BACKGROUND The sustainability of school-based health interventions after external funds and/or other resources end has been relatively unexplored in comparison to health care. If effective interventions discontinue, new practices cannot reach wider student populations and investment in implementation is wasted. This review asked: What evidence exists about the sustainability of school-based public health interventions? Do schools sustain public health interventions once start-up funds end? What are the barriers and facilitators affecting the sustainability of public health interventions in schools in high-income countries? METHODS Seven bibliographic databases and 15 websites were searched. References and citations of included studies were searched, and experts and authors were contacted to identify relevant studies. We included reports published from 1996 onwards. References were screened on title/abstract, and those included were screened on full report. We conducted data extraction and appraisal using an existing tool. Extracted data were qualitatively synthesised for common themes, using May's General Theory of Implementation (2013) as a conceptual framework. RESULTS Of the 9677 unique references identified through database searching and other search strategies, 24 studies of 18 interventions were included in the review. No interventions were sustained in their entirety; all had some components that were sustained by some schools or staff, bar one that was completely discontinued. No discernible relationship was found between evidence of effectiveness and sustainability. Key facilitators included commitment/support from senior leaders, staff observing a positive impact on students' engagement and wellbeing, and staff confidence in delivering health promotion and belief in its value. Important contextual barriers emerged: the norm of prioritising educational outcomes under time and resource constraints, insufficient funding/resources, staff turnover and a lack of ongoing training. Adaptation of the intervention to existing routines and changing contexts appeared to be part of the sustainability process. CONCLUSIONS Existing evidence suggests that sustainability depends upon schools developing and retaining senior leaders and staff that are knowledgeable, skilled and motivated to continue delivering health promotion through ever-changing circumstances. Evidence of effectiveness did not appear to be an influential factor. However, methodologically stronger primary research, informed by theory, is needed. TRIAL REGISTRATION The review was registered on PROSPERO: CRD42017076320, Sep. 2017.

中文翻译：

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学校公共卫生干预措施的可持续性：系统评价。

背景技术与医疗保健相比，在外部资金和/或其他资源结束后，以学校为基础的健康干预措施的可持续性尚未得到探索。如果有效的干预措施停止，新的做法就无法惠及更广泛的学生群体，实施方面的投资就会被浪费。本次审查询问：有哪些证据表明以学校为基础的公共卫生干预措施具有可持续性？一旦启动资金结束，学校是否会维持公共卫生干预措施？影响高收入国家学校公共卫生干预措施可持续性的障碍和促进因素有哪些？方法检索7个书目数据库和15个网站。检索了纳入研究的参考文献和引文，并联系了专家和作者以确定相关研究。我们纳入了 1996 年以来发布的报告。参考文献根据标题/摘要进行筛选，所包含的参考文献根据完整报告进行筛选。我们使用现有工具进行数据提取和评估。使用梅的一般实施理论（2013）作为概念框架，对共同主题的提取数据进行定性综合。结果 通过数据库检索和其他检索策略确定的 9677 篇独特参考文献中，有 24 项涉及 18 种干预措施的研究被纳入该评价。没有采取全面的干预措施；所有这些都有一些由一些学校或工作人员维持的组件，除了一个完全停止的组件。有效性证据和可持续性之间没有发现明显的关系。主要推动因素包括高层领导的承诺/支持、工作人员观察到对学生参与和福祉的积极影响，以及工作人员对健康促进的信心及其价值的信念。出现了重要的背景障碍：在时间和资源限制下优先考虑教育成果的规范、资金/资源不足、人员流动和缺乏持续培训。使干预措施适应现有的惯例和不断变化的环境似乎是可持续发展过程的一部分。结论 现有证据表明，可持续性取决于学校培养和留住知识渊博、技术精湛、有动力在不断变化的环境中继续提供健康促进服务的高级领导和工作人员。有效性证据似乎并不是一个影响因素。然而，需要方法论上更强有力、以理论为依据的初步研究。试验注册 该评价已在 PROSPERO 上注册：CRD42017076320，2017 年 9 月。