JNEB Editorial: Coherence in Adopting Implementation Science?

Posted by: Karen Chapman-Novakofski, PhD, RDN, LDN on Wednesday, March 13, 2019

JNEB Editorial: Coherence in Adopting Implementation Science?

Originally appears in the March issue of JNEB

Implementation science is gaining in adoption by nutrition education and behavior researchers. You probably already know this and are wondering why I bring this as a focus for this editorial. Well, although we acknowledge the growing popularity of implementation science, there are so many perspectives within this discipline that I want to raise awareness.

In the Frigge et al1 article, the authors frame their research in Normalization Process Theory. As I read more about this theory, I realized this theory could shed considerable light on if and how programs become successful and sustainable. There are 4 constructs of the Normalization Process Theory: coherence, cognitive participation, collective action, and reflexive monitoring. From a broad view, knowing whether those involved in a new program were supportive of change and had similar views on what would be required for the process of change (coherence) seems vital to any program implementation. Of course, communication and monitoring are also important, but from my view, if there is not coherence, the program will fail.

Parsons et al2 did not use this terminology, but the parental buy-in seems very similar to cohesion. These researchers were examining implementation factors that were influential in healthy eating policy, systems, and environmental strategies (PSEs) in child care settings serving low-income children. Different types of capacity emerged as very important, but the motivation of the key organizations, staff, and parents may reflect the construct of coherence.

Exploring online nutrition education in the workplace, Thompson et al3 concluded that this could be feasible for some employees. All 12 videos were viewed by only 5 of the 23 participants, with 3 using none of the programs components. Although not a part of this paper, some analysis of the implementation of the program might be useful for those wanting to move in this direction. The authors do suggest that those wanting to implement this type of program may need to consider the employees’ work responsibilities before implementing.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) at 2 locations in California were supportive of a physical activity program for pregnant Latinas, but “buy-in” may not have been strong for the target audience.4 In a similar vein as the Thompson et al worksite program, the target audience and providers were not unified in the concept of change (program implementation) or the activities associate with the change.

I think most nutrition educators and researchers have experienced this situation. The program is great, all the steps to assure high quality have been taken, the partners for recruitment and delivery are enthusiastic, and then there is low turnout. I am hopeful as we integrate Implementation Science into Nutrition Education and Behavior Science that this particular issue, coherence, will become an easier achievement than it currently seems to be. If we all sup- port this change with positive coherence, we can expand our expertise and presumably enhance the implementation of our programs and interventions.

Karen  Chapman-Novakofski, PhD, RD, LDN


  1. Frigge VK, Pratt R, Harnack L, Haggen- miller M, Nanney Using theory to evaluate the implementation and integra- tion of an expanded school breakfast pro- gram in rural midwestern high schools. J Nutr Educ Behav. 2019;51:277-286.
  2. Parsons AA, Monteban M, Lee E, Bebo P, Zubieta AC, Ginnetti S, Hewitt J, Freedman S. Indicators of readiness and capacity for implementation of healthy eating strategies in child care settings serving low-income children [published online ahead of print November 8, 2018]. J Nutr Educ Behav. https://doi. org/10.1016/j.jneb.2018.09.004.
  3. Thomson JL, Goodman H, Landry AS, Donoghue A, Chandler A, Bilderback
  4. Feasibility of online nutrition educa- tion in the workplace: working toward healthy lifestyles. J Nutr Educ Behav. 2018;50:868-875.
  5. Soto SH, Sanz S, Merchant KM, Nichols JF, Arrendondo EM. Lessons learned from a feasibility study delivered in 2 WIC sites to promote physical activity among pregnant Latinas. J Nutr Educ Behav. 2018;50:1026-1031.