Table 1 Integrated Sustainability Framework domains with corresponding factors covered, definitions, and examples of application

Outer contextual factors

• Policy and legislation

• Sociopolitical context

• Funding environment

• Leadership

• Values, priorities, needs

• Community ownership

Sociopolitical context: The external landscape, including existing policies and regulations, guidelines, and mandates that pose implications on the sustainment of evidence-based interventions (EBIs). This may also include sociocontextual norms or policies that are discriminatory or stigmatising.

External attention, e.g., from government, institutions, or agencies on programmes or interventions, national certification, or government policies.

Funding environment and availability: The funding landscape, including nature, stability, scope, diversity, and length of the funding environment.

Provision of funding support from external sources, e.g., government or non-governmental organisations.

External partnerships and leadership/environmental support: Receiving external support through networks and partnerships (e.g., through engagement or resource exchange with academic and health organisations and community partners), support, commitment, and involvement from national leadership.

Partnership with a university or health organisation who provides support (e.g., through the provision of resources or training from a local Area Health Service).

Values, needs, priorities: The extent to which an EBI or topic is regarded as a national priority or fits with national, state, or local organisational priorities, needs, and values.

Governmental policies and priorities, e.g., Federal Government prioritisation of obesity within Australia.

Inner contextual factors

• Funding/resources

• Leadership/support

• Climate/culture

• Staffing turnover

• Structural characteristics

• Capacity

• Champion

• Polices (alignment)

• Mission

Programme champions: Individuals who have strong influences on the behaviours, attitudes, and norms of their colleagues/peers and promote the ongoing delivery of EBIs.

Having an effective school champion (e.g., classroom teacher, physical education teacher, stage coordinator, or school executive) who leads and is responsible for driving the ongoing delivery of a health-promoting programme within schools.

Organisational leadership/support: Support from those within the organisation who have formal responsibility for leading, organising, and overseeing the programme.

Support from school principals, executives, and other teachers.

Organisational readiness/resources: The level of resources and support internally to facilitate the ongoing delivery of a programme (e.g., space, money, funding, time).

Allocated in-school funding for a health-promoting programme provided by the principal; or in-school access to resources, e.g., adequate equipment and programme materials or adequate space.

Organisational stability: Staff attrition and turnover of space, organisation, staffing, or leadership.

Determining the impact of staff turnover, e.g., teaching staff, principals, and school champions on the ongoing delivery of a health-promoting programme in schools.

Processes

• Partnership/engagement

• Training/support/supervision

• Fidelity

• Adaptation

• Planning

• Team/board functioning

• Programme evaluation/data

• Communication

• Technical assistance

• Capacity building

Partnership/engagement: Processes to directly and actively engage with key stakeholders (e.g., community board, role modelling, and networking).

Advisory groups and meetings with P&C committees and other stakeholders to provide updates about a health-promoting programme in schools.

Training/supervision/support: Processes related to implementation strategies (e.g., formal education or training, formal supervision processes, or other forms of support).

Provision of booster workshops and training to up-skill teachers or school champions to facilitate the ongoing delivery of a health-promoting programme in schools.

Programme evaluation/data: Collection of data and assessment or feedback to inform programme planning and decisions.

Conducting process evaluation surveys with participants involved, e.g., principals, teachers, parents, or students to inform what programme strategies were effective or ineffective and make improvements to facilitate the ongoing delivery of a health-promoting programme.

Adaptation: Processes in place to actively and systematically guide adaptation of a policy or programme.

Implementing a plan for adaptation to enable the alteration of a health-promoting programme as required, e.g., introducing wet weather plans and plans for casual teachers. This also includes the ability to adapt a programme based on factoring including climate or geographical location, e.g., implementing a contingency plan to conduct regular physical activity within a rural school experiencing consistently hot weather.

Communications and strategic planning: Processes explicitly related to or that guide the sustainment of a programme over time, e.g., through grant-writing, activities and engagement regarding sustainment, or marketing/communication plan focused on promoting the sustainment of an EBI.

Dissemination of information and promotion of a school health-promoting programme through means of school newsletters, online platforms, school social media pages, or within local newspapers.

Characteristics of the interventionists and population

• Provider/implementer characteristics

• Implementation skills/expertise

• Implementer attitudes

• Implementer motivation

• Population characteristics

Implementer characteristics: Implementer role self-efficacy, role clarity, commitment, and attitude.

Perceived personal capability, motivation, and attitudes of the teachers delivering a health-promoting programme in schools.

Implementer benefits and stressors: Implementer benefits and stressors in role (including if paid or a volunteer).

Perceived personal benefit or stressors for teachers being involved in a health-promoting programme in schools, e.g., personal satisfaction knowing a programme will positively impact on students; or alternatively feeling overwhelmed with their own ability to deliver the programme given other school priorities.

Implementer skills/expertise: Prior knowledge, training, and motivation of the implementer.

Perceived personal preparedness of teachers to adequately deliver the programme or intervention within schools, factoring in any previous training may have completed.

Population characteristics: Trust and medical mistrust, literacy, socioeconomic status, race/ethnicity, and experiences of stigma or discrimination among the target population.

Appropriateness of the programme considering the SES of the population, e.g., rural schools. Further, this includes the appropriateness of programme resources and materials considering literacy levels of the target population.

Characteristics of the intervention

• Adaptability

• Fit with population and context

• Benefits/need

• Burden/complexity

• Trialability

• Cost

Adaptability of EBI/fidelity: Degree to which an EBI can be tailored or refined to fit new settings or population needs, e.g., original guidelines or evidence vs. newer guidelines or evidence.

Adaptability of a school-based health-promoting programme for teacher’s schedule and the school environment, e.g., adaptability of a programme to include contingency plans if materials and equipment are not available.

Fit with context/population/organisation: Fit of an EBI within a context, populations, and organisations as well as the perceived trust and medical mistrust of an EBI or source of evidence.

Appropriateness of a health-promoting programme considering the context, culture, and population within schools to address an identified issue, e.g., childhood obesity; and inclusion of a credible source supporting the delivery of the programme, e.g., university or Area Health Service.

Perceived benefits: Perceived impact, evidence, cost, or relative advantage of an EBI.

Value of a health-promoting programme within a school. Prioritisation of the programme over other competing interests, e.g., maths and English. School staff (principal and teachers) belief that the programme will be advantageous and the cost of the programme is appropriate.

Perceived need: Perceived need in the community or setting for an EBI or the topic it addresses.

The value parents see in a school health-promoting programme and the benefit this will have on their children; or regard it as a burden and prioritise other subjects over the programme. This extends to the wider school community and whether they see a need for the programme, e.g., P&C committees.