Bella is a PhD candidate in the Department of Nutrition, Dietetics and Food at Monash University. She is using realist methodology in her research which examines how best to use hands-on cooking workshops to improve participants' nutrition. She hopes the outcomes of her research will better inform decisions about how cooking workshops can be successfully used as a practical tool within public health nutrition initiatives.
Using case study methods within a realist methodology
Background: To prevent nutrition related disease and the growing burden of chronic diseases associated with poor diet, nutrition education cooking interventions continue to be implemented nationally and internationally. Nutrition education cooking interventions are behaviour change interventions designed to increase cooking skills and confidence, with the aim of increasing healthy meals cooked at home improving overall diet quality. Reporting of the underlying program theory used for the planning and implementation of nutrition education cooking interventions and why they have the outcomes they do is inconsistent.
Aim: This study aimed to explore what works for whom and under what circumstances in nutrition education cooking interventions. Using a realist approach we aimed to illuminate the interplay of context, mechanism and outcome in behavioural interventions with the aim of generating evidence-based recommendations for future interventions.
Methods: Realist case studies were conducted to determine how and under what circumstances nutrition education cooking interventions work. A grey literature scoping review was undertaken to find interventions implemented and evaluated in Australia. Six cases that had been formally or informally evaluation were selected. Realist interviews, based on program theory developed in a realist review, were conducted with program facilitators. Outcome reports and other relevant literature from each program were identified. Interview and document data were coded for context-mechanism-outcome configurations and patterns examined.
Findings/Results: Preliminary analysis has found that a case study design was effective in affirming, refuting and refining the initial a program theory of works for whom and under what circumstances in nutrition education cooking interventions. The case study design allowed for comparison between cases and facilitated testing of the initial program theory that programs targeted at low socio-economic and marginalised populations produced a range of positive nutrition outcomes when the program involved hands on cooking and a skilled facilitator coupled with individual self-efficacy, knowledge gain, family support and an expectation of positive health outcomes.
Conclusions: The use of a case study design aligned with a realist methodology allows for the testing and refinement of program theory. Program theory generation provides context to the heterogenous mix of implementation and evaluation strategies that currently place limits on conclusions drawn from existing evidence. Realist evaluation of these types of interventions is important in providing much needed recommendations for policy makers.