A Realist Scoping Review of Community Nutrition Interventions in the UK: Implications for the ‘Nutrition Skills for Life’ Programme

Background
Nutrition Skills for Life (NSFL) provides training and support for communities and organisations to implement Community Nutrition Interventions (CNIs) that meet identified needs. To inform future 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.OSF.IO/D56FK.

Methodology
Reporting standards for realist syntheses (RAMESES) and scoping reviews (PRISMA-ScR) were used. Four electronic databases and grey literature were searched. Of the 1920 documents identified, 45 were included in the analysis. Data relating to Context, Mechanism and Outcomes were extracted and presented as C-M-O configurations (CMOCs). Documents were assessed for relevance to the research question and usefulness in terms of their contribution towards the IPT.

Results
The IPT, underpinned by the Ottawa Charter for Health Promotion, comprises 17 consolidated CMOCs. These are narratively discussed as follows: understanding community needs; consistent nutrition messages; knowledgeable, skilled, confident practitioners/facilitators and practising new skills.

Conclusions
Realist research and analysis of CMOCs provided a deeper understanding of how CNIs can be implemented to support SED communities in accessing a healthy diet. Interventions ‘worked’ when they acknowledged and addressed identified barriers to healthy eating, provided reliable, trusted, easy-to-understand nutrition messages, were delivered by confident, knowledgeable practitioners, and facilitated strategies such as meal preparation. Further realist evaluation to refine the IPT could inform the evaluation of other complex public health interventions.