Evaluating the effectiveness and implementation of evidence-based early-life nutrition interventions in a community setting a hybrid type 1 non-randomized trial – the Nutrition Now project protocol

Abstract

Disappointingly few efficacious health interventions are successfully scaled up and implemented in real world settings. This represents an evidence-to-practice gap, with loss of opportunity to improve practice. Aiming to improve nutrition in the first 1000 days of life, we have combined four efficacious dietary interventions into a single adapted digital resource (Nutrition Now) for implementation in a Norwegian community setting. Nutrition Now targets pregnant women and parents of 0–2-year-olds with messages focusing on healthy dietary behaviours. Early childhood education and care (ECEC) staff are provided with pedagogical tools addressing healthy food exposure and child food acceptance. Objectives: a) evaluate the effectiveness of provision of the Nutrition Now resource on child diet and diet-related outcomes, with special attention to the influence of socio-economic position, b) gather information on the effectiveness of the implementation process to inform forthcoming scale-up and c) perform trial- and model-based economic evaluations. This is a hybrid type 1 implementation study, focusing on evaluation of effectiveness. A quasi-experimental design with pre- and post-tests, where one municipality gets access to the resource (n~800), while a matched non-equivalent control municipality (n~800) does not, will be used. Effectiveness will be assessed by examining e.g., diet outcomes, developmental outcomes, and feeding practices. The resource will be implemented in ECEC settings and made available to pregnant women and parents through the Norwegian system of maternal and child health (MCH) care. The implementation process includes iterative adjustments and implementation strategies from the implementation framework Expert Recommendations for Implementing Change (ERIC) informed by dialogues with stakeholders. Implementation outcomes (e.g., acceptability and adoption) will be assessed through questionnaires and interviews with parents, ECEC and MCH staff, with particular attention to ethnic diverse groups. Both within-trial and modelling-based economic evaluation will be performed. Nutrition Now will bridge the existing evidence-to-practice gap through rigorous scientific effectiveness evaluation of municipal scale up and inform subsequent county scale up. The study is the first to implement efficacious nutrition interventions in early life with potential for health improvement using technology to maximise the reach and impact of both parental and MCH dietary guidance and ECEC practice.Clinical Trial Registrationhttps://www.isrctn.com/, identified ISRCTN10694967.

Protocol of a Parallel, Randomized Controlled Trial on the Effects of a Novel Personalized Nutrition Approach by Artificial Intelligence in Real World Scenario

“…Our approach, integrating e cacious dietary intervention comprising electronic resources and applying them in a real-world canteen situation, has uniquely t for Central Food Depot which plays an important role in the standardization of catering chains or related units. If this approach provides indications of public health bene t with reducing dietitians or healthcare professionals' workload [32], it may make a valuable contribution to other elds of medical research.…”

Scaling up evidence-based digital early life nutrition interventions in a county setting: an implementation trial – protocol for Phase 2 of the Nutrition Now project

“…Details, including theoretical underpinning of the interventions that the Nutrition Now resource comprises, are provided in protocol for Phase 1 of the project ( 14 ). The original interventions’ content and structure were modified and adapted to fit the context and user needs in the relevant settings for Phase 1 (family-, MCH centre- and ECEC- settings).…”

“…The section for ECEC-setting is available only in Norwegian. The Nutrition Now resource covers several topics presented as core components, addressing the importance of (1) diet early in life, (2) breastfeeding, (3) parental role in food provision and shaping a child’s diet, (4) responsive feeding, (5) shared meals, (6) knowledge and experience of food preparation, (7) sensory play involving vegetables and (8) ECEC collaboration with parents ( 14 ). These topics are presented through short videos, graphics, images and easy-to-read text formats.…”

“…Responding to the numerous calls for scaling up interventions early in life and the suggestions of Richter et al ( 1 ), we have established the Nutrition Now project. In Phase 1 ( 14 ), we combined four efficacious dietary digital interventions, targeting the first 1,000 days, into a single e-learning resource (the Nutrition Now resource ). This resource takes a lifecourse approach, targeting nutrition during sensitive dietary transitions, such as the initiation and maintenance of breastfeeding, the introduction of complementary foods, and the transition to early childhood education and care (ECEC) where meals are eaten outside the home environment and shared with peers ( 14 ).…”

“…Many children eat three meals a day in the ECEC setting ( 23 ), highlighting the importance of what is served and how food and meal settings are dealt with. The Nutrition Now resource comprising four digital diet interventions ( 14 ), offers a low-cost complementary tool for public health work in municipalities, and if successfully adapted when scaled-up, has the potential to improve population diet and health and respond to the need for tools and improved skills in childcare and ECECs. The Nutrition Now resource has a multisectoral approach and is directed towards parents and ECEC staff and includes elements relevant for MCH centres as well as those in the overarching municipality setting.…”