Background: Comprehensive School Health (CSH) approaches to developing a healthy school community can be effective in supporting chronic disease prevention while positively impacting on student behaviour and academic performance. Although a CSH framework provides principles for action, there is a lack of evidence regarding the processes that best facilitate CSH work, and enable action. Objective: The purpose of this study was to identify and describe the elements of practice-based evidence that contribute to the success and sustainability of healthy school communities, through the identification of positive practices and lessons learned from a sample of projects in Alberta, Canada. Setting: School communities in Alberta, Canada. Design and methods: Key individuals from a list of operating CSH projects were invited for interview. An exploratory, qualitative design examined the perspectives of these "school health champions". A total of 12 one-on-one interviews and one focus group with seven participants were completed, resulting in input from 19 individuals in total. Results: Elements to develop and sustain a healthy school community fall into one of two categories: (1) stakeholder buy-in and (2) adequate resources in the form of human resources, partnerships and peer support. Participants identified successful strategies for establishing buy-in from administrators, teachers, parents and students. Conclusion: To effectively mobilise a comprehensive school health framework, practical strategies for implementation are needed. While some of these strategies are context-specific, practice-based evidence that transcends the local context does exist and can be used more widely to support the development of a healthy school community.