ArticleBMC public health2025
A participatory framework for identifying and ranking multidimensional solutions to nutritional behavior issues in female school students: a stakeholder-based mixed-methods study.
Article in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Menstruation Is Associated with Dietary Diversity among Adolescent Girls: The Role of Social Eating Norms and Menstruation-Related Norms from a Mixed-Methods Study in Bangladesh.The Journal of nutrition · 2026Article
- Consensus, divergence, and challenges in pediatric pain management practices: a qualitative study from a multi-stakeholder perspective.BMC health services research · 2026Article
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4 authors.
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Abstract
backgroundBroad multisectoral collaboration among families, communities, schools, health services, and policymakers is essential for improving nutritional behaviors. Despite the increasing prevalence of poor dietary habits among adolescent girls, existing interventions often fail to address the complex social, cultural, and environmental determinants of nutritional behavior. This study aimed to develop a proposed solution to improve the nutritional behaviors of female school students aged 13-17 years in Khuzestan, Iran.
methodsThis study employed a mixed-methodology approach, integrating qualitative exploration and stakeholder-driven prioritization. Phase 1 utilized directed qualitative inquiry with 17 school students to identify adolescent dietary challenges, while Phase 2 applied the Nominal Group Technique (NGT) and Analytic Hierarchy Process (AHP) to prioritize solutions through expert consensus and multicriteria evaluation. The AHP framework, which is supported by Expert Choice software, ensures rigorous weight assignment (CR < 0.1) as validated by independent expert review.
resultsIn Phase 1, directed content analysis of 17 student interviews yielded six overarching themes (e.g., "Self-Monitoring and Goal Setting," "Social Environmental Influences") and 15 subthemes, from which 121 candidate solutions were generated. During Phase 2, nine panelists (five nutrition experts and four stakeholders) applied the NGT: 74.4% (90/121) of the solutions met the ≥ 4.0 mean ranking threshold (on a 5-point scale), while 25.6% (31/121) were eliminated. The 90 retained solutions were then scored via the AHP across five criteria-effectiveness, feasibility, cost efficiency, sustainability, and cultural acceptability. Cultural acceptability received the highest weight (35.7%), followed by sustainability (18.1%), cost efficiency (20.2%), effectiveness (16.8%), and feasibility (12.1%). The consistency was excellent (CR = 0.003), and sensitivity analyses confirmed the stability of the rank order under ± 15% weight variation.
conclusionThis stakeholder-driven framework highlighted balanced diet education during puberty, parental education sessions, and school nutrition campaigns as top-priority interventions, demonstrating excellent consistency (CR = 0.003). Future studies should pilot and rigorously evaluate these interventions in real-world school settings, assess their long-term impacts on dietary behaviors and health outcomes, analyze cost-effectiveness, and explore digital delivery platforms to increase adolescent engagement.
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