TABLE 25Programme theory evaluation and outcome stage: CMO configurations

Adaptation (mechanism)Context + outcome (systematic review)Context + outcome (qualitative interviews)
23. Intervention goals and outcomes for participants are culturally appropriateA community-based group education healthy eating intervention for African Americans reported that there were discrepancies between intervention goals and participant goals, for example one incentive for participants was to receive documentation of achieving healthy eating-related education and competencies for potential jobs in the food service industry, as this was a largely unemployed cohort315,316
Group-based weight loss intervention for African Americans observed a difference between participants and investigators in interpreting intervention success. Participants were happy with their 3% weight loss whereas investigators were aiming for 7% (which is considered to be clinically significant by the National Heart, Lung, and Blood Institute)412
38. Address emotional barriers and stressorsA smoking cessation intervention delivered with a guide and brief counselling plus NRT or placebo for African Americans observed that lower than expected quit rates may be influenced by environmental factors, daily life stressors and aggressive targeted advertising – all aspects that may not be measured but may influence successful quitting355,356
In a group-based behavioural weight loss programme for African Americans, the addition of motivational interviewing did not increase attendance, change dietary intake or physical activity levels or result in weight loss compared with health education only. Motivational interviewing may not enhance the effectiveness of an already culturally adapted intervention or motivate behaviour change among participants who face socioenvironmental barriers or life stressors, as motivational interviewing assissted only with the discussion of these barriers but did not help to reduce them317
23. Intervention goals and outcomes are culturally appropriateIn a group-based healthy eating education intervention for African Americans, weight loss was unlikely to be for aesthetic reasons; health improvements were found to hold more significance as an outcome than weight change323
An effective intervention outcome for the community was strong community partnership and environmental/community changes such as the development of new and better recreational facilities and opportunities and not the outcomes that the study had specified413
‘she went back in November, like 3 months later and measured them to see the sustainability of the weight loss and if any of them could keep the weight off [mm mhm] and there was still a significant loss of weight, you know they didn’t lose anything in addition, they sustained their weight losses, so their weight loss was still significant compared to base line, but it wasn’t lower than it had been, so at least they maintained, they sustained over those kind of 3 months, over the feast fast period’ (P8, healthy eating, UK)

From: 8, Realist synthesis: prioritisation for implementation and future research

Cover of Adapting Health Promotion Interventions to Meet the Needs of Ethnic Minority Groups: Mixed-Methods Evidence Synthesis
Adapting Health Promotion Interventions to Meet the Needs of Ethnic Minority Groups: Mixed-Methods Evidence Synthesis.
Health Technology Assessment, No. 16.44.
Liu JJ, Davidson E, Bhopal RS, et al.
Southampton (UK): NIHR Journals Library; 2012 Nov.
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