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Toward a framework for understanding the utilization dimension of food security through a digital health lens: a realist synthesis

Article scientifique 2026 Anglais

Résumé

Food insecurity remains a persistent challenge in low-and-middle income countries (LMICs), particularly its utilization dimension, which disproportionately impacts marginalized groups. Digital health (DH) interventions are increasingly deployed to improve nutrition outcomes in these settings, yet evidence on how, for whom, and under what conditions they shape food utilization remains limited. This review sought to explain the causal mechanisms through which DH interventions shape the utilization dimension of food security among vulnerable populations in LMICs, and to develop an explanatory framework specifying the contextual conditions that enable, modify, or constrain these effects. A realist review was conducted in line with the RAMESES II reporting standards. Searches of PubMed, Scopus, IEEE Xplore, and grey literature repositories identified 25 sources. Five initial programme theories were iteratively tested and refined through retroductive reasoning and the development of context-mechanism-outcome (CMO) configurations, with rigour and relevance appraised using the MMAT and CASP frameworks. The five refined programme theories were synthesized into a three-tiered explanatory framework linked by three cross-cutting dynamics: causal interdependence, mechanism competition, and structural compounding. Within this framework, DH tools activate micro-level caregiver and patient mechanisms (knowledge, self-efficacy, trust) and strengthen meso-level frontline nutrition service delivery, while macro-level structural conditions determine whether these lower-level gains translate into sustainable improvements in utilization. The findings show that sustained gains in food utilization depend on concurrent mechanism activation across all three levels. Standalone digital information delivery yields only transient, inequitably distributed outcomes unless accompanied by deliberate attention to enabling structural and institutional conditions.

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Achieng, M. (2026). Toward a framework for understanding the utilization dimension of food security through a digital health lens: a realist synthesis. https://doi.org/10.3389/fsufs.2026.1847230

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Auteur(s)

Mourine Achieng

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