Are dietary interventions with a behaviour change theoretical framework effective in changing dietary patterns? A systematic review

Abstract

Background The term ‘whole dietary pattern’ can be defined as the quantity, frequency, variety and combination of different foods and drinks typically consumed and a growing body of research supports the role of whole dietary patterns in influencing the risk of non-communicable diseases. For example, the ‘Mediterranean diet’, which compared to the typical Western diet is rich in fruits and vegetables, whole grains, and oily fish, is associated with reduced risk of cardiovascular disease and cancer. Social Cognition Models provide a basis for understanding the determinants of behaviour and are made up of behavioural constructs that interventions target to change dietary behaviour. The aim of this systematic review was to provide a comprehensive assessment of the effectiveness and use of psychological theory in dietary interventions that promote a whole dietary pattern. Methods We undertook a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis to synthesize quantitative research studies found in Embase, Medline, PsycInfo, CINAHL and Web of Science. The studies included were randomised and non-randomised trials published in English, involving the implementation of a whole dietary pattern using a Social Cognition Model to facilitate this. Two independent reviewers searched the articles and extracted data from the articles. The quality of the articles was evaluated using Black and Down quality checklist and Theory Coding Scheme. Results Nine intervention studies met the criteria for inclusion. Data from studies reporting on individual food group scores indicated that dietary scores improved for at least one food group. Overall, studies reported a moderate application of the theory coding scheme, with poor reporting on fidelity. Conclusion To our knowledge, this is the first review to investigate psychological theory driven interventions to promote whole dietary patterns. This review found mixed results for the effectiveness of using psychological theory to promote whole dietary pattern consumption. However, the studies in this review scored mostly moderate on the theory coding scheme suggesting studies are not rigorously applying theory to intervention design. Few studies reported high on treatment fidelity, therefore, translation of research interventions into practice may further impact on effectiveness of intervention. Further research is needed to identify which behaviour change theory and techniques are most salient in dietary interventions.

The impact of lockdown caused by the COVID-19 pandemic on glycemic control in patients with diabetes

“…It is possible that individuals who are restricted in one area (e.g., physical activity) become more willing to follow other recommendations (e.g., diet), for fear of worsening their results (e.g., glucose control or weight gain in population with diabetes). The indication of such a tendency comes from the observation dedicated to morbidly obese patients [30] and a systematic review [31]. In the last one the authors pointed that the awareness of the importance of a balanced diet can be an essential factor that may influence dietary choices.…”

Indian adolescents’ perceptions of anaemia and its preventive measures: A qualitative study

“…Theory-driven interventions are associated with larger intervention effects ( 52 ) . Theoretical models like the Health Belief Model, Transtheoretical Model (TTM), SCT, and Theory of Planned Behavior have been largely used to inform behaviour change interventions ( 53 , 54 ) . A recent systematic review highlights TTM as a successful theoretical framework for nutrition interventions aiming at improving dietary intake in adolescents ( 54 ) .…”

A Method to Estimate the Efficacy vs. Effectiveness in Meta-Analysis of Clinical Trials with Different Adherence Scenarios: A Monte Carlo Simulation Study in Nutrition

“…Adherence could be explained by a variety of factors, such as: (a) the type and duration of nutritional treatment received [ 37 , 38 ], highlighting the importance of follow-up to assess the efficacy of the intervention in the short and long term [ 39 , 40 ]; (b) motivation: as one of the facilitating factors in adherence to FV consumption [ 41 , 42 ], versus who was assigned to the control group; (c) access to information: adherence may be hampered due to the fact that practical aspects of the assigned intervention are unknown, such as portion sizes and the need for food variability [ 43 ]; (d) employment status and occupation: occupation gathers information on life styles and conditions related to education and income level; at a general level, a better professional qualification provides better working conditions and higher income, conditions associated with a higher prevalence of FV consumption [ 44 , 45 ]; (e) psychosocial stress: subjects with a history of cardiovascular disease undergoing a nutritional intervention [ 46 ], such as the consumption of FV according to recommendations assigned by the professional, in the long term generate allostatic load, that is, a maladaptive response, in this case not following the recommendations indicated [ 47 ]; (g) compensatory health beliefs: a factor that can influence adherence to FV consumption and consists of the belief that unhealthy behavior can be compensated; for example, eating unhealthily can be offset by exercising [ 42 ]; or, finally, (h) psychotherapeutic interventions: among psychotherapeutic interventions for modifying behaviors to promote adherence to nutritional interventions [ 48 ], we find Behavioral Activation (BA), focused on the reduction in avoidance behaviors and the development of routines and rewarding behaviors that allow greater adherence to FV consumption in adults with subsyndromal symptoms of depression [ 49 ].…”