Shortly after the conference, breakout session notes were shared with the facilitators to ensure completeness and accuracy. Then all members of the workshop planning committee were invited to participate in the analysis. Only six individuals (all academics representing Tuffs (1), Harvard (3), New York University (2) elected to participate in the analysis. Because no community partners chose to participate in analysis, it was decided to share coding results with the entire planning committee for comment at various stages of the process.

At the initial meeting of the analysis committee, members reviewed transcripts and notes documented at the breakout sessions. They then identified key themes related to capacity building and sustainability, facilitators, obstacles, and strategies. These key themes were compiled into a master codebook that was shared with the planning committee for comment. Then the analysis committee divided into dyads for further coding refinement. Each dyad member utilized the codebook to code text from three breakout groups and then dyads reconvened to add new codes, discuss discrepancies, and recode their transcripts together. A face-to-face meeting was held to discuss collapsing codes with duplicate themes into broader categories. When this was completed, all the text was entered into NVIVO¹⁹ and the shared themes were used to recode the text. Finally, the committee reconvened to review the coded text and identify key areas for discussion in this manuscript. Final codes and data were shared with the planning committee, who were also actively involved in writing and reviewing the manuscript drafts.

For manuscript and abstract development, all planning committee members were invited to participate. Co-authorship required review, editing, and, for some, writing sections of the manuscript.

During the breakout sessions, participants discussed the linkages between capacity building and sustainability. For example, whereas capacity building was described as preceding sustainability it was also noted that sustainability fostered capacity building. One participant noted that, “capacity building is academics ‘working themselves out of a job’ such that the community eventually takes over the process and the university moves on to other projects.” When these skills are acquired and embedded in the community, sustainability may be achieved. “Sustainability is building capacity and helping the community use their own data to help them continue work after the intervention has finished.” When community partners continue to engage in research beyond one individual project, it is sustainable CBPR.

Additional domains relevant to capacity building included committed partnerships and infrastructure building. Partnerships—referred to by one participant as the “human connection”—was described as important for capacity building.

Building capacity must be done both ways because the community will reject certain people or certain research ideas if they are not trusting of them or their aims. Universities need to be taught how to approach communities and work with them in a respectful way.

Maintaining and deepening these partnerships was an important process that built capacity and also led to sustainability. One participant actually noted that “sustainability equals relationships.” The more committed the community and academics were, the more likely that programming or research results would be sustained over time. As one participant explained:

The groups that have real sustainable partnerships that work long-term … it’s the ones that have a clear defined vision of their own and then THEY go out to find funding, find researchers that could help … and push their own agenda along.

Conference participants also discussed the need to create “infrastructure” (e.g., the mutual creation of guidelines and frameworks for collaboration) and embed these within existing systems. This could help to build capacity and institutionalize change to sustain initiatives. One participant noted:

[They] all came together to write guiding principles and a framework. The network was very important to sustain projects. Even when they don’t have funding they still meet and discuss grants and future plans. Having organizing structures really allows you to jump on opportunities.

Both capacity building and sustainability involved the bilateral transfer of knowledge or co-learning, between academics and community partners.

Building sustainability as well as capacity building through giving the community experience and skills for doing their own research and the capacity to start their own projects.

Some participants said that the goal of CBPR should not necessarily be to sustain particular projects, but to sustain community capacity to respond to emerging needs. As one participant noted:

People are mobilized around certain issues, obesity for example. Resources are scarce. You must be adaptable and strengthen the existing infrastructure. When everything (i.e., the infrastructure) is available, then you can shift with the times and need.

The concept that enduring CBPR partnerships can provide communities with greater capacity to respond to future challenges was mentioned repeatedly.

Additional domains relevant to sustainability included “enduring over time,” “multi-level focus,” and “improved health/concrete outcomes.” With regard to “enduring over time,” participants described the importance of working across generations to achieve sustainability. In this context, they stressed the importance of engaging youth in community health improvement efforts. One participant noted: “They [youth] are the voices of the next generation—we need to have them currently involved so they can continue to implement change in the future.”

Participants also stressed that the concept of sustainability was multi-level. “There are root causes and social determinants of health. In terms of long-term sustainability, you must look at the deeper issues.” In addition, the community’s ability to sustain efforts required enduring partnerships and collaborative work to address other issues beyond the initial problem.

Sustainability isn’t necessarily an intervention that we need to maintain, it can also be a way of thinking, a coalition, etc.

Finally, participants discussed that sustainable CBPR projects had to achieve concrete outcomes, including improvements in health status, the creation and strengthening of ties between community groups and partnerships with academics.

Participants also noted the major facilitators and obstacles to building capacity and sustainability (Table 2). They included partnership characteristics, availability of resources, shared vision/common goals, and work strategies.

Participants returned to the importance of strong, enduring partnerships when discussing facilitators and obstacles to strong partnerships, including membership, communication, and available resources. For example, participants felt that partnerships including broad membership from the target population, youth, relevant stakeholders, and community liaisons or “boundary spanners” would be more likely to result in productive partnerships compared to more narrowly defined partnerships. The term “boundary spanners” comes from the organizational behavioral literature^20,21 and is used in higher education to describe individuals who build bridges between “campus” and community.²² Boundary spanners possess knowledge of both academic and community environments and can serve as coordinators, facilitate information sharing across organizational boundaries, and help to match needs and resources. These individuals are often identified via prior relationships in either the community or academic setting.

Participants also discussed the manner in which communication took place as critical. For example, partnerships characterized by mutual respect were more likely to have lasting impact than those where academics took a top down approach.

Resources in the form of time, people, money, and infra -structure were described as facilitators or obstacles to sustainability. For example, the large time investment required to undertake CBPR was considered an obstacle, as was lack of funding, specifically to compensate community members. Conversely, participants also discussed how a focus on funding could undermine the involvement of committed and passionate volunteers. Regarding funding, participants also spoke about the need to educate community members to advocate for equitable budgets and compensation for their time and effort. This was a strategy that enhanced community capacity and community power in the partnership. Finally, participants identified staff turnover as a common occurrence in nonprofit agencies and as a barrier to sustainability.

Conference participants discussed the importance of partners articulating a shared vision, goals, and objectives at the beginning of any initiative. They stressed the importance of continually revisiting goals, with changing needs and priorities. Some suggested focusing on goals encompassing multiple issues to build capacity and future sustainability rather than narrow goals that would end abruptly or spark limited interest in the community. Moreover, participants discussed the importance of measuring progress over time and communicating information on project successes back to the community.

A variety of contextual factors were seen as either hindering or helping to sustain initiatives. The political climate was discussed as a potential obstacle. For example, political change at the local, state, and federal levels might mean loss of funding or support for particular projects. Participants also discussed the challenge of “research fatigue” within communities that have been over-researched, often with little benefit to the community. One participant described this obstacle as the “history of disappointment.”

As a final exercise, groups offered numerous strategies to build capacity and promote sustainability. Many revolved around how work was done, the presence of academics in the community, and obtaining needed resources. Although specific strategies to prevent research fatigue were not directly discussed, participants noted that community-responsive research that adhered to CBPR principles could change historical perceptions and potentially diminish research fatigue. In addition, by enhancing community capacity to better assess partnerships, communities can make more informed decisions about participation in research and minimize fatigue. However, workshop discussions did not address the issues that arise when multiple researchers are simultaneously conducting research in one community. Most important, participants discussed how CBPR projects could be integrated into their communities and how evidence produced might influence programming. In addition, the maintenance of academic–community partnerships, which might be revived with emerging problems, was seen as a strategy for building community capacity and sustaining efforts (Table 3).

In the post-conference evaluation, the majority of respondents commented that they were better prepared to engage in CBPR. All respondents said they were somewhat to extremely confident in addressing challenges to creating sustainable health interventions and that the skills/knowledge acquired during the workshop were likely to be applicable in future CBPR work. Congruent with the themes of the day, the conference gave the participants a multilayered definition of capacity building and sustainability that will hopefully help to prepare them for future CBPR efforts.

From this conference, we learned that capacity building and sustainability are inextricably linked, each influencing the other. Although capacity is often described as setting the stage for sustainability, sustainability also enhances capacity, and both hinge on committed partnerships and supportive infrastructure. Our findings suggest that these two domains overlap extensively. For example, Goodman and colleagues¹⁷ noted that competence “signifies how skillfully capacity to is applied” to emerging health issues. Competence is also necessary for sustainability because it is mastery of skills that positions a community for sustainable social change. Consequently, we recommend assessing both capacity and sustainability simultaneously, and identifying factors that might support one and inhibit the other. For example, if a CBPR relationship has resulted in enhanced community capacity to respond to health threats, does this capacity possess the leverage necessary to impact outcomes,¹⁴ and if so, what components of the capacity are or should be sustained? In times of fiscal constraint, community partners that join with academic partners on CBPR projects may be chiefly concerned with their own survival. In this case, sustainability and capacity building may refer to enhancing organizational governance, financial accounting, fundraising, and grant writing. Researchers and community partners should discuss their perspectives at the beginning of a project so that shared goals for capacity and sustainability are clearly communicated.

Partnership is widely recognized as fundamental to CBPR^23,24 and is broadly studied²⁵; however, it is less frequently recognized as an important outcome of the CBPR process. Although it requires effort to form and sustain partnerships, partnerships themselves represent a form of “social capital” that can facilitate resource acquisition (e.g., dollars, political power), uncover multidisciplinary approaches to solving complex problems, and enhance capacity to improve health.^26–28 The relationship between social capital and community health has been well established.^29–31 A dynamic relationship between communities and researchers is critical to addressing persistent health problems.³² This increased “social capital” can ultimately increase the capacity of communities and academics to better respond to emerging health issues.³³ Strong partnerships enhance social networks, which can support group efficacy and lead to social action.³⁰ As noted by Goodman and associates,^17,34 there are multiple benefits of partnerships. Thus, regardless of what health issue is addressed, strong partnerships may be a significant indicator of community capacity for health improvement, whose presence or absence could be viewed as an important outcome of community-engaged health research.

Knowledge transfer in CBPR is generally conceived of as the transfer of information between researchers and community partners. This conference revealed another type of knowledge transfer, namely, the intergenerational transfer of knowledge. This transfer is important for maintaining enthusiasm and providing momentum for sustainable community change.

Clear and measurable goals, objectives, and outcomes were also important for sustainability, offering participants opportunities for reflection and decision making about which aspects of programs to sustain. They also provide capacity for future fundraising and assist in partnership longevity. The need to identify goals at the onset and to assess how success is defuned was considered critical to both capacity building and sustainability.

In this conference, the majority of strategies identified to build capacity and promote sustainability resonated with prior literature including building strong partnerships, equitably sharing resources, encouraging mutual respect and co-learning, skills development, and knowledge transfer (Table 3).^{2–5,7,9,12,14,16,17,35–51} However, several novel strategies emerged, including (1) planning for leadership succession at both the community and academic levels (i.e., involving youth in coalitions as the next generation and engaging junior investigators in CBPR efforts), (2) ensuring that CBPR partnerships are flexible enough to take on emerging problems and can shift from crisis response to wellness promotion, (3) creating a dissemination plan that incorporates the perspectives of diverse stakeholders, as evidence translation must be adapted for different audiences. These additional strategies remind us that sustainable change requires concrete steps toward a future vision.

We acknowledge several limitations of this work. First, because the overall focus was to develop a joint understanding of community capacity building and sustainability, we did not instruct groups to identify differences of opinion based on academic or community partner category nor did we ask groups to come to consensus on definitions. Transcriptions were anonymous; consequently, we were unable to identify who provided specific responses. Thus, we may have missed an opportunity to better understand the differing perspectives of academics and community partners. Second, the conference participants were a self-selected group; therefore, findings from the breakout sessions may not be reflective of the views of other types of participants.

Community capacity building and sustainability are key outcomes of CBPR efforts for both academic and community partners. Their successful achievement rests in large part on the strength and endurance of academic/community partnerships. Although not typically considered outcomes, these partnerships are part of the infrastructure necessary to achieve sustainability, capacity and health change. More opportunities that facilitate dialogue between community and academia are needed to develop appropriate metrics to gauge the success of CBPR.