Evaluating Nutrition Skills for Life in Wales: a realist scoping review

Background and aims: Nutrition Skills for Life (NSFL) provides training and support for communities and organisations to implement Community Nutrition Interventions (CNIs) that meet identified needs. To optimise NSFL evaluation, this scoping review, using a realist approach sought to determine the underpinning initial programme theory (IPT) for how CNIs support socioeconomically disadvantaged (SED) communities to access a healthy diet, as detailed in the protocol doi.org/10.17605/OSF.IO/D56FK.

Description and recommendations: Reporting standards for realist syntheses (RAMESES) and scoping reviews (PRISMA-ScR) were used. Four electronic databases and grey literature were searched. Of 1920 documents identified, 45 were included in the analysis. Data relating to Context, Mechanism and Outcomes were extracted and C-M-O configurations (CMOCs) developed. Documents were assessed for relevance to the research question and usefulness in terms of their contribution towards the consolidated CMOCs. The IPT is underpinned by the Ottawa Charter’s five action areas. It comprises 10 consolidated CMOCS. Each consolidated CMOC narrative are discussed as follows; physical environment, social and cultural environment, interpersonal factors and intra personal factors. Recommendations for future delivery include attention to individual level factors (goal setting, practising new skills and confident practitioners); sociocultural factors (understanding communities, social meaning of food and consistent nutrition messages); and physical environment (food environment, mitigating food poverty).

Significance: Realist research and analysis of CMOCs provided deeper understanding of how CNIs can be implemented to support SED communities to access a healthy diet. Further realist evaluation to refine the IPT could usefully inform evaluation of other complex public health behaviour change interventions.