Purpose: Efforts to alleviate food insecurity have traditionally focused on increasing access to quantity rather than quality of food. Given burgeoning health disparities and lower dietary quality among food insecure individuals, there has been a call to focus on nutrition security—providing consistent access to foods and beverages that promote well-being.  The aim of this study was to determine the dose of key nutrients received by students using an on-campus food pantry to determine whether pantry implementation is supporting nutrition security.

Methods: In August 2020, an on-campus, client-choice, food pantry opened at a large Midwest university; distribution guidelines were based on MyPlate and the pantry was open twice a week, three days apart. Pantry staff tracked student usage, item inventory, and food discarded during the first academic year of implementation. Inventory and waste logs were used to determine items distributed per pantry opening. Items were analyzed for specific nutrients using the Nutrition Data System for Research. Nutrient and distribution data were merged and adjusted for item size and quantity. The mean nutrients distributed was measured and dose-received was calculated as the average nutrients received per person for specific macro- and micronutrients of concern. Values were compared to national recommendations to determine days of adequate intake.

Results/findings: On average, 14 items were selected per student. Nutrients exceeding Dietary Reference Intakes (DRIs) for three days included vitamins A, C, most B vitamins, carbohydrates, and protein, and for men, iron, and women, zinc and magnesium. Nutrients that did not meet the DRIs for three days included vitamin D, and for males, potassium, energy, fiber, and linoleic and alpha linolenic acid. Added sugar made up less than 10% of total calories distributed (9.1%) and Acceptable Macronutrient Distribution Ranges were met for carbohydrates (50.8%) and protein (16.9%) but were exceeded for fat (35.6%).

Conclusions: Results suggest distribution standards support students receiving key nutrients, however, more foods fortified with Vitamin D are needed and male students may need access to more food to meet sex specific DRIs. More research on pantry implementation is needed to understand how pantry implementation can best support nutrition security. 

Purpose: ‘HeLP-Diabetes’ is an evidence-based digital self-management intervention for people with type 2 diabetes, designed to change dietary and physical activity behaviours. In a randomised controlled trial (RCT) HeLP-Diabetes was effective in reducing HbA_1c; NHS England have since commissioned a national roll-out (called ‘Healthy Living’). It is important to understand the extent to which Healthy Living has fidelity to HeLP-Diabetes, as any changes may impact effectiveness. We aimed to (a) describe the behaviour change and self-management content in Healthy Living, (b) compare this with HeLP-Diabetes, and (c) explain the reasons for any changes.

Methods: A content analysis of the Healthy Living webpages using three coding frameworks: Template for Intervention Description and Replication (TIDieR); Behaviour Change Technique (BCT) Taxonomy v1 (BCTs are the ‘active ingredients’ of behaviour change interventions); and our novel framework for coding self-management tasks. Results were compared with published descriptions of HeLP-Diabetes. We conducted nine semi-structured stakeholder interviews to understand the reasons for changes during the national roll-out. Interview data were analysed thematically.

Results: There were 43 BCTs in Healthy Living, which included BCTs to help self-regulate behaviour (e.g. goal setting, self-monitoring) that were integral to the original HeLP-Diabetes intervention. Healthy Living addressed all areas of self-management: medical, emotional and role management. Healthy Living included an additional structured online learning curriculum that was not included in the HeLP-Diabetes intervention tested in the RCT. This was because of changes in NHS policy that incentivised GPs to refer people newly diagnosed with diabetes to structured education within 9 months of diagnosis; however, HeLP-Diabetes was originally designed as ongoing self-management support rather than a structured education programme. Stakeholder interviews revealed that facilitated access by health professionals and a moderated forum were removed due to general practices not being willing or able to support these features.

Conclusions: Whilst changes were identified, the national roll-out of HeLP-Diabetes had good fidelity to the core self-regulatory BCTs that have been previously associated with producing changes in diet and physical activity. This study has identified the challenges of scaling up digital interventions in a national roll-out, highlighting the importance of considering implementation challenges during RCTs.

Purpose:

The last decade has seen a rise in “Food as Medicine” interventions by healthcare organizations to address food and nutrient deficiencies among their patient populations who screen as being food insecure. Several implementation models exist, from food delivery to voucher redemption. The purpose of our study was to analyze qualitative data on perceptions of healthcare providers (HCP) on implementation and adoption of voucher-based food prescription programming within their systems among their patient populations.

Methods:

The Houston Food Bank (HFB) administers the food prescription program as part of a formal partnership with HCPs in the Houston, Texas region. An open-ended survey was administered to HCPs employed across organizations asking about their perceptions regarding implementing a food prescription program among their patients. Qualitative analysis of data from May 2018 to March 2021 included a review of question structure and response frequency by HCPs. The primary researcher reviewed all data and iteratively coded and categorized responses through thematic analysis; two research team members subsequently coded all data for reliability. All data were analyzed using Dedoose software (Los Angeles, California; Version 9.0.15).

Results:

HCP organizations (n=20) provided qualitative feedback on responses (n=252) on food prescription program perceptions. Providers were categorized by five different types of healthcare providers.  Six major themes were identified: 1) Food Quality: perceived as quality, type, variety, and availability incented continued program redemptions, 2) Patient barriers: including transportation issues and schedule conflicts with work or childcare, 3) Collaboration between HFB and HCP providers: the positive impacts of food bank provided community assistance and constant ongoing support, 4) Communication: confusion surrounding programming and eligibility and survey data collection, and 5) COVID-19 pandemic impact: transition to telehealth and shifting food distributions.

Conclusion:

Results of this qualitative analysis offer unique stakeholder insight into the charity food and HCP food prescription model.  Our study adds support to inform and improve the implementation of voucher-based food prescription models to influence health.

Purpose: Process evaluations are critical for assessing intervention implementation and context. Truck drivers often display worse health profiles than the general population. A mixed-methods process evaluation was conducted to evaluate the implementation of the Structured Health Intervention for Truckers (SHIFT), a multi-component intervention targeting physical activity, diet, and sedentary behaviour, in a cohort of 382 truck drivers in the UK.

Methods: The 6-month SHIFT intervention was evaluated within a cluster randomised controlled trial and involved 25 transport sites (12 intervention and 13 control sites). Intervention components included a health workshop, Fitbit, text messages, and cab workout equipment. As part of the process evaluation, drivers completed questionnaires at baseline and 6-months follow-up. Semi-structured focus groups/interviews were conducted with drivers (n = 19) and managers (n = 18) from each site, after completion of the final follow-up assessment (16-18 months post-randomisation). Data were collected on fidelity, dose, context, implementation, barriers, sustainability, and contamination.

Results: Both questionnaire and interview data from intervention participants indicated favourable attitudes towards SHIFT, specifically towards the Fitbit with a high proportion of drivers reporting regularly using it (89.1%). The education session was deemed useful for facilitating improvements in knowledge and behaviour change, dietary knowledge changes were predominantly recalled. Receiving feedback from the health assessments motivated participants to change aspects of their lifestyle (intervention = 91.1%, control = 67.5%). The cab workout equipment was used less and spoken unfavourably of in the interviews. Barriers to a healthy lifestyle at work were apparent and affected drivers throughout the study. The most suggested improvement was more frequent contact with drivers. Managers were positive about the objectives of SHIFT, however almost all mentioned the challenges related to implementation.

Conclusions: SHIFT was a complex, multi-component health intervention, which was received well by drivers and managers, but was logistically challenging for smaller sites to implement. Truck drivers reported unique occupational barriers that have persisted before, during and after the study. Transport sites each have distinct characteristics, which required adaptations to individual settings to encourage participation. Managers and drivers reported enthusiasm and necessity for SHIFT to be included in future Certificate of Professional Competence training.

Purpose: To investigate the factors that influence adults to drop out of behavioral Intensive Lifestyle Interventions for weight loss (ILIs) at six months. Developing successful strategies to improve retention is expected to enhance ILIs implementation and increase weight loss. 

Methods: Retrospective multiple logistic regression analysis of 268 participants from two studies: a multicenter study that included five in-person ILIs delivered by nutrition interns in two public primary healthcare clinics (n=49 and n=52), two public hospitals (n=45 and n=41), and a university clinic (n=50), and one randomized controlled trial that included one online ILI delivered by a PhD student (n=31). The same research team conducted both studies in the same population (adults aged 18 to 65 years, with a BMI≥ 25 kg/m² and living in Northern Mexico), using the same intervention components and identical instruments and techniques to collect the data. Twenty-nine factors related to the participants and five related to the interventions that have been shown in the literature to affect the dropout rate were considered. The model was selected using the stepwise automatic method. A sensitivity analysis was conducted to assess if the differences in the study designs affected the results by repeating the process, excluding the online clinic.

Results/findings: Older participants (≥ 50 years) were less likely to drop out of the ILI compared to participants <35 years old (OR=0.34, 95% CI=0.16-0.70). Participants who experienced less pain (higher scores on the bodily pain scale of the SF-36) also had a slightly lower chance of dropping out of the intervention: for each unit increase in the bodily pain score, the risk of dropping out decreased by 2% (OR=0.98, 95% CI=0.97, 0.996). Finally, change in the interventionist during the 6-month intervention more than doubled the risk of dropping out (OR 2.25, 95% CI=1.23-4.14).

Conclusions: The results of this study indicated that it might be possible to improve retention among participants of ILIs by ensuring that the same interventionist remains during the six-month intervention. In addition, ILIs may need tailoring for younger ages and participants with higher perceived pain. These factors can be accounted for in the design of the intervention.