Scoping review and thematic analysis of factors and strategies for the sustainability of evidence-based health promotion program_Chinese Journal of Evidence-Based Medicine

Authors：

PAN Shasha , SUN Wenjia ,  ZHANG Youjie

School of Public Health, Suzhou Medical College of Soochow University, Suzhou 215123, P. R. China;

Corresponding author：

ZHANG Youjie, Email: ujzhang@suda.edu.cn

Keywords：

Evidence-based health promotion program; Program sustainability; Scoping review; Thematic analysis; Factor; Strategy

DOI：

10.7507/1672-2531.202504245

Video：

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Objective To identify factors and strategies for the sustainability of evidence-based health promotion programs. Methods The articles related to program sustainability factors and strategies were retrieved from the CNKI, WanFang Data, VIP, PubMed, and Web of Science database. The search period for English literature was from June 19, 2018, to December 3, 2024, while no start date was set for Chinese literature, with the same end date. Three researchers independently screened studies based on predefined inclusion and exclusion criteria and subsequently extracted the basic characteristics from the included studies. Thematic analysis was conducted to identify the sustainability factors and strategies from the included studies. Results A total of 65 articles were included in the scoping review. Through thematic analysis, 23 factors were identified and classified into six categories: program characteristics, organization characteristics, human resources, material resources, community resources and policy resources, along with 44 strategies grouped into six categories: programming strategies, collaborative strategies, capacity-building strategies, resource mobilization strategies, communication and dissemination strategies, and evaluative strategies. Conclusion The sustainability factors and strategies identified in this study exhibit conceptual and structural alignment with existing frameworks and strategy sets in implementation science. Concurrently, by incorporating a full life-cycle perspective, this study delineates context-specific factors and strategies tailored to the unique requirements of sustaining programs over time, thereby contributing to a more nuanced understanding of program sustainability and offering practical guidance for strengthening the longevity of evidence-based health promotion programs.

1.	朱志强, 徐巧玲, 邵雪云. 肥胖和超重儿童参与身体活动的健康效益: 系统综述的系统综述. 中国康复理论与实践, 2025, 31(3): 296-305.
2.	胡雯, 母东煜, 龚杰, 等. 循证营养与国民健康促进. 中国循证医学杂志, 2020, 20(7): 851-861.
3.	钱红胜, 张庆文, 王京, 等. 运动与健康促进研究领域系统评价/Meta分析的方法学与报告质量评价——基于中文核心期刊. 中国体育科技, 2021, 57(2): 89-97.
4.	黄振, 刘艳丽, 卢霞. 延续性健康促进模式对老年痴呆患者生活质量干预效果的Meta分析. 中国临床护理, 2019, 11(1): 86-89.
5.	Po'e EK, Gesell SB, Lynne Caples T, et al. Pediatric obesity community programs: barriers & facilitators toward sustainability. J Community Health, 2010, 35(4): 348-354.
6.	Friend S, Flattum CF, Simpson D, et al. The researchers have left the building: what contributes to sustaining school-based interventions following the conclusion of formal research support. J Sch Health, 2014, 84(5): 326-333.
7.	Hayes CB, O'Shea MP, Foley-Nolan C, et al. Barriers and facilitators to adoption, implementation and sustainment of obesity prevention interventions in schoolchildren- a DEDIPAC case study. BMC Public Health, 2019, 19(1): 198.
8.	李霜, 李朝林, 丘创逸, 等. 工作场所健康促进可持续发展策略研究. 中国职业医学, 2012, 39(6): 475-478.
9.	陈斌, 陈骢. 健康促进可持续发展路径和策略探讨. 中国健康教育, 2015, (6): 620-623.
10.	Bodkin A, Hakimi S. Sustainable by design: a systematic review of factors for health promotion program sustainability. BMC Public Health, 2020, 20(1): 964.
11.	Hailemariam M, Bustos T, Montgomery B, et al. Evidence-based intervention sustainability strategies: a systematic review. Implement Sci, 2019, 14(1): 57.
12.	Munn Z, Peters MDJ, Stern C, et al. Systematic review or scoping review. Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol, 2018, 18(1): 143.
13.	Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol, 2006, 3(2): 77-101.
14.	高庆, 李朝旭. 主题分析法: 中国心理学质性研究新视角. 心理技术与应用, 2024, 12(12): 735-749.
15.	Moore JE, Mascarenhas A, Bain J, et al. Developing a comprehensive definition of sustainability. Implement Sci, 2017, 12(1): 110.
16.	Shoesmith A, Hall A, Wolfenden L, et al. Barriers and facilitators influencing the sustainment of health behaviour interventions in schools and childcare services: a systematic review. Implement Sci, 2021, 16(1): 62.
17.	Shelton RC, Cooper BR, Stirman SW. The sustainability of evidence-based interventions and practices in public health and health care. Annu Rev Public Health, 2018, 39: 55-76.
18.	Shediac-Rizkallah MC, Bone LR. Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. Health Educ Res, 1998, 13(1): 87-108.
19.	Wende ME, Umstattd Meyer MR, Perry C, et al. Implementation characteristics that may promote sustainability of a rural physical activity initiative: examination of Play Streets through the lens of community implementers. Implement Sci Commun, 2024, 5(1): 48.
20.	Donessouné FMG, Sossa GO, Kouanda S. Sustainability of community health programme using community-based organizations: a challenge for stakeholders. BMC Health Serv Res, 2023, 23(1): 434.
21.	Pedersen AK, Toft U, Bloch P. Three-year follow-up of a multi-component community-driven health promotion intervention in Denmark. Health Promot Int, 2023, 38(3): daac035.
22.	Nielsen JV, Smedegaard S, Klakk H, et al. Same, same but different: comparing program fidelity at early versus late adopters of a successful long-term school-based physical activity intervention. Health Promot Pract, 2023, 24(6): 1237-1245.
23.	Mash RJ, Schouw D. The sustainability of group empowerment and training for people with diabetes in South Africa. S Afr Fam Pract (2004), 2024, 66(1): e1-e11.
24.	Nielsen JV, Bredahl TVG, Bugge A, et al. Implementation of a successful long-term school based physical education intervention: Exploring provider and programme characteristics. Eval Program Plann, 2019, 76: 101674.
25.	Kotejoshyer R, Zhang Y, Flum M, et al. Prospective evaluation of fidelity, impact and sustainability of participatory workplace health teams in skilled nursing facilities. Int J Environ Res Public Health, 2019, 16(9): 1494.
26.	Shelton RC, Cooper BR, Stirman SW. The sustainability of evidence-based interventions and practices in public health and health care. Annu Rev Public Health, 2018, 39: 55-76.
27.	刘莹, 马卓, 安卓玲. 新版实施性研究综合框架(CFIR 2022)的构成要素解读. 中国循证医学杂志, 2023, 23(6): 738-744.
28.	Damschroder LJ, Reardon CM, Widerquist MAO, et al. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci, 2022, 17(1): 75.
29.	Vu M, Nedunchezhian S, Lancki N, et al. A mixed-methods, theory-driven assessment of the sustainability of a multi-sectoral preventive intervention for South Asian Americans at risk for cardiovascular disease. Implement Sci Commun, 2024, 5(1): 89.
30.	Poole NL, van den Brand FA, Willemsen MC, et al. Challenges and successes in the sustainment of Dutch community-level smoking cessation interventions for residents with a low socioeconomic position. BMC Public Health, 2023, 23(1): 1605.
31.	Christiansen LB, Clausen K, Smedegaard S, et al. A qualitative exploration of implementation, adaptation, and sustainability of a school-based physical activity intervention: move for well-being in school. Sage Open, 2021, 11(1): 21582440211000053.
32.	McLoughlin GM, Sweeney R, Liechty L, et al. Evaluation of a large-scale school wellness intervention through the consolidated framework for implementation research (CFIR): implications for dissemination and sustainability. Front Health Serv, 2022, 2: 881639.
33.	Olmos-Ochoa TT, Miake-Lye IM, Glenn BA, et al. Sustaining successful clinical-community partnerships in medically underserved urban areas: a qualitative case study. J Community Health Nurs, 2021, 38(1): 1-12.
34.	Fathi LI, Yang D, Walker JL, et al. Exploring the long-term sustainability of school-based nutrition and food programs: What works, where and why. Health Promot J Austr, 2024, 35(4): 1149-1157.
35.	Leeman J, Birken SA, Powell BJ, et al. Beyond "implementation strategies": classifying the full range of strategies used in implementation science and practice. Implement Sci, 2017, 12(1): 125.
36.	Powell BJ, Waltz TJ, Chinman MJ, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci, 2015, 10: 21.
37.	Waltz TJ, Powell BJ, Matthieu MM, et al. Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study. Implement Sci, 2015, 10: 109.
38.	Wiltsey Stirman S, Kimberly J, Cook N, et al. The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implement Sci, 2012, 7: 17.
39.	Schell SF, Luke DA, Schooley MW, et al. Public health program capacity for sustainability: a new framework. Implement Sci, 2013, 8: 15.
40.	Scheirer MA. Is sustainability possible. A review and commentary on empirical studies of program sustainability. Am J Eval, 2005, 26(3): 320-347.

1. 朱志强, 徐巧玲, 邵雪云. 肥胖和超重儿童参与身体活动的健康效益: 系统综述的系统综述. 中国康复理论与实践, 2025, 31(3): 296-305.
2. 胡雯, 母东煜, 龚杰, 等. 循证营养与国民健康促进. 中国循证医学杂志, 2020, 20(7): 851-861.
3. 钱红胜, 张庆文, 王京, 等. 运动与健康促进研究领域系统评价/Meta分析的方法学与报告质量评价——基于中文核心期刊. 中国体育科技, 2021, 57(2): 89-97.
4. 黄振, 刘艳丽, 卢霞. 延续性健康促进模式对老年痴呆患者生活质量干预效果的Meta分析. 中国临床护理, 2019, 11(1): 86-89.
5. Po'e EK, Gesell SB, Lynne Caples T, et al. Pediatric obesity community programs: barriers & facilitators toward sustainability. J Community Health, 2010, 35(4): 348-354.
6. Friend S, Flattum CF, Simpson D, et al. The researchers have left the building: what contributes to sustaining school-based interventions following the conclusion of formal research support. J Sch Health, 2014, 84(5): 326-333.
7. Hayes CB, O'Shea MP, Foley-Nolan C, et al. Barriers and facilitators to adoption, implementation and sustainment of obesity prevention interventions in schoolchildren- a DEDIPAC case study. BMC Public Health, 2019, 19(1): 198.
8. 李霜, 李朝林, 丘创逸, 等. 工作场所健康促进可持续发展策略研究. 中国职业医学, 2012, 39(6): 475-478.
9. 陈斌, 陈骢. 健康促进可持续发展路径和策略探讨. 中国健康教育, 2015, (6): 620-623.
10. Bodkin A, Hakimi S. Sustainable by design: a systematic review of factors for health promotion program sustainability. BMC Public Health, 2020, 20(1): 964.
11. Hailemariam M, Bustos T, Montgomery B, et al. Evidence-based intervention sustainability strategies: a systematic review. Implement Sci, 2019, 14(1): 57.
12. Munn Z, Peters MDJ, Stern C, et al. Systematic review or scoping review. Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol, 2018, 18(1): 143.
13. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol, 2006, 3(2): 77-101.
14. 高庆, 李朝旭. 主题分析法: 中国心理学质性研究新视角. 心理技术与应用, 2024, 12(12): 735-749.
15. Moore JE, Mascarenhas A, Bain J, et al. Developing a comprehensive definition of sustainability. Implement Sci, 2017, 12(1): 110.
16. Shoesmith A, Hall A, Wolfenden L, et al. Barriers and facilitators influencing the sustainment of health behaviour interventions in schools and childcare services: a systematic review. Implement Sci, 2021, 16(1): 62.
17. Shelton RC, Cooper BR, Stirman SW. The sustainability of evidence-based interventions and practices in public health and health care. Annu Rev Public Health, 2018, 39: 55-76.
18. Shediac-Rizkallah MC, Bone LR. Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. Health Educ Res, 1998, 13(1): 87-108.
19. Wende ME, Umstattd Meyer MR, Perry C, et al. Implementation characteristics that may promote sustainability of a rural physical activity initiative: examination of Play Streets through the lens of community implementers. Implement Sci Commun, 2024, 5(1): 48.
20. Donessouné FMG, Sossa GO, Kouanda S. Sustainability of community health programme using community-based organizations: a challenge for stakeholders. BMC Health Serv Res, 2023, 23(1): 434.
21. Pedersen AK, Toft U, Bloch P. Three-year follow-up of a multi-component community-driven health promotion intervention in Denmark. Health Promot Int, 2023, 38(3): daac035.
22. Nielsen JV, Smedegaard S, Klakk H, et al. Same, same but different: comparing program fidelity at early versus late adopters of a successful long-term school-based physical activity intervention. Health Promot Pract, 2023, 24(6): 1237-1245.
23. Mash RJ, Schouw D. The sustainability of group empowerment and training for people with diabetes in South Africa. S Afr Fam Pract (2004), 2024, 66(1): e1-e11.
24. Nielsen JV, Bredahl TVG, Bugge A, et al. Implementation of a successful long-term school based physical education intervention: Exploring provider and programme characteristics. Eval Program Plann, 2019, 76: 101674.
25. Kotejoshyer R, Zhang Y, Flum M, et al. Prospective evaluation of fidelity, impact and sustainability of participatory workplace health teams in skilled nursing facilities. Int J Environ Res Public Health, 2019, 16(9): 1494.
26. Shelton RC, Cooper BR, Stirman SW. The sustainability of evidence-based interventions and practices in public health and health care. Annu Rev Public Health, 2018, 39: 55-76.
27. 刘莹, 马卓, 安卓玲. 新版实施性研究综合框架(CFIR 2022)的构成要素解读. 中国循证医学杂志, 2023, 23(6): 738-744.
28. Damschroder LJ, Reardon CM, Widerquist MAO, et al. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci, 2022, 17(1): 75.
29. Vu M, Nedunchezhian S, Lancki N, et al. A mixed-methods, theory-driven assessment of the sustainability of a multi-sectoral preventive intervention for South Asian Americans at risk for cardiovascular disease. Implement Sci Commun, 2024, 5(1): 89.
30. Poole NL, van den Brand FA, Willemsen MC, et al. Challenges and successes in the sustainment of Dutch community-level smoking cessation interventions for residents with a low socioeconomic position. BMC Public Health, 2023, 23(1): 1605.
31. Christiansen LB, Clausen K, Smedegaard S, et al. A qualitative exploration of implementation, adaptation, and sustainability of a school-based physical activity intervention: move for well-being in school. Sage Open, 2021, 11(1): 21582440211000053.
32. McLoughlin GM, Sweeney R, Liechty L, et al. Evaluation of a large-scale school wellness intervention through the consolidated framework for implementation research (CFIR): implications for dissemination and sustainability. Front Health Serv, 2022, 2: 881639.
33. Olmos-Ochoa TT, Miake-Lye IM, Glenn BA, et al. Sustaining successful clinical-community partnerships in medically underserved urban areas: a qualitative case study. J Community Health Nurs, 2021, 38(1): 1-12.
34. Fathi LI, Yang D, Walker JL, et al. Exploring the long-term sustainability of school-based nutrition and food programs: What works, where and why. Health Promot J Austr, 2024, 35(4): 1149-1157.
35. Leeman J, Birken SA, Powell BJ, et al. Beyond "implementation strategies": classifying the full range of strategies used in implementation science and practice. Implement Sci, 2017, 12(1): 125.
36. Powell BJ, Waltz TJ, Chinman MJ, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci, 2015, 10: 21.
37. Waltz TJ, Powell BJ, Matthieu MM, et al. Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study. Implement Sci, 2015, 10: 109.
38. Wiltsey Stirman S, Kimberly J, Cook N, et al. The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implement Sci, 2012, 7: 17.
39. Schell SF, Luke DA, Schooley MW, et al. Public health program capacity for sustainability: a new framework. Implement Sci, 2013, 8: 15.
40. Scheirer MA. Is sustainability possible. A review and commentary on empirical studies of program sustainability. Am J Eval, 2005, 26(3): 320-347.

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