Abstract
Health promotion is fundamental in the drive to reduce the growing chronic disease burden across the globe. The prevention of chronic diseases requires behaviour modifications. Health promotion interventions aim to engage and empower individuals and communities to choose healthy behaviours and make changes that reduce the risk of developing chronic diseases. Therefore, guided by PRECEDE–PROCEED – a community-oriented participatory health promotion model, we implemented a pragmatic cluster randomized controlled trial to test the effectiveness of a community-led information technology (IT)-enabled “SMART Eating” intervention to improve dietary behaviours among urban adults from diverse socio-economic backgrounds. The intervention was informed by qualitative formative research through community involvement. “Inductive theoretical drive” helped in developing the intervention and “‘Deductive theoretical drive” in measuring intervention-induced changes at the individual and family levels. This chapter describes the epistemological analysis of the framework, paradigms, approaches and methods used in the planning, implementation and comprehensive evaluation of the “SMART Eating” intervention. “SMART Eating” experiences showed that for dealing with the complexities of unhealthy dietary behaviour, evidence-based health promotion intervention research requires paradigm integration; thus, methodological pluralism calls for a mixed methods approach and appropriate measurement of effectiveness including the use of compatible theories.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Adams, J., & White, M. (2004). Why don’t stage-based activity promotion interventions work? Health Education Research, 20(2), 237–243. https://doi.org/10.1093/her/cyg105
Albrecht, G., Freeman, S., & Higginbotham, N. (1998). Complexity and human health: the case for atransdisciplinary paradigm. Culture, Medicine and Psychiatry, 22(1), 55–92. https://doi.org/10.1023/a:1005328821675
Aldiabat, K. (2013). developing smoking cessation program for older Canadian people: An application of precede-proceed model. American Journal of Nursing Science, 2, 33. https://doi.org/10.11648/j.ajns.20130203.13
Almalki, S. (2016). Integrating quantitative and qualitative data in mixed methods research—Challenges and benefits. Journal of Education and Learning, 5, 288. https://doi.org/10.5539/jel.v5n3p288
Bartholomew, L. K., Parcel, G. S., & Kok, G. (1998). Intervention mapping: A process for developing theory- and evidence-based health education programs. Health Education & Behavior, 25(5), 545–563. https://doi.org/10.1177/109019819802500502
Bingham, S. A. (2002). Biomarkers in nutritional epidemiology. Public Health Nutrition, 5(6a), 821–827. https://doi.org/10.1079/phn2002368
Blackford, K., Lee, A., James, A. P., Waddell, T., Hills, A. P., Anderson, A. S., et al. (2017). Process evaluation of the Albany Physical Activity and Nutrition (APAN) program, a home-based intervention for metabolic syndrome and associated chronic disease risk in rural Australian adults. Health Promotion Journal of Australia, 28(1), 8–14. https://doi.org/10.1071/he16027
Bogers, R. P., Brug, J., van Assema, P., & Dagnelie, P. C. (2004). Explaining fruit and vegetable consumption: The theory of planned behaviour and misconception of personal intake levels. Appetite, 42(2), 157–166. https://doi.org/10.1016/j.appet.2003.08.015
Brink, P. J., & Wood, M. J. (1998). Advanced design in nursing research (2nd ed.). Sage.
Bronfenbrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist, 32, 513–531.
Brug, J., Conner, M., Harré, N., Kremers, S., McKellar, S., & Whitelaw, S. (2004). The Transtheoretical Model and stages of change: A critique: Observations by five commentators on the paper by Adams, J. and White, M. (2004) Why don’t stage-based activity promotion interventions work? Health Education Research, 20(2), 244–258. https://doi.org/10.1093/her/cyh005
Campbell, M. K., Piaggio, G., Elbourne, D. R., & Altman, D. G. (2012). Consort 2010 statement: Extension to cluster randomised trials. BMJ, 345. https://doi.org/10.1136/bmj.e5661
Chen, S.-Y., Feng, Z., & Yi, X. (2017). A general introduction to adjustment for multiple comparisons. Journal of Thoracic Disease, 9(6), 1725–1729. https://doi.org/10.21037/jtd.2017.05.34
Creswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed methods approaches (4th ed.). Sage.
Creswell, J. W., & Plano Clark, V. L. (2007). Designing and conducting mixed methods research. Sage.
de Vries, H., Dijkstra, M., & Kuhlman, P. (1988). Self-efficacy: The third factor besides attitude and subjective norm as a predictor of behavioural intentions. Health Education Research, 3(3), 273–282. https://doi.org/10.1093/her/3.3.273
Daivadanam, M., Wahlstrom, R., Thankappan, K. R., & Ravindran, T. K. (2015). Balancing expectations amidst limitations: The dynamics of food decision-making in rural Kerala. BMC Public Health, 15, 644. https://doi.org/10.1186/s12889-015-1880-5
Darlington, E., Namara, P., & Jourdan, D. (2020). Enhancing the efficacy of health promotion interventions: A focus on the context. Public Health in Practice, 1, 100002. https://doi.org/10.1016/j.puhip.2020.100002
Darnton, A. (2008). Practical guide: An overview of behaviour change models and their uses. Government Social Research Unit/University of Westminster: Centre for Sustainable Development.
Davis, R., Campbell, R., Hildon, Z., Hobbs, L., & Michie, S. (2015). Theories of behaviour and behaviour change across the social and behavioural sciences: A scoping review. Health Psychology Review, 9(3), 323–344. https://doi.org/10.1080/17437199.2014.941722
Dragsted, L. O., Gao, Q., Praticò, G., Manach, C., Wishart, D. S., Scalbert, A., et al. (2017). Dietary and health biomarkers-time for an update. Genes & Nutrition, 12, 24–24. https://doi.org/10.1186/s12263-017-0578-y
Engbers, L. H., van Poppel, M. N., Chin, A. P. M., & van Mechelen, W. (2006). The effects of a controlled worksite environmental intervention on determinants of dietary behavior and self-reported fruit, vegetable and fat intake. BMC Public Health, 6, 253. https://doi.org/10.1186/1471-2458-6-253
Fjeldsoe, B., Neuhaus, M., Winkler, E., & Eakin, E. (2011). Systematic review of maintenance of behavior change following physical activity and dietary interventions. Health Psychology, 30, 99–109. https://doi.org/10.1037/a0021974
Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health behavior and health education: Theory, research, and practice (4th ed.). Jossey-Bass.
Grabowski, D., Aagaard-Hansen, J., Willaing, I., & Jensen, B. B. (2017). Principled promotion of health: Implementing five guiding health promotion principles for research-based prevention and management of diabetes. Societies, 7(2). https://doi.org/10.3390/soc7020010
Grant, A., Treweek, S., Dreischulte, T., Foy, R., & Guthrie, B. (2013). Process evaluations for cluster-randomised trials of complex interventions: A proposed framework for design and reporting. Trials, 14, 15–15. https://doi.org/10.1186/1745-6215-14-15
Green, J. (2000). The role of theory in evidence-based health promotion practice. Health Education Research, 15(2), 125–129. https://doi.org/10.1093/her/15.2.125
Greene, G. W., Rossi, S. R., Rossi, J. S., Velicer, W. F., Fava, J. L., & Prochaska, J. O. (1999). Dietary applications of the stages of change model. Journal of the American Dietetic Association, 99(6), 673–678. https://doi.org/10.1016/s0002-8223(99)00164-9
Hayes, R. J., & Moulton, L. H. (2017). Cluster randomised trials (2nd ed.). Chapman & Hall/CRC Biostatistics Series.
Holton, J. (2010). The coding process and its challenges. The Grounded Theory Review, 9(1), 21–40. https://doi.org/10.4135/9781848607941.n13
John, J. H., & Ziebland, S. (2004). Reported barriers to eating more fruit and vegetables before and after participation in a randomized controlled trial: A qualitative study. Health Education Research, 19(2), 165–174. https://doi.org/10.1093/her/cyg016
Johnson, R. B., Onwuegbuzie, A. J., & Turner, L. A. (2007). Toward a definition of mixed methods research. Journal of Mixed Methods Research, 1(2), 112–133. https://doi.org/10.1177/1558689806298224
Kaur, J., Kaur, M., Webster, J., & Kumar, R. (2018). Protocol for a cluster randomised controlled trial on information technology-enabled nutrition intervention among urban adults in Chandigarh (India): SMART eating trial. Global Health Action, 11(1), 1419738. https://doi.org/10.1080/16549716.2017.1419738
Kaur, J., Kaur, M., Chakrapani, V., & Kumar, R. (2020a). Multilevel influences on fat, sugar, salt, fruit, and vegetable consumption behaviors among urban indians: Application of the social ecological model. SAGE Open, 10(2), 2158244020919526. https://doi.org/10.1177/2158244020919526
Kaur, J., Kaur, M., Chakrapani, V., Webster, J., Santos, J. A., & Kumar, R. (2020b). Effectiveness of information technology–enabled ‘SMART Eating’ health promotion intervention: A cluster randomized controlled trial. Plos One, 15(1), e0225892. https://doi.org/10.1371/journal.pone.0225892
Kerry, S. M., & Bland, J. M. (1998a). The intracluster correlation coefficient in cluster randomisation. BMJ, 316(7142), 1455–1455. https://doi.org/10.1136/bmj.316.7142.1455
Kerry, S. M., & Bland, J. M. (1998b). Statistics notes: Sample size in cluster randomisation. BMJ, 316(7130), 549. https://doi.org/10.1136/bmj.316.7130.549
Landau, S., Emsley, R., & Dunn, G. (2018). Beyond total treatment effects in randomised controlled trials: Baseline measurement of intermediate outcomes needed to reduce confounding in mediation investigations. Clinical Trials (London, England), 15(3), 247–256. https://doi.org/10.1177/1740774518760300
Lechner, L., Brug, J., De Vries, H., van Assema, P., & Mudde, A. (1998). Stages of change for fruit, vegetable and fat intake: Consequences of misconception. Health Education Research, 13(1), 1–11.
Mahajan, R., Malik, M., Bharathi, A. V., Lakshmi, P. V., Patro, B. K., Rana, S. K., et al. (2013). Reproducibility and validity of a quantitative food frequency questionnaire in an urban and rural area of northern India. National Medical Journal of India, 26(5), 266–272.
Marcolino, M. S., Oliveira, J. A. Q., D'Agostino, M., Ribeiro, A. L., Alkmim, M. B. M., & Novillo-Ortiz, D. (2018). The impact of mhealth interventions: Systematic review of systematic reviews. JMIR mHealth and uHealth, 6(1), e23. https://doi.org/10.2196/mhealth.8873
Moore, G. F., Audrey, S., Barker, M., Bond, L., Bonell, C., Hardeman, W., et al. (2015). Process evaluation of complex interventions: Medical Research Council guidance. BMJ, 350, h1258. https://doi.org/10.1136/bmj.h1258
Naska, A., Lagiou, A., & Lagiou, P. (2017). Dietary assessment methods in epidemiological research: Current state of the art and future prospects. F1000Research, 6, 926–926. https://doi.org/10.12688/f1000research.10703.1
National Institute of Nutrition. Indian Council of Medical Research. (2011). Dietary guidelines for Indians: A manual (Vol. 20 Sept 2017). ICMR.
Nutbeam, D. (1998). Evaluating health promotion: Progress, problems and solutions. Health Promotion International, 13(1), 27–44. https://doi.org/10.1093/heapro/13.1.27
Paskett, E., Thompson, B., Ammerman, A. S., Ortega, A. N., Marsteller, J., & Richardson, D. (2016). Multilevel interventions to address health disparities show promise in improving population health. Health Affairs (Project Hope), 35(8), 1429–1434. https://doi.org/10.1377/hlthaff.2015.1360
Petersen, K. S., Johnson, C., Mohan, S., Rogers, K., Shivashankar, R., Thout, S. R., et al. (2017a). Estimating population salt intake in India using spot urine samples. Journal of Hypertension, 35(11), 2207–2213. https://doi.org/10.1097/HJH.0000000000001464
Petersen, K. S., Wu, J. H. Y., Webster, J., Grimes, C., Woodward, M., Nowson, C. A., et al. (2017b). Estimating mean change in population salt intake using spot urine samples. International Journal of Epidemiology, 46(5), 1542–1550. https://doi.org/10.1093/ije/dyw239
Pomerleau, J., Lock, K., Knai, C., & McKee, M. (2005). Interventions designed to increase adult fruit and vegetable intake can be effective: A systematic review of the literature. Journal of Nutrition, 135(10), 2486–2495.
Pommier, J., Guével, M.-R., & Jourdan, D. (2010). Evaluation of health promotion in schools: A realistic evaluation approach using mixed methods. BMC Public Health, 10, 43–43. https://doi.org/10.1186/1471-2458-10-43
Porter, C. (2015). Revisiting Precede-Proceed: A leading model for ecological and ethical health promotion. Health Education Journal, 75(6), 753-764. https://doi.org/10.1177/0017896915619645
Ritchie, J., & Lewis, J. (2003). Qualitative research practice: A guide for social science students and researchers. Sage.
Rootman, I., Goodstadt, M., Potvin, L., & Springett, J. (2001). A framework for health promotion evaluation. In I. Rootman, M. Goodstadt, B. Hyndman, D. V. McQueen, L. Potvin, & J. Springett (Eds.), Evaluation in health promotion (pp. 7–38). WHO Regional Publications.
Sallis, J. F. (2018). Needs and challenges related to multilevel interventions: Physical activity examples. Health Education & Behavior, 45(5), 661–667. https://doi.org/10.1177/1090198118796458
Sandvik, C., Gjestad, R., Brug, J., Rasmussen, M., Wind, M., Wolf, A., et al. (2007). The application of a social cognition model in explaining fruit intake in Austrian, Norwegian and Spanish schoolchildren using structural equation modelling. International Journal of Behavioral Nutrition and Physical Activity, 4, 57. https://doi.org/10.1186/1479-5868-4-57
Smith, D. G., Clemens, J., Crede, W., Harvey, M., & Gracely, E. J. (1987). Impact of multiple comparisons in randomized clinical trials. American Journal of Medicine, 83(3), 545–550. https://doi.org/10.1016/0002-9343(87)90768-6
Soskolin, C. (2000). Transdisciplinary approaches for public health. Epidemiology, 11(4), S122.
Steinemann, N., Grize, L., Ziesemer, K., Kauf, P., Probst-Hensch, N., & Brombach, C. (2017). Relative validation of a food frequency questionnaire to estimate food intake in an adult population. Food & Nutrition Research, 61(1), 1305193. https://doi.org/10.1080/16546628.2017.1305193
Svetkey, L. P., Batch, B. C., Lin, P. H., Intille, S. S., Corsino, L., Tyson, C. C., et al. (2015). Cell phone intervention for you (CITY): A randomized, controlled trial of behavioral weight loss intervention for young adults using mobile technology. Obesity, 23(11), 2133–2141. https://doi.org/10.1002/oby.21226
Tashakkori, A., & Teddlie, C. (2003). Handbook of mixed methods in social and behavioral research. Sage.
The Lancet. (2019). Where next for randomised controlled trials in global health? Lancet, 394, 1481.
Tremblay, M. C., & Richard, L. (2014). Complexity: a potential paradigm for a health promotion discipline. HealthPromot Int, 29(2), 378–388. https://doi.org/10.1093/heapro/dar054. (Advance Access published 8 September, 2011)
Warwick-Booth, L., Cross, R., Woodall, J., Day, R., & South, J. (2013). Health champions and their circles of influence as a communication mechanism for health promotion. International Review of Social Research, 3(2), 113–129.
World Health Organization. (2008). 2008–2013 Action plan for the global strategy for the prevention and control of noncommunicable diseases. World Health Organization.
Yoo, S.-H., & Kim, H.-K. (2010). Intervention development stages in health promotion planning models: PRECEDE-PROCEED and intervention mapping. Korean Journal of Health Education and Promotion, 27.
Zhou, H., Taber, C., Arcona, S., & Li, Y. (2016). Difference-in-differences method in comparative effectiveness research: Utility with unbalanced groups. Applied Health Economics and Health Policy, 14(4), 419–429. https://doi.org/10.1007/s40258-016-0249-y
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Kaur, J., Kaur, M., Chakrapani, V., Kumar, R. (2022). Methodological Reflections on the “SMART Eating” Trial: Lessons for Developing Health Promotion Practices. In: Potvin, L., Jourdan, D. (eds) Global Handbook of Health Promotion Research, Vol. 1. Springer, Cham. https://doi.org/10.1007/978-3-030-97212-7_30
Download citation
DOI: https://doi.org/10.1007/978-3-030-97212-7_30
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-97211-0
Online ISBN: 978-3-030-97212-7
eBook Packages: MedicineMedicine (R0)