Sustainability measurement tools in public health and their applicability to cancer screening programs: a scoping review within the EUCanScreen joint action

The sustainability of cancer screening programs remains a key challenge in many European countries, following two decades of policy efforts. Measuring sustainability is a critical step toward improving implementation outcomes and ensuring long-term impact. Several sustainability assessment tools have been developed in public health, but their applicability to organized cancer screening programs remains unclear. This scoping review, conducted within the Joint Action on the New EU Cancer Screening Scheme Implementation—EUCanScreen, aimed to identify, synthesize, and evaluate existing tools in a cancer screening context. We updated the systematic review by Hall et al., 2022, and integrated findings from the narrative review by Moullin et al., 2020, extending the search to studies published between January 2021 and January 2025. The search was conducted in PubMed/MEDLINE, Embase, the Cochrane Library, PsycINFO, CINAHL and Scopus. Titles and abstracts were screened with AI-assisted prioritisation in Rayyan, and full texts were assessed independently by two reviewers for eligibility. We included studies reporting on the development, validation, or application of multi-item tools assessing sustainability or its determinants in public health or community settings. Tools were evaluated for validation status and coverage of six key domains of sustainability: stakeholder engagement, planning, monitoring, resource availability, human resources, and communication. Of 37 full-text articles assessed, four newly identified tools met the inclusion criteria and were integrated with 18 tools retrieved from previous reviews, yielding 22 tools for analysis. Quantitative tools predominated (n = 19). Only five tools covered all six sustainability domains. None of the tools was designed for cancer screening, and only one had been applied to a screening context, through a qualitative evaluation of the CDC Colorectal Cancer Control Program in the USA. While several comprehensive tools exist, none were designed for cancer screening. Most tools require adaptation for effective use in this context. Developing a hybrid or tailored tool, informed by validated measures and adapted to national or regional cancer screening infrastructures, may enhance implementation and long-term sustainability.