Characterisation of At-Scale Community Health Interventions Aimed to Improve Healthy Eating Behaviour in Australia: A Rapid Review

Abstract

Issue addressed: For widespread and sustained health impacts, community health interventions need to be effective, embedded in regular service delivery and maintained over longer periods.

Methods: This review followed the Cochrane Rapid Review method to: (1) characterise Australian community primary prevention interventions that focus on diet improvement and have been delivered at scale; (2) describe the pathway to implementation at scale; and (3) identify the intervention elements that contribute to success and sustainability. Eligible interventions were those (1) delivered to an Australian healthy population group with dietary intake reported; (2) where delivery was by a service or organisation; and (3) where investment in the large-scale delivery of the intervention exceeded research funding. A systematic search was undertaken in three databases for original studies published from 2009 to February 2024. Additional publications relating to the same intervention or programme were also retrieved and extracted. A Mixed Methods Appraisal Tool was used for quality appraisal of primary papers, and narrative synthesis was undertaken to characterise interventions.

Results: Twenty-five programmes met the eligibility criteria, of which 22 were state-based (82% in NSW or Victoria), and 3 were national programmes. Programme settings included primary schools (n = 6), community spaces (n = 5), childcare centres (n = 5), multiple (n = 4), home (n = 3), and other (n = 2). The lead delivery agency for programmes was most often state or local government, or a not-for-profit organisation. Twenty percent of programmes did not demonstrate effectiveness in improving dietary outcomes. Programmes were reported in 3.3 ± 1.7 evaluations (range 1-6). A range of processes was identified for scale-up across programmes including delivery-partner-initiated programmes, researcher-led interventions that were successfully scaled up, and collaborative partnerships. Frequently cited facilitators to scale-up represented inner (e.g., leadership) and outer (e.g., resources) contextual factors, as well as process-related factors and intervention characteristics. The same factors were cited as barriers; however, barriers were cited less frequently.

Conclusions: This study examining the characteristics of real-world community interventions that achieve at-scale delivery found interventions that varied widely in their target population, duration, delivery format, intensity, and development. Most programmes were not scaled-up beyond state boundaries despite Australia's national dietary health challenges, and it is recommended that the barriers to nationwide scalability of programmes be investigated. SO WHAT?: This study highlights the value of closer collaboration between researchers and community health promotion practitioners to strengthen the design and implementation of community health programmes by addressing real-world barriers to uptake and sustainability. Consideration should also be given to how scaled programme models can transcend state boundaries.

Keywords: at‐scale community interventions; characterisation; dietary intake; population health.

FIGURE 1

PRISMA diagram of included studies.