Program sustainability begins with the first events

This study examines the process by which a program becomes sustainable. In health promotion, sustainability is usually modeled as the final stage of a program's evolution. In practice, however, this stage model appears deceiving. This article proposes that processes for implementing programs and for ensuring their sustainability are concomitant. Using a multiple-case study methodology, we examined routinization-the sustainability process in organizations-of the Quebec Heart Health Demonstration Project in five community health centers over 10 years. Data came from documents and interviews. The analysis considered themes using the Critical Incident Technique. Our results suggest routinization-related events occurred as soon as the project began, and the occurrence of specific routinization events foresaw the presence of program-related routines. These events were concomitant with those associated with implementation. This supports the proposition. It suggests health promoters should consider program sustainability from the very beginning, and can take inspiration from the events presented herein when looking for ways to influence the sustainability of their programs. (c) 2005 Elsevier Ltd. All rights reserved.