Forks in the road: Critical design moments for identifying key processes in stakeholder interaction

MMuch of the knowledge regarding “what works” in creating stakeholder events remains tacit. This article describes the concept of critical design moments (CDMs) as a guide for designing context-sensitive and inclusive stakeholder interactions. The approach makes often implicit processes explicit. It is rooted in the experiences of coordinating and participating in a transdisciplinary winter school in a village in Switzerland.While the importance of transdisciplinary (Td) processes as a means to address societal problems is well-established, guidance for the intentional design of stakeholder interactions to meet specific goals, under different conditions and contexts, remains less explored. We propose the concept of critical design moments (CDMs) as a lens through which to identify key processes in the design of stakeholder interactions that affect the relevance and impact of its outcomes. We demonstrate how an approach using CDMs can help to make explicit not only the goals of stakeholder interactions, but also how these goals might be met through the process design of specific activities orienting these interactions. The CDMs were identified as part of the implementation of a Td winter school for early career researchers to provide them with real-world experiences of interacting with stakeholders and local residents of a community. This work provides an approach for how Td stakeholder interactions can be designed in other Td contexts

Forks in the road: Critical design moments for identifying key processes in stakeholder interaction

Much of the knowledge regarding “what works” in creating stakeholder events remains tacit. This article describes the concept of critical design moments (CDMs) as a guide for designing context-sensitive and inclusive stakeholder interactions. The approach makes often implicit processes explicit. It is rooted in the experiences of coordinating and participating in a transdisciplinary winter school in a village in Switzerland. While the importance of transdisciplinary (Td) processes as a means to address societal problems is well-established, guidance for the intentional design of stakeholder interactions to meet specific goals, under different conditions and contexts, remains less explored. We propose the concept of critical design moments (CDMs) as a lens through which to identify key processes in the design of stakeholder interactions that affect the relevance and impact of its outcomes. We demonstrate how an approach using CDMs can help to make explicit not only the goals of stakeholder interactions, but also how these goals might be met through the process design of specific activities orienting these interactions. The CDMs were identified as part of the implementation of a Td winter school for early career researchers to provide them with real-world experiences of interacting with stakeholders and local residents of a community. This work provides an approach for how Td stakeholder interactions can be designed in other Td contexts.ISSN:0940-555

Successfully Recruiting Adults with a Low Socioeconomic Position into Community-Based Lifestyle Programs: A Qualitative Study on Expert Opinions

We explored experts’ perceived challenges and success factors in the recruitment of adults with a low socioeconomic position (SEP) for participation in community-based lifestyle modification programs. We conducted semi-structured interviews with 11 experienced project coordinators, based on a topic list that included experiences with recruitment, perceived barriers and success factors, and general views on recruitment strategies. Results revealed challenges related to the context of the program (e.g., limited program resources), psychosocial barriers of the participants (e.g., mistrust or skepticism), practical barriers (e.g., low literacy or having other priorities), and reasons to decline participation (e.g., lack of interest or motivation). Success factors were related to securing beneficial contextual and program-related factors (e.g., multi-layered recruitment strategy), establishing contact with the target group (e.g., via existing networks, community key-members), methods to increase engagement (e.g., personal approach and involvement of the target group in the program process) and making participation easier (e.g., providing transport), and providing various types of incentives. Concluding, the group of participants with low SEP covers a wide spectrum of individuals. Therefore, multiple recruitment strategies at multiple layers should be employed, and tailored. The lessons learned of those with hands-on experiences will help to enhance recruitment in future program

Designing a Healthy Food-Store Intervention; A Co-Creative Process Between Interventionists and Supermarket Actors

Background: Without consideration for the food system in which healthy food-store interventions (HFIs) are implemented, their effects are likely to be unsustainable. Co-creation of HFIs by interventionists and food-store actors may improve contextual fit and therefore the effectiveness and sustainability of interventions, but there are few case studies on the topic. This study aims to provide insights into the integration of knowledge from contextual actors into HFI designs, through a co-creative process, to illustrate potential challenges, advantages, and outcomes. Methods: We describe the co-creative design of an HFI in a Dutch supermarket chain, conducted through three increasingly in-depth design phases. Each phase consisted of a cycle of theorizing (gather insights from literature, feedback, and pilot studies), building (develop intervention designs), and evaluating (interviews or workshops with supermarket actors, to explore barriers and facilitators for sustainable implementation), feeding back into the next phase (drafting adapted intervention designs, based on feedback, and research input). Interview transcripts underwent a qualitative content analysis. Results: We co-creatively designed four types of interventions to promote healthier food choices in supermarkets: (1) price strategies, (2) product presentation and positioning, (3) signage, and (4) interactive messaging. Interventions were aligned with the culture, structures and practices of the supermarket chain, while simultaneously challenging these system characteristics. For example, the idea of price promotions on healthy foods was well-received and encountered only practical barriers, which were easily resolved. However, the specification of tax-like price increases on unhealthy foods led to substantial resistance on cultural and commercial grounds, which were resolved through support from a key supermarket actor. Conclusion: Our results illustrate the potential benefits of co-creation approaches in HFI design. We reflect on the value of more easily accepted interventions to develop collaborative momentum and more radical interventions to drive more substantial changes

Successfully recruiting adults with a low socioeconomic position into community-based lifestyle programs: A qualitative study on expert opinions

We explored experts’ perceived challenges and success factors in the recruitment of adults with a low socioeconomic position (SEP) for participation in community-based lifestyle modification programs. We conducted semi-structured interviews with 11 experienced project coordinators, based on a topic list that included experiences with recruitment, perceived barriers and success factors, and general views on recruitment strategies. Results revealed challenges related to the context of the program (e.g., limited program resources), psychosocial barriers of the participants (e.g., mistrust or skepticism), practical barriers (e.g., low literacy or having other priorities), and reasons to decline participation (e.g., lack of interest or motivation). Success factors were related to securing beneficial contextual and program-related factors (e.g., multi-layered recruitment strategy), establishing contact with the target group (e.g., via existing networks, community key-members), methods to increase engagement (e.g., personal approach and involvement of the target group in the program process) and making participation easier (e.g., providing transport), and providing various types of incentives. Concluding, the group of participants with low SEP covers a wide spectrum of individuals. Therefore, multiple recruitment strategies at multiple layers should be employed, and tailored. The lessons learned of those with hands-on experiences will help to enhance recruitment in future programs

Forks in the road: Critical design moments for identifying key processes in stakeholder interaction

While the importance of transdisciplinary (Td) processes as a means to address societal problems is well-established, guidance for the intentional design of stakeholder interactions to meet specific goals, under different conditions and contexts, remains less explored. We propose the concept of critical design moments (CDMs) as a lens through which to identify key processes in the design of stakeholder interactions that affect the relevance and impact of its outcomes. We demonstrate how an approach using CDMs can help to make explicit not only the goals of stakeholder interactions, but also how these goals might be met through the process design of specific activities orienting these interactions. The CDMs were identified as part of the implementation of a Td winter school for early career researchers to provide them with real-world experiences of interacting with stakeholders and local residents of a community. This work provides an approach for how Td stakeholder interactions can be designed in other Td contexts.Policy Analysi

Systematic review:A systems innovation perspective on barriers and facilitators for the implementation of healthy food-store interventions

BACKGROUND: Due to their central position in the modern food system, food stores present a unique opportunity to promote healthy dietary behaviour. However, there is a lack of insight into the factors that impede or enhance the implementation of nutritional interventions in food stores. We applied a systems innovation and implementation science framework to the identification of such barriers and facilitators. METHODS: We conducted a systematic literature review. A search string was developed to identify qualitative and quantitative articles on environmental nutritional interventions in the food store. Four databases were systematically searched for studies published between 2000 and 2018. Eligible publications described study designs or original studies, focused on stimulating healthier dietary behaviour through environmental changes in retail settings and contained information on the perceptions or experiences of retailers or interventionists regarding the implementation process of the intervention. Context-descriptive data was extracted and a quality assessment was performed. RESULTS: We included 41 articles, of which the majority was conducted in the USA and involved single stores or a mix of single and multi-store organisations. We categorized barriers and facilitators into 18 themes, under five domains. In the 'outer setting' domain, most factors related to consumers' preferences and demands, and the challenge of establishing a supply of healthy products. In the 'inner setting' domain, these related to conflicting values regarding health promotion and commercial viability, store lay-out, (insufficient) knowledge and work capacity, and routines regarding waste avoidance and product stocking. In the 'actors' domain, no major themes were found. For the 'intervention 'domain', most related to intervention-context fit, money and resource provision, material quality, and the trade-offs between commercial costs and risks versus commercial and health benefits. For the 'process' domain, most factors related to continuous engagement and strong relationships. CONCLUSIONS: This review provides a comprehensive overview of barriers and facilitators to be taken into account when implementing nutritional interventions in food stores. Furthermore, we propose a novel perspective on implementation as the alignment of intervention and retail interests, and a corresponding approach to intervention design which may help avoid barriers, and leverage facilitators. TRIAL REGISTRATION: PROSPERO; CRD42018095317

Determinants of food choice and perceptions of supermarket-based nudging interventions among adults with low socioeconomic position: The supreme nudge project

Nudging has received ample attention in scientific literature as an environmental strategy to promote healthy diets, and may be effective for reaching populations with low socioeconomic position (SEP). Therefore, the objective of this study was to investigate how the determinants of food choice shape the perceptions regarding supermarket-based nudging strategies among adults with low SEP. We conducted semi-structured interviews among fifteen adults with low SEP using a pre-defined topic list and visual examples of nudges. Interviews were recorded and transcribed verbatim and content analysis was used to analyse the data. The results show that food costs, convenience, healthiness, taste, and habits were frequently mentioned as determinants of food choice. However, the relative importance of these determinants seemed to be context-dependent. Interviewees generally had a positive attitude towards nudges, especially when they were aligned with product preferences, information needs, and beliefs about the food environment. Still, some interviewees also expressed distrust towards nudging strategies, suspecting ulterior motives. We conclude that nudging strategies should target foods which align with product preferences and information needs. However, the suspicion of ulterior motives highlights an important concern which should be considered when implementing supermarket-based nudging strategies

Real-world nudging, pricing, and mobile physical activity coaching was insufficient to improve lifestyle behaviours and cardiometabolic health: the Supreme Nudge parallel cluster-randomised controlled supermarket trial

Background: Context-specific interventions may contribute to sustained behaviour change and improved health outcomes. We evaluated the real-world effects of supermarket nudging and pricing strategies and mobile physical activity coaching on diet quality, food-purchasing behaviour, walking behaviour, and cardiometabolic risk markers. Methods: This parallel cluster-randomised controlled trial included supermarkets in socially disadvantaged neighbourhoods across the Netherlands with regular shoppers aged 30–80 years. Supermarkets were randomised to receive co-created nudging and pricing strategies promoting healthier purchasing (N = 6) or not (N = 6). Nudges targeted 9% of supermarket products and pricing strategies 3%. Subsequently, participants were individually randomised to a control (step counter app) or intervention arm (step counter and mobile coaching app) to promote walking. The primary outcome was the average change in diet quality (low (0) to high (150)) over all follow-up time points measured with a validated 40-item food frequency questionnaire at baseline and 3, 6, and 12 months. Secondary outcomes included healthier food purchasing (loyalty card-derived), daily step count (step counter app), cardiometabolic risk markers (lipid profile and HbA1c via finger prick, and waist circumference via measuring tape), and supermarket customer satisfaction (questionnaire-based: very unsatisfied (1) to very satisfied (7)), evaluated using linear mixed-models. Healthy supermarket sales (an exploratory outcome) were analysed via controlled interrupted time series analyses. Results: Of 361 participants (162 intervention, 199 control), 73% were female, the average age was 58 (SD 11) years, and 42% were highly educated. Compared to the control arm, the intervention arm showed no statistically significant average changes over time in diet quality (β − 1.1 (95% CI − 3.8 to 1.7)), percentage healthy purchasing (β 0.7 ( − 2.7 to 4.0)), step count (β − 124.0 (− 723.1 to 475.1), or any of the cardiometabolic risk markers. Participants in the intervention arm scored 0.3 points (0.1 to 0.5) higher on customer satisfaction on average over time. Supermarket-level sales were unaffected (β − 0.0 (− 0.0 to 0.0)). Conclusions: Co-created nudging and pricing strategies that predominantly targeted healthy products via nudges were unable to increase healthier food purchases and intake nor improve cardiometabolic health. The mobile coaching intervention did not affect step count. Governmental policy measures are needed to ensure more impactful supermarket modifications that promote healthier purchases. Trial registration: Dutch Trial Register ID NL7064, 30 May 2018, https://www.onderzoekmetmensen.nl/en/trial/2099