Dynamic Sustainment of Evidence-Based Health Promotion Interventions in Mental Health

PROJECT ABSTRACT Adults with serious and disabling mental illness (SMI) experience a 15-30 year reduced life expectancy primarily due to modifiable cardiovascular risk factors that can be effectively addressed with behavioral lifestyle interventions. Lifestyle interventions have reduced obesity-related cardiovascular risk in upwards of 50% of adults with SMI in community-based trials, even among those taking antipsychotic medications; however, these interventions are rarely sustained once research projects are completed. This later stage translational study focuses on long-term sustainment of an evidence-based lifestyle intervention (InSHAPE) implemented in U.S. mental health organizations where integrated health promotion is not necessarily part of the core mission, but is critical to stem the tide of early mortality in adults with SMI. InSHAPE is the only lifestyle intervention for adults with SMI that has been tested multiple times with health benefits replicated in two RCTs and a statewide and national implementation study. There has yet to be an investigation of long-term sustainment of InSHAPE or any other evidence-based health promotion interventions for adults with SMI in mental health organizations. From 2014-2019, our team led an NIMH-funded type 3 hybrid effectiveness-implementation study of InSHAPE in mental health organizations across the U.S. In 2023, 14 (36%) of 39 organizations that completed our prior implementation study continued to deliver InSHAPE. In the proposed study, we will evaluate long-term sustainment of InSHAPE (6-8 years post-implementation) on two dimensions: 1) sustained delivery of the InSHAPE program, and 2) sustained InSHAPE program health benefits. We will leverage data collected in our prior trial to examine multi-level factors that predict long-term sustainment of InSHAPE at 39 implementation sites; collect new data on contextual factors, adaptations and fidelity to InSHAPE; and collaborate with an existing national network of InSHAPE teams to develop a sustainment practice guide tailored for InSHAPE. While the practice guide will be based on InSHAPE, it will be guided by the Program Sustainability Framework and thus will include key considerations for sustaining evidence-based health promotion programs more broadly in mental health organizations. The proposed study has high public health and implementation science impact as one of the first studies to identify adaptations associated with sustained health promotion interventions while also addressing longstanding assumptions about the ‘voltage drop’ in individual benefits of evidence-based interventions as they move from implementation to sustainment. It is highly innovative and impactful as one of the first studies to use participatory group model building and to leverage a large network of implementation sites to identify factors, including fidelity and adaptation, that influence long-term sustainment of an evidence-based health promotion intervention in mental health organizations and to build on these findings to develop, evaluate, and refine a sustainment practice guide for future research and practice.