Strengthening adult community-based cooking skills interventions using realist principles

The purpose of this paper is to present learning on the strategies used by cooking skills practitioners and the programme theories, behaviour change mechanisms/contexts and intended outcomes associated with these in varied contexts.

Grey literature from Scottish cooking skills courses were reviewed using realist principles. Intervention implementation variables were identified and iteratively coded to uncover intended intervention strategies and programme theories. The lack of robust evaluation processes and outcome data in the grey literature prevented the testing of intended programme theories against outcomes. Alternatively, implementation strategies were aligned against behavioural-theory constructs contained in national guidance. Prioritised theories were further clarified/refined using practitioner and participant focus group data. Learning was used to inform future practice/evaluation.

Courses targeted and reached vulnerable individuals. Practitioners articulated multiple theories and assumptions about how strategies may work. Numerous strategies and behaviour constructs were used to target, tailor and reinforce cooking/food and wider social outcomes. Mechanisms were assumed to be triggered by different contexts and lead to varied outcomes. Strategies used were consistent with evidenced behaviour change constructs and guidelines. Interventions aimed to achieve non-cooking/social outcomes as well as cooking ones – including potential mediators of cooking behaviour, e.g. self-confidence. Contexts facilitated/limited the use of certain strategies. Limitations in course design, reporting and self-evaluation need to be addressed.

Recommendations for improving intervention commissioning, design and evaluation using realist principles are provided.

Learning addresses gaps in knowledge about the implementation of cooking skills interventions identified from systematic reviews and can improve course design and evaluation.