Sustaining health interventions in urban schools to construct educational possibilities

School-based health and wellness initiatives have evolved from isolated efforts into comprehensive, multi-level programs designed to improve and sustain children's overall health and well-being. When focused on building knowledge and changing behavior, these interventions can positively influence the development of lifelong healthy habits in youth. While facilitators and barriers to initial implementation are well documented, less is known about the long-term sustainability of such programs after external support and funding end. This qualitative study examined how inputs, activities, and resources provided during implementation affect the ongoing sustainability of comprehensive health interventions in schools. Semi-structured interviews were conducted with teachers and administrators from low-income, urban elementary schools to explore their experiences and perspectives. Data were analyzed using theory-driven methods guided by the Social Ecological Model and Whole School, Whole Community, Whole Child frameworks. Open coding identified critical themes and variables related to sustaining programming post-intervention. Findings revealed that alignment and continuity across levels of implementation, strong teacher and administrator buy-in, and the availability of ongoing resources, especially time, funding, and professional development, were essential to sustaining program benefits. These results offer practical insights for supporting the long-term success of school-based health and wellness programs.