Protocol for a cluster randomised controlled trial on information technology-enabled nutrition intervention among urban adults in Chandigarh (India): SMART eating trial

Abstract

Nutrition is an important determinant of health. At present, nutrition programs in India mainly emphasize improving maternal and child nutrition. Adult nutrition has not received due attention, though diseases like hypertension and diabetes are largely preventable through changes in dietary and physical activity behaviour. Little is known about the best approaches to improve dietary behaviours, especially the role of modern information technology (IT) in health education. We describe the protocol of the SMART Eating (Small, Measurable and Achievable dietary changes by Reducing fat, sugar and salt consumption and Trying different fruits and vegetables) health promotion intervention. A Cluster Randomised Controlled Trial will evaluate the effect of an IT-enabled intervention on nutrition behaviour among urban adults of Chandigarh, India. Formative research using a qualitative exploratory approach was undertaken to inform the intervention. The IT-enabled intervention programme includes website development, Short Message Service (SMS), e-mail reminders and interactive help by mobile and landline phones. The IT-enabled intervention will be compared to the traditional nutrition education program of distributing pamphlets in the control group. The primary outcome will be the percentage of study participants meeting the dietary intake guidelines of the National Institute of Nutrition, Hyderabad, India and the change in intake of fat, sugar, salt, fruit and vegetables after the intervention. The difference in differences method will be used to determine the net change in dietary intakes resulting from the interventions. Measurements will be made at baseline and at 6 months post-intervention, using a food frequency questionnaire. The formative research led to the development of a comprehensive intervention, focusing on five dietary components and using multi-channel communication approach including the use of IT to target urban North Indians from diverse socio-economic backgrounds. The Cluster Randomised Controlled Trial design is suitable for evaluating the effectiveness of this IT-enabled intervention for dietary behaviour change.

Effectiveness of information technology–enabled ‘SMART Eating’ health promotion intervention: A cluster randomized controlled trial

“…The trial was registered under the Clinical Trial Registry of India (CTRI/2016/11/007457; Date: 9/11/ 2016). The protocol paper with a detailed description of the study design and methodology has been published elsewhere [20].…”

“…The intervention was guided by the PRECEDE-PROCEED model [24], empirical literature on interventions, dietary guidelines by the National Institute of Nutrition, India [25], and qualitative formative research. A detailed description of the intervention protocol has been published elsewhere [20]. Qualitative formative research, guided by the Social Ecological Model, revealed multi-level influences on dietary behaviours at individual, family, and social-structural level which facilitated the development of context-specific, culturally acceptable intervention [26].…”

Effectiveness of a culturally appropriate nutrition educational intervention delivered through health services to improve growth and complementary feeding of infants: A quasi-experimental study from Chandigarh, India

“…Although DID may not be the perfect substitute for randomized control trials, it is a feasible way to understand causal relationships between the intervention and outcome [39]. This type of analysis was also considered in measuring the net effect of the nutrition-based intervention to estimate the change in dietary intake from baseline to end-line in the intervention and control arm in Kaur et al study [40].…”

Community Participatory Learning and Action Cycle Groups to Reduce Type 2 Diabetes in Bangladesh (DClare): Study Protocol for a Stepped-Wedge Cluster Randomised Controlled Trial

“…[6] Prevention and control efforts have predominantly targeted individual behaviour change amongst high-risk groups, with mixed results in South Asian settings. [7][8][9][10][11][12] There is a need to develop and test population level interventions that create an enabling environment for the prevention of T2DM at scale, shifting from individualistic to structural and social interventions. [13] The DMagic (Diabetes Mellitus Action through community Groups or mHealth Information for better Control) trial used a participatory learning and action (PLA) approach directed at the general population in rural Bangladesh.…”