One Size Doesn’t Fit All: Strategies for Tailoring Community Nutrition Interventions to Community Readiness and Capacity

INTRODUCTION: Nutrition-related policy, system, and environmental (PSE) interventions have been recommended as effective strategies for promoting healthy diet for chronic disease prevention. A critical consideration when implementing these interventions is the need to strategically tailor them to address the unique needs of local contexts and capacities. There is a paucity of literature available on effective ways to prioritize barriers and provide tailored strategies to promote success in diverse contexts. We describe an approach for providing recommendations tailored to unique contexts where public health and community nutrition practitioners are engaged in implementation of PSE interventions.

METHODS: In the first stage of our approach, we developed a diagnostic tool to assess a practitioner’s readiness and capacity to implement PSE interventions through a 5-phase consensus modeling approach that included: (i) qualitative study with about 200 community stakeholders to explore facilitators and barriers influencing successful implementation of farmers’ market interventions in low-income rural and urban communities; (ii) development of themes and indicators based on operationalization of qualitative findings; (iii) development of weights to quantify relevance and importance of themes and indicators through expert panel; (iv) refinement of indicators based on expert panel; and (v) assessment of face validity of the diagnostic tool. In the second stage we curated a database of evidence-based recommendations associated with facilitators and barriers identified in the first stage. All recommendations were tagged to indicate whether they are appropriated for low, medium or high level of readiness to implement a PSE intervention. In the third stage we developed a hierarchical scoring algorithm to prioritize tailored recommendations to optimize PSE implementation. The diagnostic tool algorithm used individual or team responses to match the three most important barriers to appropriated recommendations in the curated database. The diagnostic tool, recommendation database and scoring algorithm were integrated into an online platform and a usability test of the platform done with 18 community and public health practitioners in Ohio.

RESULTS: Findings illuminate a range of implementation factors influencing PSE interventions and offer guidance for tailoring intervention delivery based on levels of community, practitioner, and organizational readiness and capacity. Usability test results of the online platform indicated its ease of use, provision of relevant recommendations and ability to detect heterogeneity in readiness and capacity among and within practitioners.

CONCLUSION: Our integrated online platform can help community nutrition and public health practitioners and policy makers understand complex factors associated with implementation of PSE interventions and offer guidance for tailoring intervention delivery based on different levels of community, practitioner, and organizational readiness and capacity.