Frontiers in Public Health 01 frontiersin.org Evaluating the outcomes and implementation determinants of interventions co-developed using human-centered design to promote healthy eating in restaurants: an application of the consolidated framework for implementation research Melissa Fuster 1 *, Emily Dimond 1 , Margaret A. Handley 2 , Donald Rose 1 , Charles Stoecker 1,3 , Megan Knapp 4 , Brian Elbel 5,6 , Cara Conaboy 1 and Terry T. K. Huang 7 1 Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States, 2 Partnership for Research in Implementation Science for Equity (PRIDE) Center and Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, United States, 3 Department of Health Policy and Management, New Orleans, LA, United States, 4 Department of Public Health Sciences, Xavier University of Louisiana, New Orleans, LA, United States, 5 Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States, 6 Wagner Graduate School of Public Service, New York University, New York, NY, United States, 7 Center for Systems and Community Design and NYU-CUNY Prevention Research Center, City University of New York Graduate School of Public Health and Health Policy, New York, NY, United States Background: Restaurants are an emerging yet underutilized setting to facilitate healthier eating, particularly among minoritized communities that disproportionately experience health inequities. The present study aimed to examine outcomes from interventions co-developed using Human-Centered Design (HCD) in two Latin American restaurants, including sales of healthier menu items (HMI) and the consumer nutrition environment. In addition, we aimed to assess implementation outcomes (acceptability, fdelity, and sustainability) and elucidate the determinants for implementation using the Consolidated Framework for Implementation Research. Methods: This study used a mixed-methods, longitudinal design. Data were collected pre-, during, and post-intervention testing. Intervention outcomes were examined through daily sales data and the Nutrition Environment Measures Survey for Restaurants (NEMS-R). Changes in HMI sales were analyzed using interrupted time series. Implementation outcomes and determinants were assessed through site visits [observations, interviews with staf (n= 19) and customers (n= 31)], social media monitoring, and post-implementation key informant interviews with owners and staf. Qualitative data were analyzed iteratively by two independent researchers using codes developed a priori based on CFIR. Results: The HCD-tailored interventions had diferent outcomes. In restaurant one (R1), where new HMI were introduced, we found an increase in HMI sales and improvements in NEMS-R scores. In restaurant two, where existing HMI were promoted, we found no signifcant changes in HMI sales and NEMS-R scores. Acceptance was high among customers and staf, but fdelity and sustainability OPEN ACCESS EDITED BY Karla Galaviz, Indiana University Bloomington, United States REVIEWED BY Elizabeth Rhodes, Emory University, United States Aida Turrini, Independent Researcher, Scansano, Italy *CORRESPONDENCE Melissa Fuster mfuster@tulane.edu RECEIVED 06 February 2023 ACCEPTED 28 April 2023 PUBLISHED 18 May 2023 CITATION Fuster M, Dimond E, Handley MA, Rose D, Stoecker C, Knapp M, Elbel B, Conaboy C and Huang TTK (2023) Evaluating the outcomes and implementation determinants of interventions co-developed using human- centered design to promote healthy eating in restaurants: an application of the consolidated framework for implementation research. Front. Public Health 11:1150790. doi: 10.3389/fpubh.2023.1150790 COPYRIGHT © 2023 Fuster, Dimond, Handley, Rose, Stoecker, Knapp, Elbel, Conaboy and Huang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. TYPE Original Research PUBLISHED 18 May 2023 DOI 10.3389/fpubh.2023.1150790