Improving Dietary Behaviour in Low and Middle Income Countries: Developing an Intervention in Urban Kathmandu, Nepal

Instances of non-communicable diseases [NCDs] such as diabetes are on the rise globally with the greatest burden in low and middle income countries [LMICs]. A major contributing factor to diabetes is unhealthy dietary behaviour. This research aimed to establish how healthy dietary behaviour can be improved in LMIC contexts through the development of a feasible intervention(s), with a focus on a specific context – Nepal, to tackle the increase in diabetes. The objectives of the research were to develop an evidence base, identify and develop theory and model potentially feasible interventions to tackle unhealthy dietary behaviour to reduce the impact of diabetes. Initially, I conducted a systematic review and meta-analysis of interventions to improve dietary behaviour in LMICs. I assessed whether behaviour change techniques [BCTs] could be effective in dietary interventions. Building on this evidence base, I then conducted qualitative research in Kathmandu, Nepal. In total forty-two semi-structured interviews and four workshops were conducted with patients, health professionals, policymakers and researchers. I analysed this data to assess potentially feasible dietary interventions leading to the proposal of intervention packages and policy improvements.
In the systematic review, meta-regressions suggested some BCTs (action planning, self- monitoring of outcome(s) of behaviour; demonstration of behaviour) were associated with larger dietary behaviour effect sizes and could be integrated into interventions to improve behaviour. Findings from my qualitative research emphasised the importance of considering socio-cultural context in developing interventions and challenge one-size-fits- all approaches. I used my quantitative and qualitative data in an innovative way to inform practical outputs in the form of: a) a set of potentially feasible intervention packages based on associated rankings and b) macro-level suggestions for policy improvements. This research project represents an attempt to develop solutions to the problem of NCDs and paves the way for further investigations using similar methods.