CO-Creation and Evaluation of Food Environments to Advance Community Health (COACH)

Negotiating healthy food retail initiatives in the research project Healthier Choices in Supermarkets: an ethnographic study of a partnership between health intervention researchers, food retailers, and public health advocates

BACKGROUND

Partnerships between researchers and food retailers are advocated as necessary for developing sustainable and effective health-promotion initiatives in supermarkets. However, little is known about how such partnerships evolve and influence different phases of intervention research. This study explores how partnerships between researchers and food retailers develop during the pre-intervention phase and examines the factors that influence both the partnerships and the initiatives they produce.

METHODS

The empirical case used in the study is a partnership between intervention researchers, food retailers, and public health advocates that aimed to develop and test healthy food retail initiatives to make healthy food choices easy for customers. We conducted an ethnographic study covering the pre-intervention phase from the establishment of the partnership in 2019 to the feasibility test of the initiatives in 2021. We used participant observation of meetings and intervention development activities, qualitative interviews with partners, and document analysis of email correspondence and project materials. We analysed the data abductively, drawing on a narrative analytical approach and theoretical concepts of institutional logics and negotiation.

FINDINGS

We present a narrative in six chapters illustrating how market logic dominated the selection and development of healthy food retail initiatives, ultimately compromising the researchers' original research interests. Furthermore, the pre-intervention phase was challenged by an unclear division of roles and responsibilities, misaligned expectations, high staff turnover in the retail organisation, and the Covid-19 pandemic. These challenges resulted in growing mistrust and an asymmetric partnership that undermined the progress and potential of the project.

CONCLUSIONS

Using the lens of institutional logics, we show how differing interests and perspectives between partners - for example regarding health and consumer behaviour - can make it difficult to realize the original research ideas and build a trusting relationship. Overall, this study illustrates the complexity of research partnerships with commercial actors such as food retailers. To develop and implement effective health-promotion initiatives in a food retail setting, researchers must stay mindful of their initial research interest, integrity, and study design, ensuring they are not compromised in the collaboration.

What does it take for healthy food retail programmes to be successful? Lessons learned in New York City

OBJECTIVE

Healthy food retail programmes (HFRP) in the USA generally aim to increase healthy foods access to improve diet quality and health, yet the impact is mixed. These programmes primarily target adults, even though adolescents frequently and independently visit stores to purchase snacks. This study's aims are to explore successes and challenges of implementing HFRP (Aim 1) and examine how HFRP can be tailored to adolescents (Aim 2).

DESIGN

One-time, virtual, semi-structured interviews with individuals who were involved in a HFRP, followed by a socio-demographic characteristics survey. Interviews were designed based on the RE-AIM framework and the Hexagon Tool and analysed using Braun and Clark's (2006) thematic analysis approach. Descriptive statistics were used to summarise participants' socio-demographic characteristics.

SETTING

New York City (NYC).

PARTICIPANTS

Adults (18 years or older) who have designed, implemented and/or evaluated an HFRP in NYC and speak/understand English (n 21).

RESULTS

Aim 1: For successes, strategies to build relationships with the community were most discussed. Regarding challenges, securing reliable funding was the hardest to overcome. Suggested solutions included designing profitable HFRP, targeting shortcomings in food distribution systems and increasing consumer demand. Aim 2: Most participants had not considered adolescents in previous HFRP but suggested involving youth in developing HFRP to encourage youth-driven solutions and promote youth advocacy.

CONCLUSIONS

Future HFRP should focus on activities that help store owners purchase affordable healthy foods from distributors, which translates to affordability for customers. Federal and local policies can assist by funding complementary programmes. Additionally, adolescents should be considered in these efforts.

Community engagement in health promotion campaigns: A qualitative photo content analysis from vitalizing communities against NCD risk factors (V-CaN) field trial in rural central India

BACKGROUND

India faces a critical challenge with 5.8 million annual deaths from non-communicable diseases (NCDs). Maharashtra, where NCDs constitute 66% of the disease burden. The youth, lacking awareness, are vulnerable. Vitalizing communities against NCD risk factors (V-CaN) melawa, inspired by the "Pandharpur Wari" pilgrimage, aims to bridge implementation gaps and empower communities. "Arogya chi wari" integrates health practices with cultural events, offering a unique approach. Photo documentation from V-CaN melawa becomes a powerful tool for assessing community engagement qualitatively. The aim of the study was to qualitatively analyze photos from V-CaN melawas, exploring community engagement in health promotion against NCD risk factors.

MATERIALS AND METHODS

V-CaN melawas were organized in the field practice area of the department of community medicine. These melawas were part of the cluster randomized field trial named V-CaN, which is being implemented in a rural area of the Wardha district of Maharashtra. The V-CaN days, also known as melawas, were organized with the aim of facilitating behavioral change among participants. A qualitative study using photo content analysis was conducted, reviewing 2000 pictures from 59 V-CaN melawas. Thematic content analysis was employed, with researchers selecting 61 photos based on uniqueness.

RESULTS

Six major themes emerged: health promotion, health system involvement, intersectoral coordination, inclusiveness, community resource mobilization, and innovation. Examples include nutrition exhibitions, health screenings, and innovative games.

CONCLUSIONS

The analysis showcases diverse community participation in V-CaN melawas, emphasizing inclusivity, collaboration, and innovation. While qualitative, the study lays the foundation for future quantitative assessments of the intervention's impact on health outcomes and community attitudes.

Systems thinking for local food environments: a participatory approach identifying leverage points and actions for healthy and sustainable transformations

BACKGROUND

Current local food environments encourage poor diets, posing a significant threat to public and planetary health. Acknowledging and addressing its inherent complexity is vital to making meaningful improvements to the food environment. Using a participatory approach with local stakeholders, this study aims to gain insight into the factors and mechanisms underlying the local food environment and to identify leverage points and system-based actions to foster healthy and sustainable local food environments.

METHODS

A systems-thinking approach was used in a Dutch municipality in 2022. Two group model building (GMB) workshops were held with community stakeholders (e.g. local policymakers, retailers and residents). During the first workshop (June 2022), factors and mechanisms influencing the local food environment were identified and visualized through a causal loop diagram (CLD). During the second workshop, leverage points and system-based actions to improve food environments were identified by the stakeholders. Four months after (October 2022), an action-implementation meeting was organized to stimulate the implementation of selected actions. Progress was monitored through brief telephone interviews 6 and 12 months after the second workshop.

RESULTS

The CLD visualises the factors and mechanisms influencing the local food environment from the point of view of the community stakeholders. The CLD consists of 46 factors shaping the local food environment, which were categorized into four identified subsystems: societal factors, individual, socio-economic factors, commercial factors and political factors. Eight leverage points were identified within the CLD, for example, 'lobby from food industry', 'governmental food policies' and 'e-commerce and platform economy'. Stakeholders formulated 20 actions targeting the identified leverage points. During the action-implementation meeting, long-term plans were created for five actions. After 1 year, only one participant (policy advisory role) remained actively engaged in three of these actions.

CONCLUSIONS

This study yields insight into the numerous factors and mechanisms underlying the local food environment and identified system-based actions as perceived by local stakeholders to improve this food environment locally. The CLD offers stakeholders valuable insights on employing a systems approach when enhancing food environments. More research is necessary, especially into the long-term processes and effects of implementing system-oriented actions to improve local food environments.

Developing Co-Creation Research in Food Retail Environments: A Descriptive Case Study of a Healthy Supermarket Initiative in Regional Victoria, Australia

Research into the co-creation of healthy food retail is in its early stages. One way to advance co-creation research is to explore and understand how co-creation was applied in developing, implementing, and evaluating a heath-enabling initiative in a supermarket in regional Victoria, Australia. A case study design was used to explore and understand how co-creation was applied in the Eat Well, Feel Good Ballarat project. Six documents and reports related to the Eat Well, Feel Good Ballarat project were analyzed with findings from the focus groups and interviews. Motivations to develop or implement health-enabling supermarket initiatives differed among the participants. Participants considered that initial negotiations were insufficient to keep the momentum going and to propose the value to the retailers to scale up the project. Presenting community-identified needs to the supermarket helped gain the retailer's attention, whilst the co-design process helped the implementation. Showcasing the project to the community through media exposure kept the supermarket interested. Retailers' time constraints and staff turnover were considered significant barriers to partnership building. This case study contributes insights into applying co-creation to health-enabling strategies in food retail outlets using two co-creation frameworks.