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

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.