Sustaining Implementation

What is the issue?

  • Chronic diseases such as heart disease, cancer, and diabetes are responsible for 70% of all deaths globally.
  • To combat this growing epidemic, governments spend billions of dollars each year investing in prevention interventions that address the leading risk factors for these diseases. These focus on increasing physical activity, improving dietary intake and reducing harmful alcohol and tobacco use.
  • Schools and early childhood education and care settings are crucial settings for the implementation of evidence based interventions that address these chronic disease risk factors.
  • The public health benefits of these intervention is dependent on how well and for how long implementation can be sustained.
  • Only 1 in 5 programs continue to be delivered once implementation support is withdrawn. This is a costly and critical health system issue.
  • Currently, there is little evidence about how best to support sustained implementation of chronic disease prevention interventions in schools and early childhood and care settings.
  • This research will seek to address some of the fundamental knowledge gaps in the field.

How this research program will help?

Our goal is to create evidence that policy makers, practitioners and other stakeholders can use to ensure their interventions are made to last, and that health benefits endure in the long term. Specifically, we are:

  • Synthesising empirical evidence about the determinants of sustained implementation of diet, physical activity and obesity prevention initiatives in education settings.
  • Developing and evaluating various measures of sustainability determinants for use in education settings.
  • Developing and testing the effectiveness of strategies for sustaining diet, physical activity and obesity prevention initiatives in education settings.

How are we conducting this research?

  • Systematic reviews of determinants, strategies and measures of sustainment.
  • Longitudinal studies with Australian primary schools and early education ad childhood centres, to explore issues relating to sustained delivery of chronic disease prevention programs.
  • Randomised controlled studies and trial-based economic analyses to explore the effect and cost of strategies to support long-term delivery of chronic disease prevention interventions.

Check out our one-page overview: Preventing chronic disease with the science of sustainability.

Research lead: Dr Nicole Nathan.


A bibliographic review of sustainability research output and investment in 10 leading public health journals across three time periods. 2023. Public Health in Practice. DOI:

Editorial: Sustaining the implementation of evidence-based interventions in clinical and community settings. 2023. Frontiers in Health. DOI:

Evaluation of measures of sustainability and sustainability determinants for use in community, public health, and clinical settings: a systematic review. 2022. Implementation Science. DOI: Plain language summary ‘Measuring sustainability in Public Health, Clinical, and Community settings: A systematic review of available measures’

Do the Expert Recommendations for Implementing Change (ERIC) strategies adequately address sustainment? 2022. Frontiers in Health Services. DOI:

School-level factors associated with the sustainment of weekly physical activity scheduled in Australian elementary schools: an observational study. 2022. BMC Public Health. DOI: Plain language summary: Sustaining weekly physical activity in schools: influential factors and useful strategies.

Understanding the sustainment of population health programmes from a whole-of-system approach. 2022. Health Research Policy and Systems. DOI:

Adaptation and Validation of the Program Sustainability Assessment Tool (PSAT) for Use in the Elementary School Setting. 2021. Int. J. Environ. Res. Public Health. DOI:

Barriers and facilitators influencing the sustainment of health behaviour interventions in schools and childcare services: A systematic review. 2021. Implementation Science. DOI:

Multi-strategy intervention increases school implementation and maintenance of a mandatory physical activity policy: outcomes of a cluster randomised controlled trial. 2021. British Journal of Sports Medicine. DOI:

What happens once a program has been implemented? A call for research investigating strategies to enhance public health program sustainability. 2019. Australian and New Zealand Journal of Public Health. DOI:

Two‐year follow‐up of a randomised controlled trial to assess the sustainability of a school intervention to improve the implementation of a school‐based nutrition policy. 2019. Health Promotion Journal of Australia. DOI:

A longitudinal study assessing childcare services’ adoption of obesity prevention policies and practices. 2016. Journal of Pediatrics and Child Health. DOI:

Adoption of obesity prevention policies and practices by Australian primary schools: 2006 to 2013. 2015. Health Education Research. DOI: