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  • Original Article
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Getting beyond outcomes: a realist approach to help understand the impact of a nutritional intervention during smoking cessation

Abstract

Objectives:

This paper discusses the benefits that a ‘realist’ approach can bring to an outcome study using the example of a nutritional intervention offered as an adjunct to the existing smoking cessation programmes to limit post-cessation weight gain.

Subjects and setting:

Participants of a smoking cessation programme in areas of deprivation in the north, south and west of Glasgow.

Results:

A realist approach enabled the development of a framework able to investigate both implementation and outcomes of the intervention. Drawing on theoretical and experiential knowledge, context–mechanism–outcome hypotheses were developed for further testing at later stages of evaluation. This will focus the further stages of evaluation on testing these specific hypotheses using outcome data collected at the end of the intervention.

Conclusion:

Adopting such an evaluation approach enables integration of process and outcome data that will refine our understanding of contexts and mechanisms, which are associated with these behavioural changes. It can aid further policy decisions by identifying the type of participant and circumstances that are associated with positive outcomes and those subgroups of participants that can be targeted more effectively using other approaches.

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Acknowledgements

We acknowledge all those involved in the conduct of this study and are grateful to Smoke Free services for collaborating with us for this study. We especially thank all the smoking cessation advisors who are involved in delivering the nutritional advice. The research described in this article is being funded by the UK Food Standards Agency.

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Correspondence to P Koshy.

Additional information

Contributors: CH, WL, MM and PK designed the study, PK carried out the fieldwork and analysis of the primary data, MM and PK wrote the preliminary version of this manuscript and all authors contributed to the final version.

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Mackenzie, M., Koshy, P., Leslie, W. et al. Getting beyond outcomes: a realist approach to help understand the impact of a nutritional intervention during smoking cessation. Eur J Clin Nutr 63, 1136–1142 (2009). https://doi.org/10.1038/ejcn.2009.38

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  • DOI: https://doi.org/10.1038/ejcn.2009.38

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