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Optimizing intervention strategies via social prescribing as a means of encouraging and enabling healthy and sustainable dietary behaviours in individuals from low-income families

Optimizing intervention strategies via social prescribing as a means of encouraging and enabling healthy and sustainable dietary behaviours in individuals from low-income families

  • Food & Drink Improvements
  • 2022-2027
Sustainable Development icon: good health and wellbeing
Sustainable Development icon: reduced inequality
Sustainable Development icon: responsible consumption and production

Challenges

There has been a lack of progress in changing dietary patterns in the Scottish population despite almost three decades of policy and government investment in interventions intended to address it. Self-reported dietary intake has been consistently poorer in more deprived households compared to more affluent households in Scotland and has declined further in recent years in the UK. Financial constraints and related stress and anxiety leading to reduced access to healthy foods, and reduced access to physical spaces and opportunities to practice physical recreational activities and food insecurity, all increase obesity risk.

Public health scientists have theorised that increased food insecurity, household economic disruption, household stress, and interruptions in healthcare will contribute to obesity and related co-morbidity. COVID-19 exacerbated existing health inequalities via the health effects of social and economic upheavals due to the pandemic, including job losses and social isolation. Therefore, it is likely that dietary patterns will further deteriorate in the post pandemic context unless dietary behaviour change interventions take account of household, socio-economic and individual circumstances in their design.

 

Social Prescribing

Many council areas in Scotland, including Aberdeen city, experienced declines in household income and increased health inequalities in 2020. Regeneration programmes have historically included interventions intended to improve nutrition in low-income communities. Such interventions are often designed and implemented in partnership with local communities and are commonly delivered via Health and Social Care partnerships in Scotland. One such is social prescribing (SP). SP recognises that people’s health and wellbeing are mostly determined by social, economic, and environmental factors, and seeks to address these needs in a holistic way. SP enables health professionals to refer people to a range of potentially beneficial, local, non-clinical services in addition to, or in place of conventional medical treatments. After initial referral from a primary care professional, a “link worker” evaluates the client’s needs and produces a “social prescription”, which either refers the client to a local enterprise offering a suitable form of support or directly prescribes a recommended course of action.

Social prescribing schemes are mainly focused on improving mental health and physical wellbeing, generally targeting people from lower income families who have a higher risk of suboptimal nutrition and mental health issues. Therefore, SP offers potential to support improved food practices in SP client households, which is currently under-realised: the social prescriptions issued are not necessarily based on the best scientific behaviour change evidence and may not be made with full awareness of all potentially relevant services offered by local authority and third sector partners.

Members of low-income families, living in the most deprived areas in Scotland are particularly at risk of suboptimal nutrition and obesity. While many different interventions and initiatives have been introduced into communities over the last 20 years to try and tackle obesity in lower income households, there is little evidence that such strategies have been successful and that they are rarely robustly evaluated. Uptake from individuals living in deprived communities is often low, and intervention design is often based on available community skills and resources rather than scientific evidence about what is required to change behaviour.

Questions

  • What behaviour change interventions can influence consumers to make long-term changes with respect to their diet and food safety and that reduce or minimise health inequalities?

Solutions

This project aims to support individuals from low-income families to change their food and eating practices in ways that are beneficial to health.

 

Reviewing existing community-based interventions

We are working with local authority, third sector and NHS partners to review existing community interventions designed to improve health and support healthy eating. We are evaluating levels of food security, diet, and attitudes to dietary change. The decision-making approaches used by SP link practitioners, particularly associated with food and physical activity practices are also being assessed. We evaluate the existence and nature of behaviour change techniques contained in these interventions so that the active components/underlying of effective interventions can be identified.

In collaboration with stakeholders involved in the Aberdeen City Health and Social Care Partnership, we mapped th full range of food access, with a particular interest in food-related community initiatives delivered in Aberdeen. Click here to access the map.

 

 

Current health inequalities interventions

We are conducting an intervention study, in collaboration with SP link practitioners and selected providers, that is collecting data on food practice and eating behaviour changes, food insecurity, mental health and well-being status, weight, diet, physical activity and systemic biomarkers.

This project is particularly focused on finding ways to reduce health inequalities in individuals from low-income households, a population where food insecurity, suboptimal health behaviours and associated morbidities are particularly prevalent, but not particularly responsive to current interventions. This project provides evidence-based recommendations for policy aiming at reducing food insecurity, improve consumer choice and reduce health inequalities.

Project Partners

The Rowett Institute
University of Aberdeen

Progress

2022 / 2023
2022 / 2023

 

Our project aims to find out what healthy food /diet related support already exists for low-income households in Aberdeen and map out the contents of this support. We also aim to identify the successful elements from all of these existing projects and combine them with things that (a) we know are helpful when we want people to change their behaviour and (b) the community wants in order to create a tool that social prescribers (Link Practitioners) can use to help support people to make positive changes to their diet.

We have identified community-based interventions which includes elements of dietary behavioural changes carried out in Aberdeen city, set up collaboration with many service providers such as cfineInstant Neighbour and Homestart and also with members of the Aberdeen Health and Social Care Partnership.  We have also created an interactive map including the relevant on-going community-based interventions within Aberdeen city that aim to improve low-income households’ quality of life.

We have also retrieved and analysed information collated from 105 users of community-based interventions from individual organisations to identify the user’s level of household food insecurity experience, diet, mental health, wellbeing and attitudes to dietary change. We have conducted interviews with 16 Link Practitioners from Aberdeen city in order to evaluate the Link Practitioners decision-making approaches for referrals related to lifestyle advice. This study provided insight into the practical reality of making social prescribing decisions and has the potential to inform training and evaluation processes and support the development of health-focused social prescribing lifestyle interventions. The information gained from that particular study, and the fact all the Link Practitioners considered diet and exercise to fit within the remit of social prescribing strengthened our idea that social prescribing is a promising platform to support improved food practices in clients’ household.

 

The project is progressing according to schedule, and we are currently trying to identify the components most likely to successfully change behaviour within low-income community and the components most likely to be valued and welcomed by members of that community, in order to make a tool that social prescribers can use to help support people to make positive changes to their diet.

 

For more information regarding the activities related to this project, visit our dedicated study website “Social Prescribing for Improving Communities Eating practices (SPICE)

 

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