(LB01-02-26) Limited Integration of Behavioral Theory in Community Health Worker-Delivered Nutrition Interventions for Underserved Adults

Objectives: To evaluate the extent to which behavioral theory is integrated into Community Health Worker (CHW)-delivered nutrition education interventions for underserved adult populations.

Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines. PubMed, CINAHL, and Web of Science were searched for studies published from 2016 to 2026. Studies were imported into Rayyan systematic review software for duplicate management, title/abstract screening, and conflict resolution. Eligible studies were screened using predefined criteria, and data were extracted on intervention structure, instructional strategies, CHW roles, and theoretical framework use. Theory integration was classified as none, partial, or full using a systematic, reproducible coding approach.

Results: Out of 608 articles identified, 18 met the inclusion criteria. Behavioral integration was inconsistent with most studies showing partial or no use of theory. Curricular structure and instructional approaches varied widely, with limited reporting of implementation fidelity, CHW training, and standardized content. CHWs were consistently involved in delivering the intervention. Yet, their roles varied widely across studies. Only one study demonstrated full integration of behavioral theory, underscoring a critical gap in implementation and scalability.

Conclusions: CHW-delivered nutrition education interventions for underserved adults are widely implemented but lack consistent integration of behavioral theory, limiting reproducibility, implementation fidelity, and scalability. These limitations reduce their ability to effectively support behavior. Developing structured, theory-driven, low-literacy curricula is a critical next step. These findings directly inform the design and testing of scalable, structured, theory-driven interventions to improve behavioral outcomes and advance health equity.

Funding Sources: None.