Exploring settings as social complex adaptive systems in setting-based health research: a scoping review.

Since launching health health-promoting settings approach to health by WHO, valuable progress has happened in implementing its holistic concepts in settings such as cities, schools, workplaces, hospitals and healthcare services. However, significant knowledge-intention-success gaps still exist in creating sustainable health-promoting changes in settings. The complexity of the task of bridging this gap has contributed to the call for a complexity-informed paradigm shift to health as well as settings, followed by increasing consultation of relevant complexity theories, frameworks and tools in health research. This paper provides a critical scoping review of the application of complex adaptive system (CAS) theory in settings-based health promotion research. We included 14 papers, mostly qualitative studies, reporting on planning or implementation of change initiatives, less on its evaluation. CAS theory application was often incomplete thereby reducing the potential benefit of using this lens to understand change management. We suggest some recommendations how to comprehensively apply the CAS theory in setting-based health research and to report on all CAS characteristics to enhance the understanding of settings as adaptive health-promoting settings.

Neutrophils Enhance Their Own Influx to Sites of Bacterial Infection via Endosomal TLR-Dependent Cxcl2 Production.

The influx of neutrophils to infection sites is a fundamental step in host defenses against the frequent human pathogen group B Streptococcus (GBS) and other extracellular bacteria. Using a mouse model of GBS-induced peritonitis, we show in this study that the chemokines Cxcl1 and Cxcl2 play distinctive roles in enhancing the recruitment and the antibacterial activities of neutrophils in a manner that is linked to differences in the cellular sources of these mediators. Cell depletion experiments demonstrated that neutrophils make a significant contribution to the in vivo production of Cxcl2 but not Cxcl1. In vitro, neutrophils responded weakly to LPS but released high levels of Cxcl2 after stimulation with GBS or other bacteria. Neutrophil-derived Cxcl2 acted in an autocrinous manner to increase its own production and to enhance antibacterial activities, including the release of oxygen radicals. In both neutrophils and macrophages, the production of Cxcl1/2 largely required the presence of functional UNC93B1, a chaperone protein involved in signaling by endosomal TLRs. Moreover, the phenotype of UNC93B1-defective phagocytes could be recapitulated by the simultaneous absence of TLR7, 9, and 13 but not by the absence of individual TLRs. Collectively, our data show that neutrophils recognize Gram-positive and Gram-negative bacteria by means of multiple phagosomal TLRs, resulting in de novo synthesis of Cxcl2, amplification of neutrophil recruitment, and potentiation of their antibacterial activities. These data may be useful to devise alternative therapeutic strategies aimed at enhancing the recruitment and the functional activities of polymorphonuclear leukocytes during infections caused by antibiotic-resistant bacteria.

The association and mediation role of Food and Nutrition Literacy (FNLIT) with eating behaviors, academic achievement and overweight in 10-12 years old students: a structural equation modeling.

BACKGROUND: Food and nutrition literacy is a key factor in shaping healthy dietary behaviors and may result in decreasing decrease the prevalence of overweight. Empirical research on food and nutrition literacy and its outcomes is limited, especially among children and adolescents. Thus, this study investigates the link between Food and Nutrition Literacy (FNLIT) with eating behaviors, academic performance, and overweight in 10-12 years old students in Tehran, Iran. METHODS: This study was performed through two phases: 1) Proposing a conceptual model of the relationship between FNLIT and its determinants and outcomes, based on the existing evidence and previous models, and 2) Testing the proposed FNLIT model through a cross-sectional study on 803 primary school students (419 boys and 384 girls, from 34 public and 10 private primary schools), aged 10-12 years using structural equation modeling. Demographic, socio-economic, and household food security characteristics were collected by interviewing the students and their mothers/caregivers using a questionnaire. FNLIT was measured by a self-administered, locally designed, and validated questionnaire. RESULTS: The fit indices suggested a reasonably adequate fit of the data to the hypothesized model (χ2/df = 2.03, p < 0.001, goodness of fit index (GFI) = 0.90, adjusted goodness of fit index (AGFI) = 0.88, comparative fit index (CFI) = 0.91, incremental fit index (IFI) = 0.91, root mean square error of approximation (RMSEA) = 0.04, standardized root mean residual (SRMR) = 0.06). SES was directly and positively related to FNLIT and its subscale in students. FNLIT score had a positive direct (non-mediated) relationship with healthy eating behavior and academic performance. This pattern was strongly reversed in unhealthy eating behavior. There was a full mediation relationship between FNLIT and overweight/obesity via healthy eating behaviors. SES predicted academic performance partially through the mediating effect of Food Label Literacy (FLL). The results indicated that despite the direct relationship between SES and academic performance, an indirect but negative relationship existed with food insecurity. The finding also revealed the fully mediating role of Food Choice Literacy (FCL) in the relationship between demographic factors and healthy eating behaviors. Our study also found that Interactive Food and Nutrition Literacy (IFNL) protected unhealthy eating behaviors, and FCL predicted healthy eating behaviors in children. CONCLUSION: Our study draws attention to FNLIT, especially the skills domain, including IFNL, FCL, and FLL, as the most important determinant of healthy eating behavior, academic performance, and weight status in school-age children reduces social inequalities in children's development. To ensure an adequate level of FNLIT, educators should assess and plan to enhance food literacy skills in children and adolescents.

Irrational use of antibiotics in Iran from the perspective of complex adaptive systems: redefining the challenge.

BACKGROUND: Irrational use of antibiotics is proving to be a major concern to the health systems globally. This results in antibiotics resistance and increases health care costs. In Iran, despite many years of research, appreciable efforts, and policymaking to avoid irrational use of antibiotics, yet indicators show suboptimal use of antibiotics, pointing to an urgent need for adopting alternative approaches to further understand the problem and to offer new solutions. Applying the Complex Adaptive Systems (CAS) theory, to explore and research health systems and their challenges has become popular. Therefore, this study aimed to better understand the complexity of the irrational use of antibiotics in Iran and to propose potential solutions. METHOD: This research utilized a CAS observatory tool to qualitatively collect and analyse data. Twenty interviews and two Focus Group discussions were conducted. The data was enriched with policy document reviews to fully understand the system. MAXQDA software was used to organize and analyze the data. RESULT: We could identify several diverse and heterogeneous, yet highly interdependent agents operating at different levels in the antibiotics use system in Iran. The network structure and its adaptive emergent behavior, information flow, governing rules, feedback and values of the system, and the way they interact were identified. The findings described antibiotics use as emergent behavior that is formed by an interplay of many factors and agents over time. According to this study, insufficient and ineffective interaction and information flow regarding antibiotics between agents are among key causes of irrational antibiotics use in Iran. Results showed that effective rules to minimize irrational use of antibiotics are missing or can be easily disobeyed. The gaps and weaknesses of the system which need redesigning or modification were recognized as well. CONCLUSION: The study suggests re-engineering the system by implementing several system-level changes including establishing strong, timely, and effective interactions between identified stakeholders, which facilitate information flow and provision of on-time feedback, and create win-win rules in a participatory manner with stakeholders and the distributed control system.

Health-enhancing foods: barriers to consumers' choice in Iran.

Given the growing market for health-enhancing or functional foods in Iran, the consumption rate is low. Identifying and understanding the causes is key for future decisions and interventions in the market. So, the present study was designed to provide this knowledge in Iran. The study was conducted in Tehran, the capital of Iran, between May and September 2014. In total, 105 people participated in this qualitative research, including 40 production/supply/health authority stakeholders and 65 consumer stakeholders (44 housewives and 21 employed women). The sampling strategy was the purposive method with maximum diversity, and snowball sampling was used to identify key stakeholders. The social marketing framework was used for analyzing the participants' views and experiences. To collect data, semi-structured focus group discussions and in-depth interviews were conducted. Data collection and content analysis were performed simultaneously, using MAXQDA® software. Categorization of the findings based on social marketing mix showed that the most important barriers to the consumption of functional dairy products were undesirable sensory and non-sensory characteristics, lack of physical and economic access to the product, the existence of product competitors in the market and inappropriate promotion strategies. Furthermore, personal barriers identified as a new dimension and included lack of knowledge about the product and its benefits, a negative attitude toward the product and personal taste and preference. Understanding these barriers might contribute to design and implement effective and appropriate interventions to increase the consumption of these products among consumers.

Food and nutrition literacy (FNLIT) and its predictors in primary schoolchildren in Iran.

This study used a locally designed and validated questionnaire to describe the distribution of food and nutrition literacy (FNLIT) in a cross-sectional sample of 803 students aged 10-12 years from elementary schools in Tehran city, Iran. Logistic regression was used to assess the extent to which various independent covariates were associated with low FNLIT. The data were used to identify significant differences using a range of social and cultural variables relevant to the context of school students in Iran. The results of the study showed that although the total FNLIT level was good, this headline finding masked important differences in the sub-domains. More than half of the children (69%) had high levels of FNLIT in the cognitive domain, but in the skills domain, very few (3%) scored highly. The study also identified some associations between the total FNLIT and its subscales and sociodemographic variables including gender, parent's education and age, birth order. These results highlighted groups within the school population who were at higher risk of having lower FNLIT levels. They also indicate that girls feel more able to exert choice and control over food and nutrition decisions than boys are but may be less able to do so in practice. Overall, these results are a general reminder to schools of the different learning needs of children from different family backgrounds. The article highlights the need for continuous improvement in the health education curriculum of schools in Iran, particularly highlighting the importance of giving greater attention to the development of practical food and nutrition skills alongside more traditional food and nutrition knowledge. Additional studies (with long-term follow-up) are needed to more fully assess and understand the predictors of FNLIT.

A complete linkage disequilibrium in a haplotype of three SNPs in Fat Mass and Obesity associated (FTO) gene was strongly associated with anthropometric indices after controlling for calorie intake and physical activity.

BACKGROUND: The underlying mechanism of the effect of FTO genotype on body mass index (BMI) and body composition is unknown. The objective of the study was to investigate the association of FTO gene polymorphisms with anthropometric indices in adolescent boys after adjustments for dietary intake and physical activity. METHODS: In this school-based study, we enrolled 123 male adolescents without extra weight and 110 male adolescents with body mass index (BMI) higher than + 1 Z-score. The DNA samples were genotyped for the FTO gene polymorphisms by DNA Sequencing. BMI and body composition were assessed using bioelectrical impedance analyzer scale. Association of the FTO polymorphisms with Weight, height, BMI, body fat percent and skeletal muscle percent were investigated. Data on potential confounders (calorie intake and physical activity) were collected through the use of pre-tested questionnaires. RESULTS: Adolescents with higher BMI and body fat percent and lower skeletal muscle percent were more likely to have a newly found haplotype of rs9930506, rs9930501 & rs9932754 (GGT) in the first intron of the FTO with complete linkage disequilibrium (LD) compared with those with the lower BMI (6.15;2.28-16.63), body fat percent (9.54;0.92-47.44) and higher skeletal muscle percent (9.26;1.85-46.38). This association was not changed after controlling for age. Additional adjustments for calorie intake and physical activity did not alter the association. CONCLUSIONS: A haplotype in the first intron of the FTO gene had a strong association with obesity indices in adolescent boys after adjustments for calorie intake and physical activity. It's suggested that the FTO genotype exert its effects on adolescents' anthropometric indices as haplotype and through mechanisms other than changes in calorie intake and expenditure. TRIAL REGISTRATION: This paper reports the first phase of a comprehensive interventional study (Interactions of Genetics, lifestyle and anthropometrics study or IGLA study) and is retrospectively registered in the Iranian Registry of Clinical Trials as IRCT2016020925699N2. Date registered: April 24, 2016. ( http://www.irct.ir/searchresult.php?id=25699&number=2 ).

How far are we from full implementation of health promoting workplace concepts? A review of implementation tools and frameworks in workplace interventions.

INTRODUCTION: Health promoting workplace frameworks provide a holistic view on determinants of workplace health and the link between individuals, work and environment, however, the operationalization of these frameworks has not been very clear. This study provides a typology of the different understandings, frameworks/tools used in the workplace health promotion practice or research worldwide. It discusses the degree of their conformity with Ottawa Charter's spirit and the key actions expected to be implemented in health promoting settings such as workplaces. METHOD: A comprehensive online search was conducted utilizing relevant key words. The search also included official websites of related international, regional, and national organizations. After exclusion, 27 texts were analysed utilizing conventional content analyses. RESULTS: The results of the analysis were categorized as dimensions (level or main structure) of a healthy or health promoting workplaces and subcategorized characteristics/criteria of healthy/health promoting workplace. DISCUSSION AND CONCLUSION: Our analysis shows diversity and ambiguity in the workplace health literature regarding domains and characteristics of a healthy/health promoting workplace. This may have roots in lack of a common understanding of the concepts or different social and work environment context. Development of global or national health promoting workplace standards in a participatory process might be considered as a potential solution.

Is an Iranian Health Promoting School status associated with improving school food environment and snacking behaviors in adolescents?

The Iranian Health Promoting Schools (IHPS) program was first piloted and then formally established in Iran in 2011 as a framework to promote healthy environment and behaviors such as proper dietary practice among adolescents. This study examined the role of IHPS in improving the school food environment and snacking behaviors among adolescents. In this cross-sectional study, 1320 eighth grade students from 40 middle schools with IHPS and non-IHPS program were selected using a proportional stratified random sampling method. A modified 55-item qualitative Food Frequency Questionnaire was used to assess the frequency of consumption of healthy and unhealthy snacks in the studied adolescents. Mixed effect negative binomial regression models were used to analyze the data. The association was also adjusted for individual variables, including gender, socio-economic status, pocket money, family structure and nutritional knowledge level. No significant difference was observed between the average of healthy and unhealthy snack items in IHPS and non-IHPS schools (p > 0.05). On the basis of adjusted analysis, being from/in IHPS was not associated with weekly frequency consumption of unhealthy [prevalence rate ratio (PRR) = 0.99; 95% CI: 0.85-1.16] and healthy (PRR = 1.08; 95% CI: 0.96-1.2) snacks among the adolescents. There was no difference regarding school food environment and snacking behaviors in IHPS and non-IHPS schools. This might indicate that there has been a weakness in institutionalizing the comprehensive concepts of the HPS approach in the studied schools. Addressing the proper understanding of HPS approach and the need for development of HPS through matching and adaptability with health promotion actions to reach defined standards, is necessary.

Partner's engagement in community-based health promotion programs: a case study of professional partner's experiences and perspectives in Iran.

Community-based health promotion requires effective participation and partnership of diverse and numerous stakeholders from community as well as external professional organizations. Although effective partnership of stakeholders is often the key for success of health promotion practice and research, but this has proved to be a complex and challenging task. This study is an exploratory study to identify professional stakeholder's perspectives and experiences toward the partner's engagement challenges in community-based participatory research conducted in Population Research Centers in Iran. A qualitative study design with in-depth semi-structured interviews as data collection method was chosen. Using purposeful sampling technique, policy-makers and managers (mainly academics) involved in community-based participatory research in these centers were invited to be interviewed. Data were collected to the point where no new information was forthcoming. All interviews were taped and transcribed. To provide answers for research questions, qualitative content analysis was employed to extract emerging main themes from numerous cods. Findings were categorized in three main themes as Partnership's relationship and trust issues, Partnership's individual issues and Partnership's system issues. Although community-based participatory research in Iran benefits from more than a decade history and some physical infrastructures, but it seems that public health experts and researchers and other partner organizations are lagging behind in terms of capacities and competencies required to effectively utilize the available structure and opportunities. Hence, capacity development, both among professional partners and community may be the main way forward to tackling the future challenges for strengthening community actions but should include both levels of individuals and systems.

Role of Toll-like receptor 13 in innate immune recognition of group B streptococci.

Murine Toll-like receptor 13 (TLR13), an endosomal receptor that is not present in humans, is activated by an unmethylated motif present in the large ribosomal subunit of bacterial RNA (23S rRNA). Little is known, however, of the impact of TLR13 on antibacterial host defenses. Here we examined the role of this receptor in the context of infection induced by the model pathogen group B streptococcus (GBS). To this end, we used bacterial strains masked from TLR13 recognition by virtue of constitutive expression of the ErmC methyltransferase, which results in dimethylation of the 23S rRNA motif at a critical adenine residue. We found that TLR13-mediated rRNA recognition was required for optimal induction of tumor necrosis factor alpha and nitrous oxide in dendritic cell and macrophage cultures stimulated with heat-killed bacteria or purified bacterial RNA. However, TLR13-dependent recognition was redundant when live bacteria were used as a stimulus. Moreover, masking bacterial rRNA from TLR13 recognition did not increase the ability of GBS to avoid host defenses and replicate in vivo. In contrast, increased susceptibility to infection was observed under conditions in which signaling by all endosomal TLRs was abolished, i.e., in mice with a loss-of-function mutation in the chaperone protein UNC93B1. Our data lend support to the conclusion that TLR13 participates in GBS recognition, although blockade of the function of this receptor can be compensated for by other endosomal TLRs. Lack of selective pressure by bacterial infections might explain the evolutionary loss of TLR13 in humans. However, further studies using different bacterial species are needed to prove this hypothesis.

Studying the relationship between insomnia and sleep disorders with hypertension: a report from community-dwelling older adults living in Tehran, Iran.

Introduction: Sleep disorders are common health problems in the elderly. One of the unusual and often overlooked risk factors for hypertension is insomnia. Therefore, this study investigated the relationships between insomnia and sleep problems with hypertension in the elderly population living in Tehran, Iran. Materials and methods: In this cross-sectional study conducted in 2017, 450 elderly individuals (aged ≥ 60 years) living in households were randomly selected from five areas in the city of Tehran, Iran, via a multi-stage sampling method (stratified and clustered). Their sleep status and hypertension were examined using a self-reported comprehensive questionnaire to assess the physical, mental, and spiritual health needs of the elderly. The utilized questionnaire was designed and previously psychometrically validated. Univariate and multivariate logistic regression models assessed the responses regarding sleep and hypertension along with other variables to explore their relationships. Results: 450 elderly individuals were recruited, of which 52.7% were men, and 47.3% were women. The mean age of the participants was 70.1 ± 7.3 years, and About 74.2% of participants were in the 60 to 74 years old, age group. Hypertension had a statistically significant relationship with insomnia. For one unit of increase in better sleep status score, hypertension decreased by 4% (OR = 0.96, P = 0.017). Conclusion: It seems that in preventive and therapeutic interventions related to insomnia, the risk of hypertension in the elderly should be considered, and their blood pressure should be monitored and constantly controlled. We suggest a more clinically accurate approach to insomnia, sleep disorders, and hypertension and further evaluation of variables such as sleep duration and obstructive sleep apnea in future studies.

Anti-CTLA-4 nanobody as a promising approach in cancer immunotherapy.

Cancer is one of the most common diseases and causes of death worldwide. Since common treatment approaches do not yield acceptable results in many patients, developing innovative strategies for effective treatment is necessary. Immunotherapy is one of the promising approaches that has been highly regarded for preventing tumor recurrence and new metastases. Meanwhile, inhibiting immune checkpoints is one of the most attractive methods of cancer immunotherapy. Cytotoxic T lymphocyte-associated protein-4 (CTLA-4) is an essential immune molecule that plays a vital role in cell cycle modulation, regulation of T cell proliferation, and cytokine production. This molecule is classically expressed by stimulated T cells. Inhibition of overexpression of immune checkpoints such as CTLA-4 receptors has been confirmed as an effective strategy. In cancer immunotherapy, immune checkpoint-blocking drugs can be enhanced with nanobodies that target immune checkpoint molecules. Nanobodies are derived from the variable domain of heavy antibody chains. These small protein fragments have evolved entirely without a light chain and can be used as a powerful tool in imaging and treating diseases with their unique structure. They have a low molecular weight, which makes them smaller than conventional antibodies while still being able to bind to specific antigens. In addition to low molecular weight, specific binding to targets, resistance to temperature, pH, and enzymes, high ability to penetrate tumor tissues, and low toxicity make nanobodies an ideal approach to overcome the disadvantages of monoclonal antibody-based immunotherapy. In this article, while reviewing the cellular and molecular functions of CTLA-4, the structure and mechanisms of nanobodies' activity, and their delivery methods, we will explain the advantages and challenges of using nanobodies, emphasizing immunotherapy treatments based on anti-CTLA-4 nanobodies.

Assessment of risk factors for suicidal behavior: results from the Tehran University of Medical Sciences Employees' Cohort study.

Introduction: Suicide is a major issue of concern for public health. It is estimated that suicide accounts for 700,000 deaths every year. A personal history of one or more suicide attempts is the most important determinant of suicide among the general population. This study aimed to assess the major risk factors associated with suicidal behaviors among Iranian employees in a medical setting. Methods: In this study, 3,913 employees of Tehran University of Medical Sciences who participated in the employees' cohort study conducted by the university were recruited. Suicidal behaviors (SBs) and their associated risk factors were evaluated using the World Mental Health Composite International Diagnostic Interview (CIDI) Version 3.0. Univariate and multivariate logistic regressions were performed to identify the determinants of SBs among the participants, and crude and adjusted odds ratios (ORs) with corresponding 95% confidence intervals (95% CIs) were calculated. Results: Overall, 49.6% of respondents (n = 1,939) reported that they were tired of life and thinking about death. The lifetime prevalence rate of suicidal ideation (SI) was 8.1% (n = 317), that of suicide planning (SP) was 7.3% (n = 287), and that of suicide attempts (SA) was 3.1% (n = 122). Being female (OR: 1.87, CI: 1.64-2.12), being divorced (OR: 3.13, CI: 1.88-5.22), having a low level of education (OR: 1.57, CI: 1.15-2.14), and working in clinical and medical services (OR: 1.25, CI: 1.09-1.43) were associated with being tired of life and thinking about death. These factors were also associated with SI, SP, and SA. Discussion: These findings highlight the need to prioritize mental health for suicide prevention, especially for high-risk groups, in workplace mental health promotion programs and policies.

Can a Single General Self-Rated Health Question Mirror Social Determinant of Health?

Background: Self-rated health (SRH) indicator is widely used and recommended in health research as a standard indicator for measuring health in different populations. This paper reports SRH of employees at Tehran University of Medical Sciences (TUMS), Tehran, Iran; and its related factors. Methods: We used the TUMS Employee's Cohort Study (TEC) data, collected from September 2017 to August 2019. SRH of 2158 employees were assessed using a single question. Univariate and multivariate logistic regression were performed to determine factors associated with sub-optimal SRH. Results: Overall, 14.9% (n = 321) of respondents rated their health as sub-optimal. Differences were observed with subgroups. Women, lower socioeconomic status (SES), experiences of more economic fluctuation conditions and lower reading scores could predict sub-optimal SRH variations in crude and adjusted regression analyses. The age, social capital, work experience and employment status could predict sub-optimal SRH variations only in crude regression analyses (P<0.05). Conclusion: Differences in SRH report reflected differences in socioeconomic conditions. The biggest gap was observed between people of different SES (five times). Considering that SRH reflected socioeconomic characteristics of individuals, it may be considered as a quick, non-expensive, and simple way of identifying groups in need of addressing their social determinants of health.

Community-based participatory interventions to improve food security: A systematic review.

Introduction: This systematic review aimed to evaluate community-based participatory (CBP) interventions to improve food security and/or its dimensions to highlight the scope and characteristics of interventions and extract the characteristics of effective interventions. Methods: The electronic databases, including PubMed/MEDLINE, SCOPUS, EMBASE, Web of Science, and Google Scholar, were searched from 1980 to 30 August 2022 for relevant studies. We included randomized controlled trials (RCTs), cluster randomized controlled trials (cRCTs), controlled before and after studies (CBAs), non-randomized controlled trials (nRCT), and interrupted time series (ITS) studies to identify the community-based participatory interventions. The indicators of food and nutrition security into four dimensions, as well as food insecurity measured as score and/or prevalence of food insecurity based on validated perception-based measures were considered outcome. Two reviewers independently evaluated the studies for eligibility, extracted data, and evaluated the risk of bias in the included studies using the Effective Public Health Practice Project (EPHPP). The quality of included reports was categorized as strong (when there were no weak ratings), moderate (when one factor was rated as weak), or weak (when two or more factors were rated as weak). A descriptive analysis of the findings was performed. Results: A total of twelve studies were included. The quality of all eligible studies (n = 12) was rated as moderate/weak. Most CBP interventions were guided by formative research (n = 9, 75%). Two main groups for utilized strategies were identified: agricultural and nutrition strategies. Agricultural strategies included agricultural education, preparing and improving soil and seeds, promoting and supporting gardening/harvesting utilizing traditional skills based on the local culture, and agroecological practices. Nutrition strategies included store and shopping programs, farmers' markets, fresh fruit and vegetable programs, nutrition education programs for mothers, and food vouchers. The main outcomes improved in the CBP interventions were food security (n = 2) and its dimensions, including availability (n = 3), access (n = 5), and utilization (n = 2). All agroecological practices achieved statistically significant outcomes in the intended food security target(s). However, nutritional interventions were not effective for some access components such as mean adequacy ratio, fruit and vegetable intake, and nutrition environment of the stores. No studies evaluated stability outcome components of food security. Discussion: CBP interventions guided by formative research data and agroecological practices were promising strategies to improve food security and its dimensions. Insufficient data on the stability components of food security and weak design studies were the considerable gaps in the research evidence reviewed. More research employing randomized experimental designs with adequate sample size and high retention rates is required. Systematic review registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42020189477].