Table 2 Summary of included studies
Source, Design, and Setting | Aim/s | Participants and Follow-up period | Intervention | Outcome Measures | Results | Conclusions | Funding |
|---|---|---|---|---|---|---|---|
Stepped-wedge RCT followed by Longitudinal sub-study Extremely remote communities of Northern Territory | Examine the impact of a 20% price discount on fruit, vegetables, water, and artificially sweetened soft drink purchases +/− consumer education Assess impact of the intervention on mediators, moderators and consequent dietary behaviour | 20 communities where the community store was managed by the ALPA or OBS with no alternative food outlet present within a 20 km radius Community populations of at least 100 persons (most approx. 200–400 persons) with estimated total population 8515 persons Also assessed randomly selected adult ‘primary soppers’ from 5 communities via 3x questionnaire (on iPad) over 48-week period -T1 baseline (n = 148) -T2 immediately post intervention (n = 85) -T3 24-weeks post intervention (n = 73) − 92% female respondents -Questionnaire completion incentivised with $20 gift of fruit, vegetables and water | All stores: 20% discount on all fresh and frozen fruit & vegetables (excluding potato products), bottled water and artificially sweetened soft drinks promoted in store and applied at point of sale Discounts applied over 24-week period 0 stores: 10 stores (2 in each set) randomly assigned to receive consumer education (with at least 1 ALPA and 2 OBS in each set) Consumer nutrition education delivered in-store using posters, activities, demonstrations and prizes Delivered over 24-week period Different themes each month Use of Social Cognitive Theory | Weight of fruit and vegetables purchased per capita (in grams) Weight of water and artificially sweetened soft drinks per capita (in grams) Weight of less healthy foods, regular soft drinks and other beverages per capita (in grams) Daily intake of fruit (g), vegetables (g), water (mL), regular soft drink (mL) and diet soft drink (mL) Percieved affordability of fruit and vegetables Self-efficacy to positively change intake, cook and try new foods | 12.7% (95% CI, 4.1–22.1) increase in purchase of both fruit and vegetables Largest change in fruit purchases 20.6% (95% CI, 6.8–36.2) as opposed to 9.0% for vegetables (1.2–17.4) Consumer education further increased purchase of fruit and vegetables 7.6% (95%CI, 3.6–20.2) with greatest benefit seen in purchase of vegetables 13.6% (95% CI, 2.6–25.7) Other food purchases also increased, including those of less-healthy foods 13.4% (95%CI, 1.7–26.4) Perceived affordability of fruit and vegetables was associated with positive changes in dietary intake | Discounting fruits and vegetables by 20% to help protect against obesity and diet-related disease is partially effective The effects of fiscal interventions can be enhanced by the use of creative merchandising techniques and consumer education The intervention was partially effective in increasing consumption of fruits and vegetables among the target population, but was not strong enough to overcome mediators and moderators affecting lasting behaviour change | NHMRC |
Canuto, et al. [43] Pragmatic RCT Urban South Australia (Adelaide) | Evaluate the effectiveness of intervention on reducing cardio-metabolic risk in population of interest Assess whether outcomes maintained at 3 months post intervention | 100 Indigenous women with waist circumference > 80 cm Aged 18–64 years Followed up over approx. 6 months with measurements taken at intervals: - pre-intervention (T1) - immediately post 12-week intervention (T2) - 3 months post intervention (T3) Poor participation at classes and workshops | 12-week structured exercise and nutrition education program The program comprised: - bi-weekly 1-h group exercise classes (aerobic and resistance training by female instructor) - incidental activity and walking measurement (pedometer and exercise diary) - nutrition workshops (4 × 1 h by female dietician) - positive reinforcement and encouragement (fortnightly newsletters) | Anthropometric and Biomedical Measurements: -Body weight -BMI -Hip and waist circumference -BP -Fasting glucose and insulin -HbA1C -Lipid profile -CRP | Statistically significant reduction in weight and BMI in ‘active’ group relative to ‘waitlisted’ group at T3: -Weight: 2.5 kg (95%CI, 4.46–0.54) -BMI: 1.03 kg/m2 (95%CI, 1.79–0.27) Other relative differences in measures noted however none were statistically significant | Modest reductions in weight, BMI and BP evident at T2 with further improvement by T3 No change in primary outcome measures (waist circumference and metabolic measures) | NHMRC |
Ju, et al. [44] RCT Port Augusta, Regional South Australia | Determine the effect of an oral health literacy intervention on oral health-literacy related outcomes among rural-dwelling Indigenous Australian adults | 400 Indigenous adults residing in Port Augusta or surrounds Case group mostly female, low levels of education, receiving welfare and regular consumers of tobacco and alcohol Randomised into: -Group A Intervention (n = 203) -Group B Control (n = 197) Incentive-based participation - gift vouchers were used to compensate participants for their time Overall attendance at workshops just 46.8% (95 participants) | Five 1.5-h workshops over 12 months conducted by Indigenous staff Workshops comprised of presentations, hands-on activities, interactive displays, group discussion and role playing Developed with two Indigenous research officers Use of Bandura’s Social Cognitive Theory Incentive-based intervention model Self-report questionnaires at baseline and 12 months | Some improvement of reported related to: -Knowledge -Skills -Attitudes -Self- Efficacy -Motivation -Activation -Behaviour Change Outcome measures used include HeLD-14, OHIP-14, Lachman and Weaver and Finlayson scales | Improvement of oral health literacy (mean change 1.3, 95% CI) – difference statistically significant Creating awareness of the social impacts of poor oral healt Increasing sense of personal control and oral health self-efficacy Statistically significant improvement in participants who reported ‘water with fluoride is good’ (RR 1.2, 95%CI, 1.1–1.3) | The intervention was found to be partially successful in improving oral health literacy and oral health literacy-related outcomes only after multiple implementations The intervention is considered by the authors to not be feasible in practice, due to poor attendance and expense. | NHMRC |
Mills et al. [45] Pre-Post Quasi Experimental Urban areas of South East Queensland | Improve health outcomes of individuals with or at risk of cardiovascular disease Improve self-management Assess effectiveness of intervention on clinical outcome measures | Inclusion of 85 participants Referral by general practitioner Inclusion criteria: -Presence of at least one cardiovascular disease, or -Presence of at least one cardiovascular disease risk factor Age 18–74+ years 12-week follow up period | 45-min ‘yarning’ (education) sessions followed by 1-h exercise sessions (both with qualified health professionals and Indigenous staff in attendance) | Changes in clinical outcome measures: -Weight -BMI -BP -Waist & hip circumferences -Results of 6-min walk test | Statistically significant results included: -Reduction in the weight of extremely obese participants (1.6 kg, 0.1–3.0 kg, 95% CI) -Improved distance able to be walked in six minutes (0.053 km, 0.01–0.07 km, 95% CI) -Decreased BP in participants who were hypertensive at baseline (11 mmHg, 3.2–18.8 mmHg, 95%CI) | This short-term study may indicate a possibility for increased improvements in clinical outcomes as the result of behaviour change over longer time periods This program could provide a useful model for similar future interventions among Aboriginal and TSI populations | National Heart Foundation Australian Indigenous Scholarship |
Pettigrew, et al. [46] Pre-Post Longitudinal Survey Both metropolitan and regional areas throughout Western Australia | Assess the relative effectiveness of an adult nutrition education program for both Indigenous and non-Indigenous participants Evaluate whether the program requires modification to achieve the same knowledge and behaviour changes in the Indigenous group as the non-Indigenous group | Total sample of 875 Western Australians: − 706 non-Indigenous − 169 Indigenous Pre-post questionnaires followed up over 2- year evaluation period | Two course types were offered to participants: -Single-session course of 1–2 h covering a limited number of nutrition topics -Multi-session courses ranging from 2 to 8 sessions providing information on a broader range of nutrition topics Participants free to choose which best suited their needs | Confidence in ability to buy healthy foods on a budget Knowledge about risk factors and disease Informed food choices and better nutrition Motivation and behaviour change | Improvements in outcome measures greater among Indigenous participants in all instances Improvement in confidence of ability to buy healthy foods on a budget between participants: -Indigenous: (M = 0.74, SD = 1.17, n = 156) -Non-Indigenous: (M = 0.53, SD = 1.05, n = 676) | The program demonstrated superior outcomes amongst Indigenous participants when compared to non-Indigenous participants on many key outcomes Potential to achieve positive results with broader population while also addressing health inequities for Indigenous population | Western Australian Department of Health |