Health literacy as an opportunity? Adaptation and implementation of interventions to promote healthy lifestyle behaviours and food environments

The prevalence of people with overweight or obesity is continually increasing worldwide. This high prevalence is an important public health issue, both for individuals as well as society as a whole. The complex problems associated with overweight and obesity relate to individual and environmental factors. Unhealthy dietary patterns and physical inactivity may result in an individual’s energy intake continuously exceeding their energy expenditure, increasing their risk of becoming overweight or obese. Environments that influence these lifestyle behaviours also may play an important role in improving such behaviours. At the societal level, the obesogenic food environment plays an important role and at the individual level, people’s food environments at home and at work play an important role in eating patterns. Most adults spend the majority of their time at home or at work. Thus, people may gain most benefit from health promotion interventions focused on healthy lifestyle behaviours and the home and workplace food environment.
The starting point of this dissertation is the further development, implementation, and evaluation of two evidence-based health promotion interventions. One intervention is SMARTsize, which focuses on portion control strategies and the home food environment. The other intervention is the Healthy worksite cafeteria, which focuses on the food environment at the workplace. Previous studies on these interventions clearly indicated the need for further development for groups with low socioeconomic position and health literacy levels. Intervention implementation processes and tools should be aligned to this group, relevant settings and stakeholders to increase the intervention’s effectiveness and sustainable implementation.
The aim of this dissertation is two-fold: ∙ Aim 1. Further develop the individual lifestyle intervention SMARTsize and Healthy worksite cafeteria intervention towards suitability for adults with low levels of health literacy. This further development is based on three exploratory studies in the work setting. These three studies serve as the stepping stone for aim 2.∙ Aim 2. Implement and evaluate the developed SMARTsize intervention (version 2021) in a real-life setting, among clients in the primary care dietitian practice setting.

An additional question arose during the research project based on the studies: How can individuals practically apply the skills for maintaining and improving positive health, especially those adults with a low socioeconomic position who also have limited health literacy? This topic was reflected upon in a perspective paper.
The original research goal was to conduct the SMARTsize and Healthy worksite cafeteria interventions in the workplace. This could not be achieved due to COVID-19 pandemic lockdowns and social distance requirements. Finally, we introduced and evaluated the further developed SMARTsize intervention in primary care dietitian practices.