Sustaining Healthy Communities in rural settings: lessons from multisectoral teams in Alberta, Canada

The Alberta Healthy Communities Approach (AHCA) supports communities in creating environments that support healthy behaviors and reduce the risk of cancer and chronic disease. In this 4-year project, participating rural communities implemented an iterative five-step process that included establishing multisectoral teams (MSTs) to develop, implement, and evaluate health promotion initiatives aligned with local priorities. Communities received implementation support through mentoring and facilitation, evidence-based tools, and seed funding. This study examined: What factors are essential to sustaining the AHCA in rural communities? Nineteen communities and 258 MST members participated. Community perspectives on factors and strategies influencing sustainability were captured through surveys and focus groups. Data were analyzed using conventional content analysis and codebook thematic analysis, and findings were synthesized narratively. Five key factors were identified, including: strong local leadership, community engagement, municipal support, capacity building, and maintaining collaboration. Strategies that supported sustainability included: developing transition plans and sharing responsibilities across MST members; maintaining ongoing, tailored engagement activities and using multiple communication channels; engaging local government early and aligning initiatives with municipal priorities; identifying training, mentoring, and shared learning opportunities; and investing continuously in relationships and trust building. These findings offer actionable recommendations for strengthening rural health promotion efforts and sustaining MSTs and community-led initiatives. Overall, the study highlights that proactive sustainability planning is a key contributor to the long-term success of community-led health promotion in rural settings.