Investigating how implementation strategies promote successful adoption of nutrition interventions for adults with cardiovascular disease using mixed methods evidence synthesis

Article type
Authors
Eastway J1, Lizarondo L1, Martin P2
1JBI, The University Of Adelaide, Australia, Adelaide, South Australia, Australia
2Rural Clinical School, Faculty of Medicine, Toowoomba, Queensland, Australia
Abstract
Background: Evidence-based nutrition intervention is critical in reducing the burden of cardiovascular disease (CVD), yet its integration in routine clinical practice remains suboptimal. The specific implementation strategies and outcomes for promoting adoption of these interventions in adults with CVD or related conditions are not well-defined.
Objectives: To determine the outcomes of implementation strategies used to promote the adoption of nutrition interventions in adults with CVD or CVD-related clinical conditions, specifically related to acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability.
Methods: This study utilized the JBI methodology for mixed methods systematic review. Databases including PubMed, EMBASE, PsycINFO, CINAHL, Scopus, and Cochrane CENTRAL were searched for relevant studies. A cross-study synthesis was conducted to generate overarching themes that emerged from the collective evidence.
Results: The majority of included studies utilized multi-component, tailored implementation strategies guided by theoretical frameworks. Acceptability, adoption, feasibility, and fidelity were the most frequently reported outcomes. Nutritional interventions generally included dietary counselling and education among populations with CVD, diabetes, cancer, and obesity. Implementation strategies described included training and educating stakeholders; developing stakeholder interrelationships; and use of evaluative and iterative strategies such as audit and feedback. Some studies described using interactive assistance such as facilitation. Only a few studies reported sustainability as a distinct implementation outcome.

Conclusions: The findings highlight the importance of multifaceted implementation strategies guided by theoretical frameworks in promoting the adoption of evidence-based nutrition interventions for adults with CVD or related conditions. While considerable attention has been given to immediate outcomes (e.g., acceptability, feasibility), there is a notable gap in addressing long-term sustainability. Future research should focus on developing strategies aimed at ensuring the enduring integration of these interventions into routine clinical practice, thereby optimizing the impact on cardiovascular health outcomes.