Purpose: To identify and synthesise factors (barriers and facilitators) that influence the sustainment of interventions (policies, practices, or programmes) in schools and childcare services that address the leading risk factors of chronic disease.

Methods: Seven electronic databases and relevant reference lists were searched for articles, of any design, published in English, from inception to March 2020. Articles were included if they qualitatively and/or quantitatively reported on school or childcare stakeholders’ (including teachers, principals, administrators, or managers) perceived barriers or facilitators to the sustainment of interventions addressing poor diet/nutrition, physical inactivity, obesity, tobacco smoking, or harmful alcohol use. Two independent reviewers screened texts, and extracted and coded data guided by the Integrated Sustainability Framework, an existing multi-level sustainability-specific framework that assesses factors of sustainment.

Results:  Of the 13,158 articles identified, 31 articles met the inclusion criteria (8 quantitative, 12 qualitative, 10 mixed-methods, and 1 summary article). Overall, 29 articles were undertaken in schools (elementary n=17, middle n=3, secondary n=4, or a combination n=5) and two in childcare settings. Findings suggest that the majority of the 59 barriers and 74 facilitators identified to impact on intervention sustainment were similar across school and childcare settings. Factors predominantly relating to the ‘inner contextual factors’ of the organisation including: availability of facilities or equipment, continued executive or leadership support present, and team cohesion, support, or teamwork were perceived by stakeholders as influential to intervention sustainment.

Conclusions: This review identified multi-level factors that can be addressed by strategies to improve the sustainment of such interventions, and the presentation will show how future research might address gaps in the evidence base.

Methods: The research team distributed a survey to directors of sites who were previously trained in FF (n = 29) or WISE (n = 27). The survey included two indicators of sustainment as primary outcomes: (1) Continued Attention (e.g., general focus on nutrition and physical activity promotion) and (2) Program Fidelity (how well centers used specific components of WISE or FF). A modified Program Sustainability Assessment Tool (PSAT, Luke et al., 2014) assessed internal and external factors potentially related to program sustainment. The participant program (WISE/FF), the number of years since the program had been implemented (i.e., lag), and the subscales of the PSAT were entered into regression models as predictors of Continued Practice and Program Fidelity.

Results: PSAT scores accounted for a signification portion of variance in Program Fidelity [F(8,37) = 12.21, p < .001, R² = 0.67] but not Continued Attention [F(8,37) = 1.28, p = .28, R² = .22]. The Environmental Support [β = .44, t(37) = 2.58, p = .014] , Organizational Capacity [β = .62, t(37) = 3.04, p = .004], and Program Adaptation [β = .340, t(37) = 2.67, p = .011] subscales were significant, positive predictors, and Fund Stability was a negative predictor [β = -.57, t(37) = 2.67, p = .011] of Fidelity. Program type (WISE/FF) and lag did not predict Continued Attention or Program Fidelity.

Conclusion: This study suggests that predictors of sustained Program Fidelity are distinct from predictors of Continued Attention. Further, organizational capacity was the strongest predictor of sustained Program Fidelity. This suggests that future implementation science in ECE may explore the value of capacity building strategies to improving sustainment of evidence-based practices for nutrition and physical activity.

Purpose: To assess if a multi-strategy intervention which effectively increased weekly minutes of structured physical activity (PA) implemented by classroom teachers at 12 months is sustained at 18 months.

Methods: A cluster randomised controlled trial with 61 primary schools in New South Wales Australia. The 12-month multi-strategy intervention included; centralised technical assistance, ongoing consultation, principal’s mandated change, identifying and preparing school champions, development of implementation plans, educational outreach visits and provision of educational materials. Control schools received usual support (guidelines for policy development via education department website and telephone support). Weekly minutes of structured PA implemented by classroom teachers (primary outcome) was measured via teacher completion of a daily log-book at baseline (October–December 2017), 12-month (October–December 2018) and 18-month (April–June 2019). Data were analysed using linear mixed effects regression models.

Results: Overall, 400 class teachers at baseline, 403 at 12 months follow-up and 391 at 18 months follow-up provided valid primary outcome data. From baseline to 12-month follow-up, teachers at intervention schools recorded a greater increase in weekly minutes of PA implemented than teachers assigned to the control schools by approximately 44.2 min (95% CI 32.8 to 55.7; p<0.001) which remained at 18 months, however, the effect size was smaller at 27.1 min (95% CI 15.5 to 38.6; p≤0.001)

Conclusion: A multi-strategy intervention increased mandatory PA policy implementation. Some, but not all of this improvement was maintained after implementation support concluded.