Empowerment as a key mechanism for supporting changes in eating behaviors among disadvantaged immigrant women living with diabetes, obesity or hypertension: a realistic evaluation.

BACKGROUND

While interventions aimed at improving the food habits of people living with diabetes, obesity or hypertension have been implemented and proven effective, we know little about how they produce effects. To develop meaningful programs, it is essential to identify the elements that favor or prohibit successful outcomes and the mechanisms at work. Using a realist approach to evaluation, this study aimed to assess a diet support program offered by a community-based organization in the Greater Paris Region to disadvantaged women living with diabetes, obesity or hypertension.

METHODS

We carried out a qualitative study using observations and semistructured interviews (n = 12) with women supported by the organization. The data were analyzed thematically and then cross-sectionally. The intervention-context-actor-mechanism-effect (ICAMO) configuration was used to structure the analysis and identify interactions between the various components.

RESULTS

We identified three different types of effects: awareness of the importance of a balanced diet (cognitive change), initiation of changes in eating behavior, and significant changes in food habits. The mechanisms that led to these changes were based on empowerment (strengthening knowledge and skills, self-esteem, participation, and critical awareness). We also identified individual contextual factors that either limited changes in eating behavior (lack of financial resources, culinary habits) or facilitated them (having experienced a critical health event, access to a kitchen).

CONCLUSION

This study contributes to a better understanding of how support programs for eating behavior change work and can overcome the constraints faced by disadvantaged populations living with a chronic disease. The exploration of ICAMO configurations enables us to identify the intervention's mechanisms and key characteristics that will be relevant to consider when replicating the program in other contexts or territories.