Diet related non-communicable diseases (NCDs), as well as micronutrient deficiencies, are of widespread and growing importance to public health. Authorities are developing programs to improve nutrient intakes via foods. To estimate the potential health andeconomic impact of these programs there is a wide variety of models. The aim of this review is to evaluate existing models to estimate the health and/or economic impact of nutrition interventions with a focus on reducing salt and sugar intake andincreasing vitamin D, iron, and folate/folic acid intake. The protocol of this systematic review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42016050873). The final search was conducted onPubMed and Scopus electronic databases and search strings were developed for salt/sodium, sugar, vitamin D, iron, and folic acid intake. Predefined criteria related to scientific quality, applicability, and funding/interest were used to evaluate the publications. In total 122 publications were included for a critical appraisal: 45 for salt/sodium, 61 for sugar, 4 for vitamin D, 9 for folic acid, and 3 for iron. The complexity of modelling the health and economic impact of nutrition interventions is dependent on the purpose and data availability. Although most of the models have the potential to provide projections of future impact, the methodological challenges are considerable. There is a substantial need for more guidance and standardization for future modelling, to compare results ofdifferent studies and draw conclusions about the health and economic impact of nutrition interventions.
MULTIFILE
Europe’s aging population is leading to a growing number of people affected by chronic disease, which will continue over the coming decades. Healthcare systems are under pressure to deliver appropriate care, partly due to the burden imposed on their limited financial and human resources by the growing number of people with (multiple) chronic diseases. Therefore, there is a strong call for patient self-management to meet these patients’ healthcare needs. While many patients experience medication self-management as difficult, it poses additional challenges for people with limited health literacy. This thesis aims to explore the needs of patients with a chronic disease and limited health literacy regarding medication self-management and how support for medication self-management can be tailored to those needs.
Specific approaches are needed to reach and support people with a lower socioeconomic position (SEP) to achieve healthier eating behaviours. There is a growing body of evidence suggesting that digital health tools exhibit potential to address these needs because of its specific features that enable application of various behaviour change techniques (BCTs). The aim of this scoping review is to identify the BCTs that are used in diet-related digital interventions targeted at people with a low SEP, and which of these BCTs coincide with improved eating behaviour. The systematic search was performed in 3 databases, using terms related to e/m-health, diet quality and socioeconomic position. A total of 17 full text papers were included. The average number of BCTs per intervention was 6.9 (ranged 3–15). BCTs from the cluster ‘Goals and planning’ were applied most often (25x), followed by the clusters ‘Shaping knowledge’ (18x) and ‘Natural consequences’ (18x). Other frequently applied BCT clusters were ‘Feedback and monitoring’ (15x) and ‘Comparison of behaviour’ (13x). Whereas some BCTs were frequently applied, such as goal setting, others were rarely used, such as social support. Most studies (n = 13) observed a positive effect of the intervention on eating behaviour (e.g. having breakfast) in the low SEP group, but this was not clearly associated with the number or type of applied BCTs. In conclusion, more intervention studies focused on people with a low SEP are needed to draw firm conclusions as to which BCTs are effective in improving their diet quality. Also, further research should investigate combinations of BCTs, the intervention design and context, and the use of multicomponent approaches. We encourage intervention developers and researchers to describe interventions more thoroughly, following the systematics of a behaviour change taxonomy, and to select BCTs knowingly.
The ELSA AI lab Northern Netherlands (ELSA-NN) is committed to the promotion of healthy living, working and ageing. By investigating cultural, ethical, legal, socio-political, and psychological aspects of the use of AI in different decision-makingcontexts and integrating this knowledge into an online ELSA tool, ELSA-NN aims to contribute to knowledge about trustworthy human-centric AI and development and implementation of health technology innovations, including AI, in theNorthern region.The research in ELSA-NN will focus on developing and mapping ELSA knowledge around three general concepts of importance for the development, monitoring and implementation of trustworthy and human-centric AI: availability, use,and performance. These concepts will be explored in two lines of research: 1) use case research investigating the use of different AI applications with different types of data in different decision-making contexts at different time periods duringthe life course, and 2) an exploration among stakeholders in the Northern region of needs, knowledge, (digital) health literacy, attitudes and values concerning the use of AI in decision-making for healthy living, working and ageing. Specificfocus will be on investigating low social economic status (SES) perspectives, since health disparities between high and low SES groups are growing world-wide, including in the Northern region and existing health inequalities may increase with theintroduction and use of innovative health technologies such as AI.ELSA-NN will be integrated within the AI hub Northern-Netherlands, the Health Technology Research & Innovation Cluster (HTRIC) and the Data Science Center in Health (DASH). They offer a solid base and infrastructure for the ELSA-NNconsortium, which will be extended with additional partners, especially patient/citizens, private, governmental and researchrepresentatives, to have a quadruple-helix consortium. ELSA-NN will be set-up as a learning health system in which much attention will be paid to dialogue, communication and education.
