Enabling sustainability through co-adaptation
A process evaluation of a school-based physical activity program
Bibliographic Data
Schools represent strategic settings for adolescent health promotion across multiple domains, including physical activity (PA). Despite the development of numerous effective programs, sustaining their impact within the school context remains a key challenge. This process evaluation explores how mechanisms, participant experiences, and contextual factors shaped the design, implementation and potential sustainability of the replicated Sigue la Huella (SLH) program (originally designed to increase PA and reduce sedentary time) in a new secondary school in Spain. Grounded in the Replicating Effective Programs framework and co-creation principles, the intervention was co-adapted and implemented over a three-year period through an iterative, collaborative process. The approach emphasized contextual relevance, gradual transfer of responsibility, and long-term sustainability. Participants (ntotal = 43) included teachers (i.e. school implementers), the school principal, students, parents, and policymakers. Data were collected through field notes, focus groups, and interviews. Using the Framework Analysis, findings were organized into thematic matrices capturing stakeholder perspectives across co-adaptation and three implementation phases. While the core structure of SLH was retained, delivery strategies were adapted to reflect school priorities and constraints. Key enablers of sustainability included strategic planning, flexible implementation, stakeholder empowerment, and institutionalization. However, challenges such as training needs, coordination gaps, and competing initiatives persisted. In essence, the processes of co-adaptation, accompanied by a staged withdrawal of research implementation support, have been found to foster school ownership, high-fidelity delivery, and institutionalization creating optimal conditions for autonomous sustainability while recognizing context-dependent challenges.
Context (archaeology) · Focus group · Institutionalisation · Process (computing) · Stakeholder · Stakeholder engagement · Sustainability · Thematic analysis · Health Policy Implementation Science · Obesity, Physical Activity, Diet · Physical Education and Pedagogy
Making sense of implementation theories, models and frameworks
The World Health Organization’s Health Promoting Schools framework
Process evaluation in randomised controlled trials of complex interventions
The sustainability of public health interventions in schools
Developing a comprehensive definition of sustainability
Uncovering the Benefits of Participatory Research
Context matters in implementation science
Implementing evidence-based interventions in health care
A new framework for developing and evaluating complex interventions
Our future
Strategies for ensuring trustworthiness in qualitative research projects
Using the framework method for the analysis of qualitative data in multi-disciplinary health research
Qualitative data analysis for applied policy research
Systems thinking and complexity
Rethinking children’s physical activity interventions at school
Navigating process evaluation in co-creation
Sustaining health obesity prevention programs
Co-production
Examining the sustainability and effectiveness of co-created physical activity interventions in vocational education and training
Factors associated with physical activity policy and practice implementation in British Columbia’s childcare settings
School-level factors associated with the sustainment of weekly physical activity scheduled in Australian elementary schools
Enriching the evidence base of co-creation research in public health with methodological principles of critical realism
| Citation velocity | historical |
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| Highly cited | No |