Evaluating the outcomes and implementation determinants of interventions co-developed using human-centered design to promote healthy eating in restaurants

An application of the consolidated framework for implementation research

Datos Bibliográficos

ID22074773
AutoresMelissa Fuster (0000-0001-6357-9986, Tulane University, autor de correspondencia), Emily Dimond (Tulane University), Margaret A Handley (0000-0001-5034-2111, University of California, San Francisco), Donald Rose (0000-0002-2110-8059, Tulane University), Charles Stoecker (0000-0001-5438-9312, Tulane University), Megan Knapp (0000-0001-8575-9101, Xavier University of Louisiana), Brian Elbel (0000-0003-1615-9430, Wagner College), Cara Conaboy (Tulane University), Terry T-K Huang (0000-0001-5544-5187, The Graduate Center, CUNY), Terry T K Huang
Año2023
Volumen11
Páginas1150790-1150790
Fecha de publicación2023-05-18
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaFrontiers in Public Health (JOURNAL)
Identificadores de la revistaISSN: 2296-2565 • E-ISSN: 2296-2565
EditorialFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2023.1150790
PMID37275479
OpenAlexW4377023076
IdiomaEN
Referencias citadas33

Background Restaurants are an emerging yet underutilized setting to facilitate healthier eating, particularly among minoritized communities that disproportionately experience health inequities. The present study aimed to examine outcomes from interventions co-developed using Human-Centered Design (HCD) in two Latin American restaurants, including sales of healthier menu items (HMI) and the consumer nutrition environment. In addition, we aimed to assess implementation outcomes (acceptability, fidelity, and sustainability) and elucidate the determinants for implementation using the Consolidated Framework for Implementation Research. Methods This study used a mixed-methods, longitudinal design. Data were collected pre-, during, and post-intervention testing. Intervention outcomes were examined through daily sales data and the Nutrition Environment Measures Survey for Restaurants (NEMS-R). Changes in HMI sales were analyzed using interrupted time series. Implementation outcomes and determinants were assessed through site visits [observations, interviews with staff ( n = 19) and customers ( n = 31)], social media monitoring, and post-implementation key informant interviews with owners and staff. Qualitative data were analyzed iteratively by two independent researchers using codes developed a priori based on CFIR. Results The HCD-tailored interventions had different outcomes. In restaurant one (R1), where new HMI were introduced, we found an increase in HMI sales and improvements in NEMS-R scores. In restaurant two, where existing HMI were promoted, we found no significant changes in HMI sales and NEMS-R scores. Acceptance was high among customers and staff, but fidelity and sustainability differed by restaurant (high in R1, low in R2). Barriers and facilitators for implementation were found across all CFIR constructs, varying by restaurant and intervention. Most relevant constructs were found in the inner setting (restaurant structure, implementation climate), individual characteristics, and process (HCD application). The influence of outer setting constructs (policy, peer pressure) was limited due to lack of awareness. Conclusion Our findings provide insights for interventions developed in challenging and constantly changing settings, as in the case of restaurants. This research expands the application of CFIR to complex and dynamic community-based settings and interventions developed using HCD. This is a significant innovation for the field of public health nutrition and informs future interventions in similarly dynamic and understudied settings

Business · Environmental health · Fidelity · Implementation research · Process management · Psychological intervention · Qualitative property · Qualitative research · Research design · Sustainability · Applied Psychology · Computer Science · Consumer Attitudes and Food Labeling · Health Policy Implementation Science · Medicine · Nursing · Obesity, Physical Activity, Diet · Psychology