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Background: Ileostomy formation is a common surgical procedure. Complications include high output and obstruction for which dietary management is common but not clearly defined. Aim: To explore dietary advice and modifications for ileostomy management through investigation of the current evidence and experiences of people with an ileostomy, and healthcare professionals (HCPs). Methods: 1) A systematic scoping review of the evidence for dietary management in people with an ileostomy, following JBI methodology. Experimental, observational, and qualitative studies were included, as well as published expert opinion from the last decade. 2) An online survey asking adults with an ileostomy about dietary advice they received and would have preferred to receive. 3) A qualitative study involving in-depth interviews with hospital-based HCPs; analysed thematically using the framework method. Results: The review found an abundance of literature, particularly expert opinion, on dietary management for people with an ileostomy. However, this literature was highly heterogenous in terms of dietary strategies and outcomes reported. Of 291 survey respondents, 90 did not receive dietary advice; however, 82 (91%) of these would have liked advice. >1/3 of respondents experienced anxiety, confusion, and frustration relating to their diet. Stoma nurses were the most common source of dietary advice. Qualitative findings revealed differences in understanding, priorities and framing of dietary advice between professions which may contribute to conflicting information. Inter-disciplinary working increased HCP confidence in, and consistency of, dietary advice to patients with an ileostomy but varied between hospitals. Conclusion: People with an ileostomy need better dietary advice. This could reduce anxiety and physical complications, improving quality of life and reducing burden on the NHS. To achieve this, high quality research evaluating dietary management and provision of dietary advice for people with an ileostomy is a priority to inform best practice. Findings from this thesis will inform future development of relevant and realistic dietary interventions.

Background: Familial hypercholesterolaemia (FH) is a genetic disorder characterised by elevated low-density lipoprotein cholesterol (LDL-C) levels and increased risk of cardiovascular disease (CVD). Clinical guidelines advocate dietary and physical activity recommendations adjuvant to life-long pharmacological treatment. However, there is a lack of evidence to support the effectiveness of diet and physical activity in the treatment of FH. Aim: The aim of this thesis was to develop and evaluate an intervention targeting the dietary and physical activity behaviours of children and their parent who are affected by FH. Following the Medical Research Council guidance for the development and evaluation of complex interventions, this was addressed through four studies. Methods and results: Study one summarised the existing evidence base for the role of diet and physical activity in the treatment of FH. Study two synthesised the qualitative evidence regarding the experiences and beliefs of individuals with FH and identified several enablers and barriers to treatment adherence. This informed suggestions for clinical practice that could facilitate optimal treatment adherence. In study three, a theoretical framework was applied to the findings of study two to develop an intervention targeting dietary and physical activity behaviours of individuals with FH. Twenty-six behaviour change techniques were identified for inclusion in the intervention to target the theoretical constructs identified to influence behaviour. Study four was a randomised, controlled feasibility trial (n=21 families) that found it is feasible to recruit, randomise and retain families with FH and to implement and evaluate the intervention designed in study two. The results also provide evidence that the intervention may be associated with improvements in CVD risk factors, including LDL-C. Conclusion: The intervention development and evaluation undertaken for this thesis has provided the evidence required ahead of conducting a definitive randomised controlled trial (RCT). This RCT will be adequately powered to evaluate the potential effectiveness of diet and physical activity treatment recommendations on LDL-C treatment goals and CVD risk amongst individuals with FH.