The Process and Case Study Approach to Implementing a Nutrition-Specific Dissemination and Implementation Science Training in Appalachia

Abstract

Introduction: Nutrition professionals face implementation challenges due to their lack of knowledge to incorporate D&I science into intervention design. To improve intervention outcomes, nutrition professionals must be trained in D&I science, which are currently absent in the field. Aims: To identify and assess nutrition educators and practitioners perceived motivations, self-efficacy, and attitudes in using D&I science to inform the educational design and strategies of a nutrition-specific D&I curriculum for nutrition educators. Then to test feasibility of the nutrition-specific curriculum in increasing knowledge, self-efficacy, and attitudes by a case study approach, pre/post intervention design. Methods: First, scoping review methodology involved the search of six academic databases. Data extraction included intervention type, population, study aim, methods, theoretical approach, outcomes, and results. Secondly, using the Theory of Planned Behavior (perceptions survey), participants recruited from the Society of Nutrition Education and Behavior directory were asked to report perceptions of D&I science through an online survey. Data were analyzed for nonparametric measures (Spearman’s p) and thematic analysis. Third, a content mapping exercise categorized the nutrition-specific D&I training learning objectives to validated D&I course competencies. Then, experts were recruited by a selective sample of practitioners in nutrition implementation science. Experts reported feedback on the curriculum by responding to 7-point Likert scale questions and qualitative responses, which were analyzed for themes. Lastly, the nutrition-specific D&I training was pilot tested under a case study approach. Participants were enrolled in the 8-week intervention and completed a pre/post assessment with an exit interview. Quantitative measures were analyzed for changed over time using a Wilcoxon signed rank test. Qualitative measures were deductively analyzed using the Kirkpatrick Model, Implementation Outcome measures, and the Systems Level Framework. Results: From the scoping review, thirty-four retained articles qualitatively identified benefits (successful planning and organization of complex interventions) and challenges (limited resources, trainings, and lack of knowledge) to utilizing systems science in nutrition D&I research. Further results suggest that an active and mentorship methods for a nutrition-specific D&I curriculum for university nutrition and public health students is likely to perceived behavioral control. From the mixed-methods perceptions survey (n=70), perceived behavioral control (knowledge and learning autonomy) positively influenced behavioral intention to use D&I science (p=0.0119). From the 43 validated competencies, this course covers 22 of the core competencies. 31 experts categorized the learning strategies and syllabus towards the positive Likert scale end (i.e.; helpful, clarifying, effective, useful, encouraging, and important) with scores between 4-7. Participants in the