Applying research in nutrition education planning: a dietary intervention for Bangladeshi chronic kidney disease patients

Co-Design Practices in Diet and Nutrition Research: An Integrative Review

Co-design, the method of involving users, stakeholders, and practitioners in the process of design, may assist to improve the translation of health evidence into tangible and acceptable intervention prototypes. The primary objective of this review was to identify and describe co-design techniques used in nutrition research. The secondary objective was to identify associations between co-design techniques and intervention effectiveness. An integrative review was performed using the databases Emcare, MEDLINE, PsycINFO and Google Scholar. Eligible studies included those that: (1) utilised participatory research or co-design techniques, (2) described development and/or evaluation of interventions aimed at improving dietary behaviours or nutrition, and (3) targeted community-dwelling adults aged ≥18 years. We identified 2587 studies in the initial search and included 22 eligible studies. There were 15 studies that utilised co-design techniques, with a strong focus on engagement of multiple stakeholder types and use of participatory research techniques. No study implemented a complete co-design process. Most studies (14/15) reporting outcomes reported positive health (maximum p < 0.001) or health behaviour outcomes attributed to the intervention; hence, associations between co-design techniques and effectiveness could not be determined. Currently published intervention studies have used participatory research approaches rather than co-design methods. Future research is required to explore the effectiveness of co-design nutrition interventions.

Development of interventions for an intelligent and individualized mobile health care system to promote healthy diet and physical activity: using an intervention mapping framework

BACKGROUND

The mortality of coronary heart disease can be largely reduced by modifying unhealthy lifestyles. However, the long-term effectiveness of interventions for modifying unhealthy diet and physical inactivity of patients with coronary heart disease remain unsatisfactory worldwide. This study aims to systematically design a set of theory-based and evidence-based, individualized, and intelligent interventions for promoting the adoption and maintenance of a healthy diet and physical activity level in patients with coronary heart disease.

METHODS

The interventions will be delivered by a mobile health care system called Individualized, Intelligent and Integrated Cardiovascular Application for Risk Elimination. Three steps of the intervention mapping framework were used to systematically develop the interventions. Step 1: needs assessment, which was carried out by a literature review, in-depth interviews and focus group discussions. Step 2: development of objective matrix for diet and physical activity changes, based on the intersection of objectives and determinants from the Contemplation-Action-Maintenance behavior change model. Step 3: formulation of evidence-based methods and strategies, and practical applications, through a systematic review of existing literature, research team discussions, and consultation with multidisciplinary expert panels.

RESULTS

Three needs relevant to content of the intervention, one need relevant to presentation modes of the intervention, and four needs relevant to functional features of the application were identified. The objective matrix includes three performance objectives, and 24 proximal performance objectives. The evidence-based and theory-based interventions include 31 strategies, 61 evidence-based methods, and 393 practical applications.

CONCLUSIONS

This article describes the development of theory-based and evidence-based interventions of the mobile health care system for promoting the adoption and maintenance of a healthy diet and physical activity level in a structured format. The results will provide a theoretical and methodological basis to explore the application of intervention mapping in developing effective behavioral mobile health interventions for patients with coronary heart disease.

TRIAL REGISTRATION

Chinese Clinical Trial Registry: ChiCTR-INR-16010242. Registered 24 December 2016. http://www.chictr.org.cn/index.aspx.

Engaging stakeholders in the co-development of programs or interventions using Intervention Mapping: A scoping review

BACKGROUND

Health care innovations tailored to stakeholder context are more readily adopted. This study aimed to describe how Intervention Mapping (IM) was used to design health care innovations and how stakeholders were involved.

METHODS

A scoping review was conducted. MEDLINE, EMBASE, Cochrane Library, Scopus and Science Citation Index were searched from 2008 to November 2017. English language studies that used or cited Intervention Mapping were eligible. Screening and data extraction were done in triplicate. Summary statistics were used to describe study characteristics, IM steps employed, and stakeholder involvement.

RESULTS

A total of 852 studies were identified, 449 were unique, and 333 were excluded based on title and abstracts, 116 full-text articles were considered and 61 articles representing 60 studies from 13 countries for a variety of clinical issues were included. The number of studies published per year increased since 2008 and doubled in 2016 and 2017. The majority of studies employed multiple research methods (76.7%) and all 6 IM steps (73.3%). Resulting programs/interventions were single (55.4%) or multifaceted (46.4%), and 60.7% were pilot-tested. Programs or interventions were largely educational material or meetings, and were targeted to patients (70.2%), clinicians (14.0%) or both (15.8%). Studies provided few details about current or planned evaluation. Of the 4 (9.3%) studies that reported impact or outcomes, 3 achieved positive improvements in patient or professional behaviour or patient outcomes. Many studies (28.3%) did not involve stakeholders. Those that did (71.7%) often involved a combination of patients, clinicians, and community organizations. However, less than half (48.8%) described how they were engaged. Most often stakeholders were committee members and provide feedback on program or intervention content or format.

CONCLUSIONS

It is unclear if use of IM or stakeholder engagement in IM consistently results in effective programs or interventions. Those employing IM should report how stakeholders were involved in each IM step and how involvement influenced program or intervention design. They should also report the details or absence of planned evaluation. Future research should investigate how to optimize stakeholder engagement in IM, and whether use of IM itself or stakeholder engagement in IM are positively associated with effective programs or interventions.