Key Points

· This article examines success factors that relate specifically to the ability of a comprehensive community initiative (CCI) to achieve the scope and scale required to generate community-level outcomes and to sustain those positive impacts over time.

· The CCIs selected for study represent a wide range of goals, strategies, and organizational structures.

· Six factors were found to cut across scope, scale, and sustainability. These factors include having a single broker or entity that holds the vision of the change effort; clearly defined roles; alignment among interventions, resources, and geography; meaningful community engagement; competent leadership and staff; and strategic, cross-level relationships.

· Additional factors were found to relate to success in achieving scope, scale, or sustainability individually.

· Lessons include to plan, operate, and evaluate based on a systems- and community-change framework; choose focused and affordable strategies; build the capacity to use data; and plan for change and conflict.

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