Noah Cooke

Background: The SALIENT consortium aimed to bring together research, government and food system stakeholders to co-design, implement and evaluate public-facing food system interventions targeting health and sustainability whilst maintaining affordability and commercial viability. A total of 40 organizations engaged with SALIENT; 8 progressed to deliver and evaluate a total of 10 interventions. We conducted an evaluation to understand how and why the SALIENT stakeholder engagement process worked for different organizations and to inform future food system intervention research. Methods: Using theory-based evaluation principles, a theory of change (ToC) was developed to describe how the SALIENT process was expected to function. A total of 38 semi-structured interviews were conducted with government partners, researchers and food system representatives. Data were thematically analysed and interpreted in relation to the ToC. Results: Findings highlighted the fragmented nature of existing health and sustainability actions across the food system, shaped by differing priorities, agendas and constraints of stakeholders. Power dynamics influenced stakeholder participation, with engagement strongest when research was aligned with core stakeholder goals and offered them tangible benefits. Whilst pragmatic co-design processes built trust and feasibility, they sometimes led to interventions with limited potential to address critical uncertainties in the evidence base. Academic processes were often perceived as misaligned with stakeholders’ practical needs. Conclusions: Long-term government direction, stronger accountability, and incentives are needed to foster meaningful collaboration between researchers and food system stakeholders. Future partnerships should balance flexibility with rigour, build trust through sustained relationships, and establish strong governance, communication and evaluation processes early to generate robust, scalable evidence for meaningful food system change.

Background: Preparing and consuming food at home is associated with healthier diets. Recipe box subscriptions may support meal preparation at home while improving dietary quality and cooking skills, reducing time-poverty, and facilitating family cohesion. We are conducting an unblinded pilot and feasibility randomized waitlist-controlled trial to test the feasibility and acceptability of the trial design, identify perceived benefits and barriers for participants, and assess impacts on food agency. Methods: We are partnering with a Recipe Box Company. Primary food providers of households in Birmingham, UK, with school-aged children were recruited via five channels: social media, schools, employers, community organizations, and referrals from customers of the Company. Upon completing an eligibility form, interested individuals were sent the participant information sheet and consent form. Consented participants completed online questionnaires and 24-h dietary recalls using the Intake24 platform and were then randomized into intervention or waitlist control groups. We aimed to randomize n = 150 participants. Recruitment is complete but data collection (last participant/last visit) is ongoing. The intervention group is offered a 6-week recipe box subscription, discounted by 60% in week 1 and 50% in weeks 2 to 6, with the option to continue ordering at a 20% discount for 4 weeks. The waitlist control group receives an identical discounted subscription 10 weeks post-randomization. Participants in both groups complete online questionnaires and dietary recalls at 6 and 10 weeks post-randomization. A subsample is invited for qualitative interviews at baseline and in weeks 7 to 9 from both groups. We will assess the acceptability and feasibility of the recruitment methods and enrolment procedures, recipe box subscription, and allocation to both groups using mixed methods analyses. To calculate sample size required for an effectiveness trial, we will assess change in dietary quality, defined by the Alternative Healthy Eating Index. We will assess perceived benefits and barriers to using recipe boxes, and impacts on food agency, in semi-structured interviews. Discussion: Our study will evaluate whether the trial design is feasible and acceptable for households with school-aged children in the UK and inform progression to an effectiveness study. Trial registration number: ISRCTN45164711. Retrospectively registered.