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. 2022 Mar 10;80(4):962-979.
doi: 10.1093/nutrit/nuab096.

A systematic review of adaptations and effectiveness of scaled-up nutrition interventions

Rachel L Sutherland  1   2   3 , Jacklyn K Jackson  1   2 , Cassandra Lane  1   2 , Sam McCrabb  1   2 , Nicole K Nathan  1   2   3 , Sze Lin Yoong  1   2   3   4 , Melanie Lum  1   2   3 , Judith Byaruhanga  1   2   3 , Matthew McLaughlin  1   2 , Alison Brown  1   2 , Andrew J Milat  5 , Adrian E Bauman  1   5 , Luke Wolfenden  1   2   3
Affiliations

A systematic review of adaptations and effectiveness of scaled-up nutrition interventions

Rachel L Sutherland et al. Nutr Rev. .

Abstract

Context: Public health nutrition interventions shown to be effective under optimal research conditions need to be scaled up and implemented in real-world settings.

Objectives: The primary aim for this review was to assess the effectiveness of scaled-up public health nutrition interventions with proven efficacy, as examined in a randomized controlled trial. Secondary objectives were to: 1) determine if the effect size of scaled-up interventions were comparable to the prescale effect, and; 2) identify any adaptations made during the scale-up process.

Data sources: Six electronic databases were searched and field experts contacted.

Study selection: An intervention was considered scaled up if it was delivered on a larger scale than a preceding randomized controlled trial ("prescale") in which a significant intervention effect (P ≤ 0.05) was reported on a measure of nutrition.

Data extraction: Two reviewers independently performed screening and data extraction. Effect size differences between prescale and scaled-up interventions were quantified. Adaptations to scale-up studies were coded according to the Adaptome model.

Results: Ten scaled-up nutrition interventions were identified. The effect size difference between prescale trials and scaled-up studies ranged from -32.2% to 222% (median, 50%). All studies made adaptations between prescale to scaled-up interventions.

Conclusion: The effects of nutrition interventions implemented at scale typically were half that achieved in prior efficacy trials. Identifying effective scale-up strategies and methods to support retainment of the original prescale effect size is urgently needed to inform public health policy.

Systematic review registration: PROSPERO registration no.CRD42020149267.

Keywords: adaptation; public health nutrition; scale-up; systematic review.

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Figures

Figure 1
Figure 1
PRISMA flow diagram of included studies
See this image and copyright information in PMC

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