Community Leaders: Maintenance of Health Behavior Interventions

Definition: The extent to which a program or policy becomes part of the routine organizational practices and policies. Within the RE-AIM framework, maintenance also applies at the individual level. At the individual level, maintenance is defined as the long-term effects of a program on outcomes after 6 or more months after the most recent intervention contact.

Ways to increase maintenance of an intervention and to have a greater positive impact

Minimize required resources.
Conduct follow-up assessments and interviews to learn from those who were successful and those who were not.
Institute incentives and policy supports.

Minimize required resources.
Conduct follow-up assessments and interviews to learn from those who were successful and those who were not.
Incorporate “natural environmental” and community supports.

Project ACTIVE (Dunn et al., 1999) was a 24-month randomized clinical trial. Scientists compared the effects of two treatment arms on physical activity and cardiorespiratory fitness in adults. The study provides an example of maintenance at the individual level. Both treatment groups received six months of intensive intervention. Scientists measured physical activity at the beginning of the clinical trial, at six months, and at 24 months. Both groups increased activity from the beginning to six months (i.e., during the intensive intervention) but decreased activity from six to 24 months. Without multiple assessments, scientists cannot identify patterns of behavior or learn whether participants maintain activity.

Although few studies have documented setting level maintenance or institutionalization, Richmond and colleagues (1998) did both. They also reported patient level long-term follow-up results and attrition rates. They followed up on family physicians who had participated in their smoking cessation training program. Six months after the 2-hour training, 93% of participating physicians reported still using the program.