At the moment, more attention is being paid to such a problem as the nutrition of the younger generation. Thus, the introduction of intervention programs and methods that focus on diet and nutrition is critical in this case. Particular attention should be paid to the implementation of this approach in the school environment in Bangladesh. For a more efficient flow of this process, a trans-theoretical model or a Re-Aim approach can be used. The primary objective of this research is to consider the most reliable and best way to introduce a change in attitudes to nutrition and diet among Bangladeshi schoolchildren.
Any research involves the collection of valuable information to obtain the planned results. The patient public involvement (PPI) method in data collection is of particular importance because it gives a clear and honest idea of a particular phenomenon being studied (1). Moreover, the participation of people in research has a significant financial advantage, as it attracts the formation of a correct and ethically sound framework for school-based diet and nutrition-focused behavioural change intervention. Involvement and resource sharing can play a significant role in building a study based on PPI. However, the resources involved in any interventions are characterized by a lack of consistency, which can lead to unnecessary double efforts.
In addition, it is worth mentioning that involving patients and the public in scientific research can be a driving force for engagement, as it ensures that research priorities are aligned with the priorities of patients and service users. Moreover, the use of this method in a school setting in Bangladesh may be effective since it will be directly based on the opinion of the public. With the help of various interviews, questionnaires, and tests, the desired innovations can be implemented with a reduced probability of negative consequences. This is because researchers will be given the opportunity to find out all the necessary information about the diet and nutrition of schoolchildren, whether they are taught this, how they observe them, and much other information related to these topics.
Thus, it can be concluded that the public have the opportunity to provide precious expert opinions on the phenomena under study. This is especially important in the case of Bangladesh because despite the development of science and technology, at the moment, there is not enough work on this topic. Thus, obtaining knowledge from the primary source provides an advantage for researchers in acquiring unique material. The involvement of human life experience gives a complete picture of the problem under investigation.
One of the patient public involvement method characteristics is the ability to challenge the results of other studies that do not have a solid evidence base using the acquired knowledge. Moreover, this approach can make several valuable contributions at each stage of the research cycle (2). Participation can guide the conceptual aspects of the study, such as defining and clarifying the scope and issues of the study, as well as its practical elements, such as recruiting participants, determining possible results and hypotheses, and directly conducting the study.
The limitation in the application is that despite the increasing number of studies and publications on this topic, it remains not fully understood. Moreover, there is a possibility of meeting an unreliable source based on unsubstantiated data. Moreover, many scientific papers are characterized by the study of the process as a whole without affecting more specific data. Most conclusions about consequences, outcomes, and possible problems are descriptive and based on episodic experience.
The advantage of using the Public Patient Involvement method is identifying specific priority views and opinions that are important to patients and society. It provides an opportunity to identify research prospects, problems, and risks that may be missed at the initial stage of intervention development. These may include aspects such as factors important to the study participants, certain protocols and activities, aspects of ethics and confidentiality, and materials used and data from past studies.
Many studies emphasize the benefits of using the PPI method to improve project performance. Thus, it contributes to increasing the coverage and retention of participants in the proposed study. In addition, people will take part in the work with great interest, as their personal views will be directly affected. The approach analyzed in this paper is also characterized as a positive aspect of conducting the scientific intervention since patients and the general public encourage consideration of their rights, which gives them confidence in the success of the study. It is worth noting that increasing awareness of health problems and a sense of responsibility are considered an advantage of implementing this method.
Among the problematic situations that may arise when developing a project using the PPI method are issues related to the uneven distribution of power, conflicts, and stressful situations. This is because a situation may arise that involves a conflict between researchers and participants about the distribution of roles and interests. In substantiation of this factor, it should be mentioned that often due to the inclusion of patients’ opinions and generality, these participants may incorrectly assess their significance, trying to reshape the study to fit their vision. Thus, it may be difficult for research managers to share power honestly. Another problem associated with attracting people to the study is the lack of effort and the lack of desire to share complete and reliable information. This fact may lead to insufficient validity and reliability of the work carried out, thereby reducing its value.
PPI’s stages present a valuable tool for conducting the intervention in LMICs. First of all, they will bring more awareness and awareness to the participants since the first stage is to familiarize patients and the public about the design, goals, and desired results. This is especially important when working in a school environment since the younger generation needs to be given an understanding of this or that action and what significance it will have both for them and for scientific research. The next stage implies a review by the participants of the main issues necessary for consideration. At this stage, it is possible to make minor adjustments if there are productive proposals from the participants.
At the third stage, the questionnaire is being developed directly for students and employees of the educational institution. It will include questions based on the first two stages and a study of the school environment concerning nutrition and diet. The stages of determining the critical demographics of participants and finalizing draft materials are also essential to achieve the best results and achieve the goals and objectives of conducting research on the school environment of Bangladesh. The last stage is to identify the necessary specialists and personnel who can provide significant assistance in the work. This is due to the fact that it is necessary to find such people who have proven and complete knowledge both about the place of the study and about the attitude of the population to nutrition and diets.
As already mentioned, recently, more and more interest has been paid to the introduction of patients and society into scientific research. For this purpose, more different methods and tools are being developed and used to help participants understand the goals and objectives and the direction of their involvement in the work of researchers. For this purpose, during the analysis of the previous experience of scientific sources, the method of the matrix of involvement was developed (Smits et al. 3). This approach consists in distinguishing the fields of patient involvement and generality at various stages of the study.
Notable roles have been defined to conduct the work better and understand where the opinions and views of the participants will be more effective. Thus, the involvement matrix is characterized by the presence of the following roles: receiver, co-thinker, consultant, partner, and decision-maker. The study developers, patients, and society discuss and determine the distribution of these roles in advance and evaluate the effectiveness of this method not only during the study but also according to the results of its completion. Thus, the involvement matrix method provides a significant advantage in supporting the participation of patients and the public, as it guarantees a valuable exchange of information between all parties involved.
In addition, there are several positive aspects of the application of this approach for the organizers of future research. Hence, the matrix makes cooperation the central and main aspect of scientific work and improves the organization of interaction between experts and other participants based on shared experience. Moreover, it is possible to report on the results of such an exchange and create an increased level of systematicity. To improve this process, several ways have also been developed to start using the engagement matrix. Therefore, among various sources, researchers can find various workshops, pre-prepared matrices, and a list of control points for research managers by which they can track the effectiveness of the project.
Thus, the engagement matrix is a helpful tool directly for research managers when establishing relationships with participants. It also helps in drawing up special agreements with patients and the public, which are mainly related to the establishment of roles. Not all aspects of the study can be clarified at the initial stages, but they can be added and adjusted at any stage.
The joint creativity of participants and managers or co-creation is an effective method that involves end-users in the development of goals, objectives, and concepts for the proposed research. Driessen-Willems et al. (4) emphasize that “In designing and re-designing school-based interventions, it is important to enhance optimal context-oriented implementation adaptation by involving the complex adaptive school system”. Methods such as online testing, personal interviews, seminars, or the use of discussion groups can be applied to this approach. During group consideration of issues related to the progress of scientific work, patients and the public are usually involved in meeting and discussing details with the direct supervisors of scientific research. At such meetings, the presentation of the project takes place first, and then the necessary adjustments are made after discussion and revision of some concepts. Such generation of various ideas contributes to the creation of such research, which will probably have the most effective and productive results.
As already mentioned, joint creativity can be carried out online through online tools, without their use in person. Such interaction is a great way to encourage a constant dialogue between project participants and their representatives (5). It makes it possible to get pretty detailed, reliable answers from a relatively large number of people involved in scientific work. Moreover, the element of competition contributes to the better generation of ideas for the changes needed in the study.
Transtheoretical Model can also be a suitable tool for developing diet and nutrition-focused behaviour change interventions. The essence of this model is that it describes certain implemented and ongoing changes not as a separate event but rather as a sequence of steps (6). Thus, these stages occur in accordance with the degree of motivation of the people who are involved in this process (7). The model has several main components that provide the necessary efficiency (8). Among them, the stages of changes, their processes, self-efficacy, and the balance of decision-making are noted directly. These stages have received the most attention among researchers in terms of the motivational level of participants and researchers.
Thus, the literature comes to the conclusion that at the preparatory and initial stage, this indicator is low. This is since with regard to nutrition and diet, the participants are not aware of the possible harm of their actions and are not sufficiently informed about the topic of the problem is raised. Moreover, even with the awareness of the negative impact, schoolchildren do not have enough knowledge about how they can change their eating habits and lifestyle, which also has a harmful effect on their desire to make changes.
Further, at the contemplation stage, participants are less inclined to change, but they fully understand and realize the presence of a particular gap. To implement change programs, it is necessary to prepare people and inform them about the need for changes and how they can be achieved. At the stage of action, which stands out in the trans-theoretical model of interventions implementation, a transformation process takes place, which must be constantly maintained and maintained to achieve positive dynamics and progress.
The trans-theoretical model implies the passage of six stages of change, which can show effectiveness when implemented in school accounting in Bangladesh. It is worth noting that each stage involves the use of various strategies and tools that will primarily encourage and motivate changes. They are necessary for a more efficient and smooth transition from one stage to another, without the occurrence of negative consequences.
The first stage consists of the preliminary preparation of the participants of the survey. This stage is necessary because, at first, the level of resistance of the participants may be high. This fact may provoke a refusal to accept any transformations related to nutrition and diet. This is also due to the fact that people often do not realize that their behaviour is wrong or leads to negative consequences. Thus, it is necessary to gradually familiarize students with the project being introduced, its goals, and expected results in relation to the school environment. This can be achieved by holding special meetings with representatives of the study and specialists in the field of nutritiology.
At the stage of reflection, consideration by participants of the usefulness of possible changes may be noted by the researchers. It is necessary to show them what results and positive changes can result from following the proposed lifestyle change strategies. Even minor measures can lead to practical consequences. However, at this stage, participants may be characterized by an ambivalent attitude and show doubts about the proposed measures.
The preparation stage is also of particular importance in the research. At this stage, people are ready to act, and the time interval for this process can be up to a month. Participants, after obtaining the necessary knowledge, should take small steps to implement changes. It is also essential to maintain a positive attitude to the ongoing research, to increase motivation and eliminate doubts. This can be done by organizing intermediate meetings where the subjects could account for their activities and compare it with others. Such an element of competitiveness can also have a favorable influence on the outcomes of the research.
At the stage of action, it can be one of the most difficult since not everyone can adhere to and maintain the changes made in relation to nutrition and diet for a long time. This is also because motivation may fall due to external factors of influence. However, with positive dynamics, participants will be described by such manifestations as the successful change of problematic behaviour and the acquisition of new healthy and valuable habits. The maintenance or maintenance phase is conducted to track results and trends. Provided that the study itself will take a month, this stage is carried out for six months. If there is no alternative, it is essential to track progress by holding meetings or using online questionnaires. The main task of this stage is to work on preventing relapses and forgetting old eating habits.
Another strategy that, according to a critical assessment, can contribute to achieving satisfactory results concerning changes in nutrition and diet in Bangladesh is the RE-AIM method. This method is presented as a valuable tool for researchers and specialists in health promotion and changing eating habits (9). It is incredibly productive in the transition from theoretical justifications of changes to practical application. Re-aim stands for the five primary processes for evaluating the effectiveness of research, such as reach, effectiveness, adoption, implementation, and maintenance. These aspects have a remarkable impact on implementing innovations and evaluating them at the individual and organizational levels.
In particular, RE-AIM provides a valuable starting point for determining the impact of health promotion strategies on public health by directing an assessment of the reach. It reflects the percentage of people from a given population group participating in the program and describes their characteristics. At the organizational level, maintenance reflects the sustainability of the programs being implemented. This approach can be assessed as particularly effective, as it is used to ensure the practical implementation and evaluation of health, nutrition, and diet measures. Given the importance and a large number of different aspects of transformations in these areas, it is logical to use RE-AIM. Its components, such as coverage, efficiency, acceptance, implementation, and maintenance, contribute to strengthening the proposed strategies’ impact on changing the outlook on healthy eating habits. This method also makes it possible to estimate the results, effectiveness and the relevance for the real world.
The measurement of coverage, which the re-aim method assumes, consists of assessing the participants’ characteristics and how they relate to the proposed interventions. This factor includes an analysis of their expectations and expected results. Moreover, their attitude to the conditions and framework to which the participants will be placed and the implementation of the study, which relates to the sequence and cost of the intervention, is taken into account. A recent, important aspect is the maintenance and long-term sustainability both at the level of the educational institution and at the individual level. The effectiveness of the study includes an analysis of these negative consequences that may arise both during the study and when it ends.
Sequential exploratory mixed-method approach for data collection and analysis is an effective tool for research in the field of nutrition and diet. Terrell et al. (10) state that “depending on choices made across four dimensions, mixed-methods can provide an investigator with many design choices which involve a range of sequential and concurrent strategies”. This method is described by the starting qualitative phase of the gathering and analysis of information (11). This is accompanied by the accumulation quantitative base, subsequent by the integration of the information gained from the data of the two stages of the preparatory stage of the examination (12). To collect qualitative data, it is necessary to use a thematic analysis. It includes an analysis of interviews and focused groups. This is followed by the identification of patterns between them (13). Such information may include the participants’ attitude to food, how they eat, whether they want to make any changes to their eating habits. It is also necessary to use descriptive statistics to describe quantitative data. Such data include the number of meals a day, how often they blame themselves for certain eating habits, how often participants think about the need for changes.
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