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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

Frontiers in Public Health · 9 authors, 7 centres

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This mixed-methods study evaluated two human-centered design interventions in Latin American restaurants to promote healthy eating. One restaurant introducing new healthier menu items saw increased sales and improved nutrition environment scores, while the other promoting existing items saw no significant changes, with implementation fidelity and sustainability varying between sites.

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This mixed-methods, longitudinal study evaluated two human-centered design (HCD) co-developed interventions in Latin American restaurants to promote healthier eating. Intervention outcomes were assessed via daily sales data analyzed with interrupted time series and the Nutrition Environment Measures Survey for Restaurants (NEMS-R). Implementation outcomes and determinants were evaluated through site visits, staff (n=19) and customer (n=31) interviews, and post-implementation key informant interviews analyzed using the Consolidated Framework for Implementation Research (CFIR). Results differed by restaurant: in one, introducing new healthier menu items (HMI) increased HMI sales and improved NEMS-R scores, while in the other, promoting existing HMI led to no significant changes. The findings provide insights for implementing health interventions in dynamic community settings like restaurants.

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public health

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ORIGINAL PAPER

PMC10233011

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

Frontiers in Public Health

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ABSTRACT

Abstract 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. Keywords: restaurant, nutrition, human-centered design, consolidated framework for implementation research, implementation science, Hispanic (demographic)

CITATION EXPORT

Melissa Fuster, Emily Dimond, Margaret A Handley et al.. 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. Frontiers in Public Health. (2023). https://doi.org/10.3389/fpubh.2023.1150790

AUTHORS

9 · 7 CENTRES

Melissa Fuster, Emily Dimond, Margaret A Handley, Donald Rose, Charles Stoecker, Megan Knapp, Brian Elbel, Cara Conaboy, Terry T K Huang

1Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
2Partnership for Research in Implementation Science for Equity (PRIDE) Center and Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, United States
3Department of Health Policy and Management, New Orleans, LA, United States
4Department of Public Health Sciences, Xavier University of Louisiana, New Orleans, LA, United States
5Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States,
6Wagner Graduate School of Public Service, New York University, New York, NY, United States
7Center for Systems and Community Design and NYU-CUNY Prevention Research Center, City University of New York Graduate School of Public Health and Health Policy, New York, NY, United States