Applying Innovative Approaches to Design and Implement an Intervention to Improve Cardiovascular Health in Hispanic/Latin communities through Restaurants

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The overall goal of this application is to provide the candidate, Melissa Fuster, Ph.D., essential training to transition into an independent researcher promoting nutrition and cardiovascular health in Hispanic communities through innovative, evidence-based environmental interventions and policies. The proposed project responds to the critical need to improve diet quality and cardiovascular health among Hispanic Caribbean communities using innovative approaches. While most nutrition interventions target individual behaviors, there is a pressing need to create environments that support healthy food choices. Restaurants can be a vehicle to facilitate this change, given the growing importance of foods consumed away from home. Working with an interdisciplinary and multi- sectoral team of mentors and collaborators, Dr. Fuster will apply a theory-based framework from Implementation Sciences to develop and test the Hispanic Caribbean Restaurants in Action (HCRiA) initiative, an intervention to improve nutrition environments in Puerto Rican and Dominican restaurants. Addressing the complex and dynamic nature of restaurant environments, the study complements the theoretical framework with approaches from systems science and human-centered design. These approaches facilitate the engagement of restaurant stakeholders (owners, cooks, and wait-staff) to identify and solve barriers preventing healthier eating behaviors in restaurants. Aim 1 will use a participatory group discussion technique from systems science to characterize customer and restaurant-level factors that facilitate and hinder healthy nutrition environments in HC restaurants. Aim 2 will apply the Behavioral Change Wheel (Implementation Sciences theoretical framework) and human- centered design approaches to engage restaurant stakeholders (owners, staff, and customers) in the design of the HCRiA initiative. Aim 3 will use a mixed-method, quasi-experimental design to pilot test the resulting intervention in a total of four restaurants. Research activities will be intertwined with coursework and mentorship to further development in the following critical training areas: (1) Human-Centered Design and Systems Science, (2) Implementation Science, (3) Quasi-experimental methods, and (4) Large-scale project and grant development. This K01 project contributes public health approaches to improve food environments to ameliorate diet-related health disparities, and the application of implementation science to tackle an important evidence- practice gap, where evidence-based dietary patterns to prevent and treat cardiovascular disease are not being practiced at the community level. The completion of the proposed plan will provide a solid base to successfully compete for R01-level funding for a full-scale community trial of the HCRiA initiative, bolster the applicant’s publication record through dissemination activities among researchers and the community, and augment diversity among nutrition researchers.