Researchers spent 10 years testing a program called Med-South that helps people eat better and exercise more through counseling sessions. When their funding ended, they faced a big problem: how to keep the program going without research money. This study shows how they created a step-by-step plan to build the systems, training, and support needed for health departments and clinics to continue running the program on their own. They tested their approach with 170 health workers and found that when given proper training and support, these workers felt confident delivering the program and people liked it. This research offers a useful roadmap for other health programs facing the same challenge.

The Quick Take

  • What they studied: How to create a lasting system for health departments and clinics to continue running a successful lifestyle program after research funding runs out
  • Who participated: 170 public health workers from health departments and community clinics who deliver health programs to the public
  • Key finding: When researchers followed a 3-step planning process and trained 88 health workers, those workers reported feeling confident and capable of delivering the program, and people in the community found the program acceptable and helpful
  • What it means for you: Health programs that work well in research studies are more likely to continue helping people in real communities if researchers plan ahead for how to support them after funding ends. This could mean better access to proven health programs in your area.

The Research Details

This study describes how researchers created a plan to keep the Med-South program running after 10 years of research funding ended. The Med-South program teaches people how to eat healthier and be more active through four monthly counseling sessions and three follow-up phone calls. The researchers followed a three-step process: first, they looked at what resources and support systems already existed in health departments and clinics; second, they identified what would help or hurt the program’s adoption; and third, they customized their plan to fit what was already there and address the challenges they found. They worked with 170 health workers through three rounds of improvements, training them and gathering their feedback to make the system better each time.

Most research studies end when funding runs out, but the programs they test often stop too, even if they work well. This study is important because it shows researchers how to think ahead and build lasting systems so successful programs can keep helping people. This approach could be used for many different health programs, not just this one.

This study involved real health workers from actual clinics and health departments, which makes the findings more relevant to real-world situations. The researchers improved their plan three times based on feedback, which shows they were testing and refining their approach. However, the study focuses on whether health workers liked the program and felt confident delivering it, rather than measuring whether people’s health actually improved over time. The study also doesn’t compare this approach to other ways of scaling up programs.

What the Results Show

The researchers created five key parts of their infrastructure system: a team of people to support the program, a training curriculum to teach health workers, clear instructions for how to deliver the program, a system to track data and results, and ways for people to communicate and share information. Out of 170 health workers who started training, 88 completed all the training sessions (about 52%). The health workers who completed training reported high levels of satisfaction with the program and felt very confident in their ability to deliver it to their communities. People who received the program found it acceptable and helpful. The researchers also found that by asking health workers what barriers they faced and what would help them succeed, they could design a better support system that fit into what was already happening in their clinics and health departments.

The study showed that involving health workers in multiple rounds of feedback and improvement was valuable—each cycle helped refine the training and support systems. The researchers learned that successful scale-up required attention to practical details like having enough staff, clear communication channels, and systems to monitor whether the program was being delivered correctly. The study also demonstrated that health workers were more likely to adopt and deliver the program when the system was designed to fit their existing workflows rather than requiring them to completely change how they worked.

This research addresses a gap that has been recognized in public health for years: most studies focus on testing whether a program works, but they don’t plan for how to keep it going afterward. This study takes a more practical approach by showing how to build the infrastructure needed for long-term success. The three-step process (assess, identify barriers, tailor solutions) is based on established implementation science methods, but applying it specifically to the problem of sustaining programs after research funding ends is relatively new and useful.

The study measured whether health workers felt confident and whether people found the program acceptable, but it didn’t measure whether people’s actual health improved or whether the program continued running successfully after the study ended. The study involved one specific program (Med-South) in particular regions, so the results might not work exactly the same way for other programs or in very different communities. The study also didn’t compare this three-step approach to other methods of scaling up programs, so we can’t say for certain that this way is better than alternatives. Additionally, not all health workers who started training completed it (only 52%), which might mean the approach works better for some people than others.

The Bottom Line

If you work in public health or run a health program, this research suggests you should start planning for long-term sustainability while your program is still being tested and funded. Specifically: (1) assess what resources and systems you already have in place, (2) talk to the people who will deliver your program to understand what challenges they face, and (3) design your support systems to fit their real-world situations rather than asking them to change everything. This approach appears to increase the chances that successful programs will keep helping people after research funding ends. Confidence level: Moderate—this is based on one program’s experience, but the approach is grounded in established implementation science principles.

Public health officials, clinic administrators, and program directors should care about this research because it gives them a practical roadmap for keeping successful health programs running long-term. Community health workers and counselors will benefit from understanding that their input and feedback matter in designing sustainable programs. People in communities who benefit from health programs should care because this research increases the likelihood that programs that help them will continue to be available. Researchers developing new health interventions should use this approach to plan for sustainability from the beginning. This research is less directly relevant to individual patients or people making personal health decisions, though they benefit indirectly when programs stay available.

The study doesn’t measure how long it takes to see health improvements in participants, but the Med-South program itself involves four monthly sessions plus follow-up calls, suggesting changes might take several months to become noticeable. For health systems implementing this approach, building the infrastructure took time through multiple improvement cycles, suggesting organizations should plan for several months of preparation before full scale-up. Long-term sustainability would need to be monitored over years, not weeks or months.

Want to Apply This Research?

  • If you’re using a health app to support a lifestyle program like Med-South, track completion of counseling sessions (attended yes/no), topics covered in each session, and confidence levels before and after training. For health workers, track the number of participants enrolled, sessions completed, and dropout rates to monitor program delivery fidelity.
  • Users could set reminders for their monthly counseling sessions and booster phone calls, log what they learned about nutrition and activity in each session, and track their own dietary and physical activity changes between sessions. Health workers could use the app to access training materials, record session notes, and receive real-time feedback on their implementation.
  • Establish a long-term tracking system that monitors whether health workers continue delivering the program 6 months, 1 year, and 2 years after initial training. Track participant engagement rates and health outcomes over time. Create a feedback loop where health workers report barriers they encounter and suggest improvements, with regular review cycles (quarterly or semi-annually) to refine the support system based on real-world experience.

This research describes how to build systems to sustain health programs, but it does not provide medical advice. The Med-South program itself involves lifestyle counseling about diet and physical activity; anyone considering making significant changes to their diet or exercise routine should consult with their healthcare provider first. This study measured health workers’ confidence and program acceptability, not actual health outcomes, so individual results may vary. The findings are based on one specific program and may not apply identically to all health programs or all communities. Always work with qualified health professionals when implementing health interventions.