Health professionals perspectives towards innovations in personalized nutrition advice

The growing rate of diet-related diseases has further encouraged calls for innovative health promotion (HP) approaches that motivate people to eat healthily. Personalization of nutrition advice is often depicted as one of the most promising approaches. Recent reviews of health intervention methods (1, 2, references, see below) and research on the effect of personalization (3-5) share this enthusiasm at least to a certain extent. They show information targeted to an individual’s physical constitution, lifestyle, and environmental situation to be more effective in influencing that person’s health behavior than general information.

The newest discipline in nutrition science, nutritional genomics (a.k.a. nutrigenomics) is expected to add a new approach to personalized nutrition advice. Nutrigenomics can be characterized as the study of how nutrients in food interact with our genes at the molecular and cellular levels, and the impacts these reactions have on our health (6). There are promises and expectations that based on those studies, the currently used physical parameters for assessing personal physical vulnerability to diet-related disease can be extended with information about individual genetic make-up. In literature, this development is referred to as ‘personalized nutrition’.

Personalized nutrition emerges at the junction of different disciplines and technologies, and, as with many projected innovation trajectories that may directly influence people’s lives, potential public concern “lurks in the background”. This situation makes personalized nutrition an interesting candidate for early stakeholder involvement, not so much to smoothen the introduction of the technology as to improve socio-technical decision making more generally (cf.7). In this paper, we focus on the contribution of stakeholders who are potentially concerned with implementing personal nutrition trajectories. They can be located somewhere between the insiders and the outsiders of an innovation trajectory (8), a position that allows for bridging activities between different sorts of actors.

The study results that we present in this paper are based on findings of our first study. In that study, we drew on discourse analysis to examine how Dutch stakeholders in health education, health care, health insurance, social science, the food industry and the media make sense of innovations in the field of personalized nutrition, and their own role and significance in an early stage of technology development. Previous Research has focused on a range of success and hindering factors relating to collaboration between stakeholders, and to the development, management and implementation of joint programs. However, no attention has been paid to how potential participating stakeholders of joint programs themselves handle issues of responsibility and initiative in relation to early technology development, and the goal(s) of collaborative interactions. Our study showed how such stakeholders establish themselves as gatekeepers of innovation by displaying experiential authority on what consumers ‘want’ and ‘can’t’, and at the same time avoid a pro-active role in collaborative interactions. Uncertainty in scientific knowledge, fixed roles and responsibilities and dependency from incompetent or biased others are drawn upon to account for a wait-and-see policy (9).

In our second study, we draw on qualitative analysis of in-depth interviews to examine how family doctors from diverse countries make sense of personalized nutrition, and their own role and significance in an early stage of the development process. In line with our first study, we show that most of the participants establish themselves as gatekeepers that need to consider their clients. They  draw upon uncertainty in scientific knowledge and limited possibility to generalize research result in practice. In addition, the participants construct their role as more or less ‘fixed’ by building their arguments on the basis of normative assumptions about how family doctors are supposed to work.

To conclude, stakeholders are expected to improve socio-technical decision making of personalized nutrition. However, most participants in our studies do not treat the early stages of the development process as an opportunity for co-shaping the innovation. Greater reflexive awareness among stakeholders about their own discursive practices is needed before any change can take place. In this respect, it would be interesting to initiate action-oriented research by integration of our preliminary findings into existing needs assessment tools for collaborative efforts.

References:

1. Contento I, Bach G, Bronner Y, Lytle L, Maloney S, Olson C, et al. The effectiveness of nutrition education and implications for nutrition education policy, programs and research: a review of research. J Nutr Educ. 1995;27:277-420.

2. Hillsdon M, Foster C, Naidoo B, Crombie H. The effectiveness of public health interventions for increasing physical activity among adults: a review of reviews. London: Health Development Agency, National Health Institute; 2005.

3. Brug J, Glanz K, Van Assema PP, Kok G, van Breukelen G. The impact of computer-tailored feedback and iterative feedback on fat, fruit, and vegetable intake. Health education & behavior. 1998;25(4):517.

4. Kreuter MW, Farrell D, Levitch L, Brennan L. Tailored Health Messages: customizing communication with Computer Technology. Mahwah NJ: Lawrence Erlbaum; 1999.

5. Curry S, Grothaus L, Wagner E. A Randomized trial of self-help materials, personalized feedback, and telephone counselling with non-volunteer smokers. JConsult Clin Psychol. 2005;63(6):1005-14.

6. Castle D, Cline C, Daar AS, Tsamis C, Singer PA. Science, Society and the Supermarket; The opportunities and challenges of nutrigenomics. 1st ed. Hoboken, New Jersey: John Wiley & Sons, Inc.; 2007.

7. Wilsdon J, Willis R. See-through Science; Why public engagement needs to move upstream. London: DEMOS; 2004.

8. Garud R, Ahlstrom D. Technology assessment: a socio-cognitive perspective. Journal of Engineering and Technology Management. 1997;14:25-48.

9. Bouwman L, Te Molder H. About Evidence-Based and Beyond: Stakeholders' perspective on involvement in the early development of personalized nutrition. Health Education Research. Submitted.

- Extended Abstract for the Heelsum conference, Bouwman L, Te Molder H & GJ Hiddink, Wageningen University, December 2006