Attribution of dietary behavior changes to the Eating Well with MS intervention

Determine whether the observed changes in dietary behaviors measured by the Diet Habits Questionnaire, Critical Nutrition Literacy Tool, and Food Literacy Behaviour Checklist can be causally attributed to Eating Well with MS, the asynchronous, co-designed online nutrition education program for people with multiple sclerosis, rather than to external factors or measurement error.

Background

Eating Well with MS (EWWMS) is a co-designed, asynchronous, online nutrition education program for people with multiple sclerosis, comprising seven modules with five core education modules. In a single-arm pre-post feasibility paper, participants demonstrated statistically significant improvements in diet quality (Diet Habits Questionnaire), critical nutrition literacy (Critical Nutrition Literacy Tool), and food literacy (Food Literacy Behaviour Checklist).

However, the paper did not include a comparator arm. As explicitly stated by the authors, this limitation prevents establishing whether the observed improvements in dietary behaviors are attributable to the EWWMS intervention itself or to other confounding factors. Resolving this uncertainty requires establishing causal attribution of the measured changes to the intervention.