.” “They're willing to spend the money, if need be, or reach out to others in the community.”	“Because we do not have latitude in how we spend money, I think there are probably… it probably impedes our ability to think about solutions to problems that could be affected had we been able to obtain and sustain.”
Partnerships	Cultivating connections between your program and its stakeholders (connecting to greater resources/expertise, taking over providing services, advocating for the cause)	“We have to have collaborative people in there. Without them, we just couldn’t achieve a third of what we achieve.”	“There’s no way we could do it on our own. No way. You have to have the community, you have to have the community partners, because if it’s community, then that means you don’t do it by yourself.” “If you’re not doing it, you’re assured that someone else is doing it.”
Organizational Capacity	Having the internal support and resources needed to effectively manage your program	“Our director and our senior management team [….] have to be of a mind to where we prioritize the evidence-based needs above other pet projects or other types of needs.” “involve the frontline staff to help us develop the solutions to the problems, so it’s not just us as the managers saying, this is what you have to do. We actually get them involved in the whole process.”	“Sometimes we have support in, yes, we would like for you to do that. We think that's great, but time is limited, our funds are limited, and this is what you have to work with.” “If we had more personnel and more resources and more funding, we could be better equipped to implement evidence-based practices always. We have a hard time ever doing any evaluation, just because of limited resources.”
Program Evaluation	Assessing your program to inform planning and document results (staying on track with goals/outcomes, collecting data about successes/impact to gain support and funding)	“We plan it, we implement it, we check the data, then we go through the cycle again.” “We now have a standardized quality improvement (QI) process that’s written and each division within the department is asked to participate in one quality assurance project annually.”	“They're not measuring anything, and of course I've only been here two years, and my question is, What are we measuring, and how are we evaluating the program to determine the impact?[….] If we can’t show where the outcomes truly are, are we really making an impact? Is that where we need to be spending our dollars?”
Program Adaptation	Taking actions that adapt your program to ensure its ongoing effectiveness	“We will identify the problem, obviously, and then go through a process by which we evaluate where the issues and the concerns are and then put into place an action plan.” “Usually people are pretty enthusiastic when it comes to something new. And this is kind of our reputation at this particular public health [department?], try it, if it doesn’t work, move on.”	“You’ve got to prove not only that it works other places, but just because something works somewhere else, doesn’t mean that it’s going to work here, in the eyes of a lot of people.” “The evidence-based programs that exist out there may or may not always be the perfect fit for your program and success in it and trying to put everybody into a mold is… we’re all different.” (4.0 EBI Barriers)
Communication	Strategic communication with stakeholders and the public about your program (internal and external)	“There is formal monthly meetings and then there is the dissemination via emails and policies that are posted. I don’t think we ever will just post a policy and say, ‘here’s a new policy.’ No. So we’ll at least send the changes by email and talk about them.” “Our director and our senior management team [….] have to be of a mind to where we prioritize the evidence-based needs above other pet projects or other types of needs.”	“You’ve just got to show it locally that those things are important and that they matter, they work.” “Our culture is pretty clear that wasted energy on non-evidence-based practices and programs is just that, wasted energy, and really not fitting in with our vision and mission.”
Strategic Planning	Using processes that guide your program’s direction, goals, and strategies	“We are very forward thinking and have a vision of where we want this department to go and what we want it to be, I think those are very strong factors in continuing to sustain evidence-based interventions”	“I don't think we've got a systematic way of doing it. I think unfortunately, I have to admit, that it's oftentimes simply forced on us by way of grant opportunities.”