ABSTRACT
BACKGROUND: Aboriginal and Torres Strait Islander communities in remote Australia have initiated bold policies for health-enabling stores. Benchmarking, a data-driven and facilitated 'audit and feedback' with action planning process, provides a potential strategy to strengthen and scale health-enabling best-practice adoption by remote community store directors/owners. We aim to co-design a benchmarking model with five partner organisations and test its effectiveness with Aboriginal and Torres Strait Islander community stores in remote Australia. METHODS: Study design is a pragmatic randomised controlled trial with consenting eligible stores (located in very remote Northern Territory (NT) of Australia, primary grocery store for an Aboriginal community, and serviced by a Nutrition Practitioner with a study partner organisation). The Benchmarking model is informed by research evidence, purpose-built best-practice audit and feedback tools, and co-designed with partner organisation and community representatives. The intervention comprises two full benchmarking cycles (one per year, 2022/23 and 2023/24) of assessment, feedback, action planning and action implementation. Assessment of stores includes i adoption status of 21 evidence-and industry-informed health-enabling policies for remote stores, ii implementation of health-enabling best-practice using a purpose-built Store Scout App, iii price of a standardised healthy diet using the Aboriginal and Torres Strait Islander Healthy Diets ASAP protocol; and, iv healthiness of food purchasing using sales data indicators. Partner organisations feedback reports and co-design action plans with stores. Control stores receive assessments and continue with usual retail practice. All stores provide weekly electronic sales data to assess the primary outcome, change in free sugars (g) to energy (MJ) from all food and drinks purchased, baseline (July-December 2021) vs July-December 2023. DISCUSSION: We hypothesise that the benchmarking intervention can improve the adoption of health-enabling store policy and practice and reduce sales of unhealthy foods and drinks in remote community stores of Australia. This innovative research with remote Aboriginal and Torres Strait Islander communities can inform effective implementation strategies for healthy food retail more broadly. TRIAL REGISTRATION: ACTRN12622000596707, Protocol version 1.
Subject(s)
Benchmarking , Diet, Healthy , Food Supply , Humans , Australia , Australian Aboriginal and Torres Strait Islander Peoples , Commerce , Food Supply/standards , Rural Population , Randomized Controlled Trials as TopicABSTRACT
Reporting key dietary indicators from sales data can help us guide store decision makers in developing effective store policy to support healthier customer purchases. We aimed to develop a web-based reporting tool of key dietary indicators from sales data to support health-promoting policy and practice in stores in geographically remote Aboriginal and Torres Strait Islander communities. Tool development included identifying key dietary indicators (informed by sales data from 31 stores), community consultation (19 Aboriginal and Torres Strait Islander store directors and two store managers) and a web-build. Tool evaluation involved feedback interviews with stakeholders (25 store managers and two nutritionists). Key dietary indicators aligned with Australian Dietary Guideline food groupings and recommendations. An online portal for accessing and customising reports was built. Stakeholder feedback indicated that the strengths of the reports were the visuals, ease of interpretation, providing information that was not currently available and potential to increase capacity to support healthy food retailing. Difficulties were defining healthiness classification with alignment to other nutrition guidelines used and ensuring reports reached relevant store decision makers. This tool may be valuable to support store decision makers in identifying and prioritising nutrition issues and optimising the health-enabling attributes of stores.
Subject(s)
Australian Aboriginal and Torres Strait Islander Peoples , Diet , Humans , Australia , Commerce , Health PolicyABSTRACT
OBJECTIVE: Different forms of public and private regulation have been used to improve the healthiness of food retail environments. The aim of this scoping review was to systematically examine the types of private regulatory measures used to create healthy food retail environments, the reporting of the processes of implementation, monitoring, review and enforcement and the barriers to and enablers of these. DESIGN: Scoping review using the Johanna Briggs Institute guidelines. Ovid MEDLINE, PsycINFO, Embase, CINAHL Plus, Business Source Complete and Scopus databases were searched in October 2020 and again in September 2023 using terms for 'food retail', 'regulation' and 'nutrition'. Regulatory measure type was described by domain and mechanism. Deductive thematic analysis was used to identify reported barriers and enablers to effective regulatory governance processes using a public health law framework. SETTING: Food retail. PARTICIPANTS: Food retail settings using private regulatory measures to create healthier food retail environments. RESULTS: In total, 17 694 articles were screened and thirty-five included for review from six countries, with all articles published since 2011. Articles reporting on twenty-six unique private regulatory measures cited a mix of voluntary (n 16), mandatory (n 6) measures, both (n 2) or did not disclose (n 2). Articles frequently reported on implementation (34/35), with less reporting on the other regulatory governance processes of monitoring (15/35), review (6/35) and enforcement (2/35). CONCLUSIONS: We recommend more attention be paid to reporting on the monitoring, review and enforcement processes used in private regulation to promote further progress in improving the healthiness of food retail environments.
Subject(s)
Food , Marketing , Humans , Environment , Food Preferences , CommerceABSTRACT
The right to food security has been recognised internationally, and nationally in Australia by Aboriginal Community Controlled Health Organisations. This study aims to explore food (in)security and solutions for improvement of food security in remote Aboriginal and/or Torres Strait Islander communities in Australia, from the perspective of caregivers of children within the context of the family using photovoice. Participants took part in workshops discussing participant photographs of food (in)security, including solutions. Themes and sub-themes with associated solutions included traditional food use, sharing as a part of culture, the cost of healthy food, energy and transport, and housing and income. Community leaders used these data in setting priorities for advocacy to improve food security in their communities.
Subject(s)
Australian Aboriginal and Torres Strait Islander Peoples , Health Services, Indigenous , Humans , Australia , Food Security , Public HealthABSTRACT
BACKGROUND: Environmental factors can impact the ability of food retail businesses to implement best practice health-enabling food retail. METHODS: We co-designed a short-item survey on factors influencing food retail health-enabling practice in a remote Australian setting. Publicly available submissions to an Australian Parliamentary Inquiry into food pricing and food security in remote Indigenous communities were coded using an existing remote community food systems assessment tool and thematically analysed. Themes informed survey questions that were then prioritised, refined and pre-tested with expert stakeholder input. RESULTS: One-hundred and eleven submissions were coded, and 100 themes identified. Supply chain related data produced the most themes (n = 25). The resulting 26-item survey comprised questions to assess the perceived impact of environmental factors on a store's health-enabling practice (n = 20) and frequency of occurrence (n = 6). CONCLUSIONS: The application of this evidence-informed, co-designed survey will provide a first-time cross-sectional analysis and the potential for ongoing longitudinal data and advocacy on how environmental factors affect the operations of remote stores.
Subject(s)
Australian Aboriginal and Torres Strait Islander Peoples , Food Insecurity , Food , Health Services, Indigenous , Humans , Australia/epidemiology , Cross-Sectional Studies , Food/economics , Surveys and Questionnaires , Rural Population , Food Insecurity/economicsABSTRACT
BACKGROUND: Food retailers can be reluctant to initiate healthy food retail activities in the face of a complex set of interrelated drivers that impact the retail environment. The Systems Thinking Approach for Retail Transformation (START) is a determinants framework created using qualitative systems modelling to guide healthy food retail interventions in community-based, health-promoting settings. We aimed to test the applicability of the START map to a suite of distinct healthy food marketing and promotion activities that formed an intervention in a grocery setting in regional Victoria, Australia. METHODS: A secondary analysis was undertaken of 16 previously completed semi-structured interviews with independent grocery retailers and stakeholders. Interviews were deductively coded against the existing START framework, whilst allowing for new grocery-setting specific factors to be identified. New factors and relationships were used to build causal loop diagrams and extend the original START systems map using Vensim. RESULTS: A version of the START map including aspects relevant to the grocery setting was developed ("START-G"). In both health-promoting and grocery settings, it was important for retailers to 'Get Started' with healthy food retail interventions that were supported by a proof-of-concept and 'Focus on the customer' response (with grocery-settings focused on monitoring sales data). New factors and relationships described perceived difficulties associated with disrupting a grocery-setting 'Supply-side status quo' that promotes less healthy food and beverage options. Yet, most grocery retailers discussed relationships that highlighted the potential for 'Healthy food as innovation' and 'Supporting cultural change through corporate social responsibility and leadership'. CONCLUSIONS: Several differences were found when implementing healthy food retail in grocery compared to health promotion settings. The START-G map offers preliminary guidance for identifying and addressing commercial interests in grocery settings that currently promote less healthy foods and beverages, including by starting to address business outcomes and supplier relationships.
Subject(s)
Beverages , Food , Humans , Commerce , Emotions , VictoriaABSTRACT
Introduction: Food environments are a key determinant of food intake and diet-related health. This paper describes the development of an iterative, adaptive, context-specific framework for health-enabling food environments embedded in cocreation theory. Methods: A 3-stage multimethod framework for the coproduction and prototyping of public health interventions was followed in an iterative manner during the development of the framework. These 3 stages were (1) evidence review, including systematic review, consultation with experts, and observation of current work; (2) codesign of the framework prototype with multiple stakeholders; and (3) coproduction through refinement of the prototype through stakeholder workshops and expert reviews with incorporation of researcher notes and workshop evaluation. We use the term prototype during the development phase and the term framework to report on the final product. Results: COACH (CO-creation and evaluation of food environments to Advance Community Health) is a process framework that describes what best practice application of cocreation in health-enabling food retail environments should involve. COACH consists of 10 interdependent factors within a 4-phase continuous quality improvement cycle. The 4 phases of the cycle are engagement and governance establishment, communication and policy alignment, codesign and implementation, and monitoring and evaluation. Conclusions: Utilizing cocreation theory represents an innovative step in research and practice to improve the healthiness of food retail environments. COACH provides a specific, unique, and comprehensive guide to the utilization of cocreation to improve the healthiness of food environments in practice.
ABSTRACT
BACKGROUND: Local government authorities are well-placed to invest in evidence-based food policies that promote a population-wide shift to healthy and sustainable diets. This study describes the contextual factors that facilitated or impeded policy-making related to healthy and sustainable diets within a 'best-performing' local government in Victoria, Australia. METHODS: Guided by the Consolidated Framework for Implementation Research (CFIR), data from semi-structured interviews with individuals involved in developing the City of Greater Bendigo's Food System Strategy were analysed using the seven-stage Framework Method. RESULTS: Semi-structured interviews (n = 24) were conducted with City of Greater Bendigo employees (n = 15) and key stakeholders working for local organisations (n = 6) or at a state or national level (n = 3). Interviewees mostly held positions of leadership (n = 20) and represented diverse areas of focus from health (n = 7), food systems (n = 4) and planning and public policy (n = 3). Data analysis revealed 12 cross-cutting themes; eight facilitating factors and four impeding factors. Facilitating factors included perseverance, community engagement, supportive state policy, effective leadership, a global platform and networks, partnerships, workforce capacity and passion, and the use of scientific evidence. Impeding factors included access to secure, ongoing financial resources, prohibitive state and federal policy, COVID-related disruptions to community engagement and competing stakeholder interests. Overall, this study suggests that the City of Greater Bendigo's success in developing an evidence-based local food system policy is built upon (i) a holistic worldview that embraces systems-thinking and credible frameworks, (ii) a sustained commitment and investment throughout the inner-setting over time, and (iii) the ability to establish and nurture meaningful partnerships with community groups, neighbouring local government areas and state-level stakeholders, built upon values of reciprocity and respect. CONCLUSIONS: Despite insufficient resourcing and prohibitive policy at higher levels of government, this 'best performing' local government in Victoria, Australia developed an evidence-based food system policy by employing highly skilled and passionate employees, embracing a holistic worldview towards planetary health and harnessing global networks. Local government authorities aspiring to develop integrated food policy should nurture a workforce culture of taking bold evidence-informed policy action, invest in mechanisms to enable long-standing partnerships with community stakeholders and be prepared to endure a 'slow-burn' approach.
Subject(s)
COVID-19 , Local Government , Humans , Victoria , Diet , Nutrition PolicyABSTRACT
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.
Subject(s)
Food Supply , Supermarkets , Humans , Victoria , Food , Marketing , CommerceABSTRACT
This study explored the local food environment of Hong Kong and Singapore using a qualitative case study approach to inform future upstream public health nutrition policies. Food outlets that provide food to be eaten in the home were mapped in selected areas of high and low socioeconomic status (SES) of Hong Kong and Singapore. Food outlet density relative to land area was determined. In both countries, lower SES areas surveyed were shown to have higher food outlet density while higher SES areas had fewer but larger food outlets. In Hong Kong, both SES areas reported similar proportions of healthy and unhealthy food outlets.This study highlights the accessibility of food outlet types through their geographical location and density. Future research assessing the differences in eating culture between these two countries should be considered alongside this study's findings, to investigate strategies influencing the food environment in order to promote healthier eating habits.
Subject(s)
Food , Low Socioeconomic Status , Humans , Hong Kong , Singapore , Cross-Sectional StudiesABSTRACT
OBJECTIVE: This article aims to investigate the capacity of nutrition professionals to engage in food retail practice change to improve population diet. METHODS: Convergent mixed method design was used that includes pre-interview surveys, in-depth interviews, and retrospective mapping of service provision. The study was conducted in organisations that provide a nutrition professional service to food retail stores in remote Australia. The study participants include 11 nutrition professionals and eight organisation representatives, including managers, organisation directors and policy officers. Systems-mapping and thematic analysis of the in-depth interviews were conducted using a capacity development framework. Descriptive analysis was applied to pre-interview survey and mapping data. RESULTS: A gap between the aspirational work and current capacity of nutrition professionals to engage effectively with stores was identified. Engagement with stores to improve population health was valued by organisations. Dominance of the medical health model limited organisation strategic support for store work and created barriers. Key barriers included the limited access to training, decision-support tools, information, financial resources and organisational structures that directed store work. CONCLUSIONS: Provision of adequate store-specific training, resources and organisational support may empower the nutrition professional workforce to be powerful leaders in co-design for healthy food retail. IMPLICATIONS FOR PUBLIC HEALTH: Building capacity for this critical workforce to engage in food retail practice change must consider the influence of the broader health system and employer organisations and need for access to evidence-based decision-support tools.
Subject(s)
Marketing , Public Health , Humans , Retrospective Studies , Nutritional Status , Workforce , Food SupplyABSTRACT
OBJECTIVE: This article aims to examine the framing of the issue of food security in very remote Aboriginal and Torres Strait Islander communities in print media and press releases during the beginning of the COVID-19 pandemic in 2020. METHODS: Newspaper articles were identified following a systematic search of the Factiva database, and press releases were identified from manual search of key stakeholder websites from January to June 2020 and analysed using a combined adapted framework of the Bacchi's What's the Problem Represented to be? Framework and the Narrative Policy Framework. RESULTS: A food delivery "problem" dominated representations in press releases, and food supply at store level had prominence in print media. Both presented the cause of food insecurity as a singular, identifiable point in time, framed the issue as one of helplessness and lack of control, and proposed policy action. CONCLUSIONS: The issue of food security was represented in the media as a simple issue requiring an immediate fix, as opposed to a complex issue requiring a systems-level and sustained policy response. IMPLICATIONS FOR PUBLIC HEALTH: This study will help to guide future media dialogue to impact on both immediate and longer-term solutions to food insecurity in very remote Aboriginal and Torres Strait Islander communities in Australia.
Subject(s)
COVID-19 , Health Services, Indigenous , Humans , Australia/epidemiology , Australian Aboriginal and Torres Strait Islander Peoples , Food Security , Nutrition Policy , Pandemics , Mass MediaABSTRACT
BACKGROUND: Local government authorities are well positioned to change the way food is produced and consumed through the implementation of integrated food policies. By facilitating the uptake of healthy and sustainable diet-related practices, integrated local government food policy can trigger change throughout the food supply chain. This study aimed to provide insights as to how the policy hierarchy surrounding local governments may be influencing local government's capacity to create integrated food policy. METHODS: Content analysis was conducted on local government food policies (n = 36) from signatory cities of the Milan Urban Food Policy Pact were mapped to seven global regions. A set of 13 predetermined healthy and sustainable diet-related practices, organized into three categories: "where to source food", "what to eat" and "how to eat", was used to assess the level of integration of each local government food policy. Additional policies from the broader policy hierarchy that were mentioned in each local government food policy were sourced and then screened for relevancy, charted according to their level of administration (local, national, global region, international) and analysed to consider which diet-related practice(s) each broader policy was likely to promote. RESULTS: Analysis revealed three key insights: (i) local government food policies across all included global regions (n = 4) mostly promoted practices in the "where to source food" category, (ii) local government food policies across all global regions referred to policies from higher levels of administration (local, national, global region and international) which tended to also promote practices in the "where to source food" category and (iii) regarding the level of integration, local government food policies in Europe and Central Asia targeted the highest number of diet-related practices. CONCLUSIONS: The level of integration of food policy at national, global region and international levels may be influencing that of local governments. Further research is required to understand why local government food policies are referring to some relevant policies and not others, and to determine whether a greater focus on the diet-related practices of "what to eat" and "how to eat" in policies from higher levels of government would support local governments to also prioritize these practices in their food policies.
Subject(s)
Diet , Local Government , Humans , Cities , Europe , Nutrition PolicyABSTRACT
INTRODUCTION: Co-creation of healthy food retail comprises the systematic collaboration between retailers, academics and other stakeholders to improve the healthiness of food retail environments. Research into the co-creation of healthy food retail is in its early stages. Knowledge of the roles and motivations of stakeholders in intervention design, implementation and evaluation can inform successful co-creation initiatives. This study presents academic experiences of stakeholder roles and motivations in the co-creation of healthy food retail environments. METHODS: Purposive sampling of academics with research experience in the co-creation of healthy food retail initiatives. Semi-structured interviews conducted between October and December 2021 gathered participants' experiences of multi-stakeholder collaborative research. Thematic analysis identified enablers, barriers, motivations, lessons and considerations for future co-creation of healthy food retail. RESULTS: Nine interviewees provided diverse views and applications of co-creation research in food retail environments. Ten themes were grouped into three overarching areas: (i) identification of stakeholders required for changes to healthier food retail; (ii) motivations and interactions, which included the intrinsic desire to build healthier communities along with recognition of their work; and (iii) barriers and enablers included adequate resourcing, effective and trusting working relationships and open communications. CONCLUSION: This study provides insights that could help future co-creation in healthy food retail environments. Trusting and respectful relationships and reciprocal acknowledgement between stakeholders are key practices in the co-creation process. These constructs should be considered in developing and testing a model that helps to systematically co-create healthy food retail initiatives that ensure all parties meet their needs while also delivering research outcomes.
Subject(s)
Food , Marketing , Humans , Food Supply , Health Status , MotivationABSTRACT
This study aimed to determine perceptions of the lived experience of food insecurity and suggestions to improve food security in four remote Aboriginal communities in the Northern Territory, and Queensland. Participants were Aboriginal and/or Torres Strait Islander pregnant and breastfeeding women, and parents/carers of children aged six months to five years. Semi-structured interviews (n=17) were conducted between June-July 2021 and the data thematically analysed using a four stage process. No specific term was used by participants to describe being either food secure or insecure. Descriptions of food security were centred in food sharing, food sufficiency, and family activities. Elements describing food insecurity were physical pain and emotional stress, adults going without food, seeking family help and managing without food until payday. Factors contributing to food insecurity were reported to be: (i) Low income and unemployment, (ii) Cost of living remotely, (iii) Resource sharing, and (iv) Impact of spending on harmful commodities and activities. Three themes were conceptualised: (1) Cultural practices buffer food insecurity, (2) Coping with food insecurity, (3) People accept a degree of food insecurity as normal. Findings suggest Aboriginal and Torres Strait Islander cultural practices such as sharing food buffer episodic food insecurity and constitute 'cultural food security'. Despite use of cultural practices (e.g., procuring traditional food) and generic coping strategies, regular episodes of food insecurity often aligned with the off week of social assistance payments. Household energy (electricity) security was coupled to food security. Suggestions for improving food security included better transport and food access, extending electricity rebates, increases in the regularity of social assistance payments, and computer access and training in budgeting. Policies to advance food security should embody deeper Aboriginal and Torres Strait Islander descriptions and experiences. Community-derived policy suggestions which aim to increase access to adequate, regular, stable household income are likely to succeed.
Subject(s)
Australian Aboriginal and Torres Strait Islander Peoples , Health Services, Indigenous , Adult , Female , Humans , Pregnancy , Australia , Caregivers , Concept Formation , Food Security , Parents , Infant , Child, PreschoolABSTRACT
BACKGROUND: Adoption of health-enabling food retail interventions in food retail will require effective implementation strategies. To inform this, we applied an implementation framework to a novel real-world food retail intervention, the Healthy Stores 2020 strategy, to identify factors salient to intervention implementation from the perspective of the food retailer. METHODS: A convergent mixed-method design was used and data were interpreted using the Consolidated Framework for Implementation Research (CFIR). The study was conducted alongside a randomised controlled trial in partnership with the Arnhem Land Progress Aboriginal Corporation (ALPA). Adherence data were collected for the 20 consenting Healthy Stores 2020 study stores (ten intervention /ten control) in 19 communities in remote Northern Australia using photographic material and an adherence checklist. Retailer implementation experience data were collected through interviews with the primary Store Manager for each of the ten intervention stores at baseline, mid- and end-strategy. Deductive thematic analysis of interview data was conducted and informed by the CFIR. Intervention adherence scores derived for each store assisted interview data interpretation. RESULTS: Healthy Stores 2020 strategy was, for the most part, adhered to. Analysis of the 30 interviews revealed that implementation climate of the ALPA organisation, its readiness for implementation including a strong sense of social purpose, and the networks and communication between the Store Managers and other parts of ALPA, were CFIR inner and outer domains most frequently referred to as positive to strategy implementation. Store Managers were a 'make-or-break' touchstone of implementation success. The co-designed intervention and strategy characteristics and its perceived cost-benefit, combined with the inner and outer setting factors, galvanised the individual characteristics of Store Managers (e.g., optimism, adaptability and retail competency) to champion implementation. Where there was less perceived cost-benefit, Store Managers seemed less enthusiastic for the strategy. CONCLUSIONS: Factors critical to implementation (a strong sense of social purpose; structures and processes within and external to the food retail organisation and their alignment with intervention characteristics (low complexity, cost advantage); and Store Manager characteristics) can inform the design of implementation strategies for the adoption of this health-enabling food retail initiative in the remote setting. This research can help inform a shift in research focus to identify, develop and test implementation strategies for the wide adoption of health-enabling food retail initiatives into practice. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN 12,618,001,588,280.
Subject(s)
Beverages , Food , Humans , Australia , Marketing , Food PreferencesABSTRACT
Despite long histories of traditional food security, Indigenous peoples globally are disproportionately exposed to food insecurity. Addressing this imbalance must be a partnership led by Indigenous peoples in accordance with the UN Declaration of the Rights of Indigenous Peoples. We report the co-design process and resulting design of a food security research project in remote Australia and examine how the co-design process considered Indigenous peoples' ways of knowing, being, and doing using the CREATE Tool. Informed by the Research for Impact Tool, together Aboriginal Community Controlled Health Organisation staff, Indigenous and non-Indigenous public health researchers designed the project from 2018-2019, over a series of workshops and through the establishment of research advisory groups. The resulting Remote Food Security Project includes two phases. Phase 1 determines the impact of a healthy food price discount strategy on the diet quality of women and children, and the experience of food (in)security in remote communities in Australia. In Phase 2, community members propose solutions to improve food security and develop a translation plan. Examination with the CREATE Tool showed that employing a co-design process guided by a best practice tool has resulted in a research design that responds to calls for food security in remote Indigenous communities in Australia. The design takes a strengths-based approach consistent with a human rights, social justice, and broader empowerment agenda. Trial registration: The trial included in Phase 1 of this project has been registered with Australian New Zealand Clinical Trials Registry: ACTRN12621000640808.
Subject(s)
Australian Aboriginal and Torres Strait Islander Peoples , Health Services, Indigenous , Child , Humans , Female , Australia , Diet , Food , Food SecurityABSTRACT
The Thumbs food classification system was developed to assist remote Australian communities to identify food healthiness. This study aimed to assess: (1) the Thumbs system's alignment to two other food classification systems, the Health Star Rating (HSR) and the Northern Territory School Canteens Guidelines (NTSCG); (2) its accuracy in classifying 'unhealthy' (contributing to discretionary energy and added sugars) and 'healthy' products against HSR and NTSCG; (3) areas for optimisation. Food and beverage products sold between 05/2018 and 05/2019 in fifty-one remote stores were classified in each system. System alignment was assessed by cross-tabulating percentages of products, discretionary energy and added sugars sold assigned to the same healthiness levels across the systems. The system/s capturing the highest percentage of discretionary energy and added sugars sold in 'unhealthy' products and the lowest levels in 'healthy' products were considered the best performing. Cohen's κ was used to assess agreement between the Thumbs system and the NTSCG for classifying products as healthy. The Thumbs system classified product healthiness in line with the HSR and NTSCG, with Cohen's κ showing moderate agreement between the Thumbs system and the NTSCG (κ = 0·60). The Thumbs system captured the most discretionary energy sold (92·2 %) and added sugar sold (90·6 %) in unhealthy products and the least discretionary energy sold (0 %) in healthy products. Modifications to optimise the Thumbs system include aligning several food categories to the NTSCG criteria and addressing core/discretionary classification discrepancies of fruit juice/drinks. The Thumbs system offers a classification algorithm that could strengthen the HSR system.
Subject(s)
Food Labeling , Thumb , Nutritive Value , Australia , Food , SugarsABSTRACT
Collaboration between community members, researchers, and policy makers drives efforts to solve complex health problems such as obesity, alcohol misuse, and type 2 diabetes. Community participation is essential to ensure the optimal design, implementation and evaluation of resulting initiatives. The terms 'co-creation', 'co-design' and 'co-production' have been used interchangeably to describe the development of initiatives involving multiple stakeholders. While commonalities exist across these concepts, they have essential distinctions for public health, particularly related to the role of stakeholders and the extent and timing of their engagement. We summarise these similarities and differences drawing from the cross-disciplinary literature, including public administration and governance, service management, design, marketing and public health. Co-creation is an overarching guiding principle encompassing co-design and co-production. A clear definition of these terms clarifies aspects of participatory action research for community-based public health initiatives.
Subject(s)
Diabetes Mellitus, Type 2 , Public Health , Community Participation , Health Services Research , Humans , Research PersonnelABSTRACT
OBJECTIVE: To synthesize peer-reviewed literature that utilize co-creation principles in healthy food retail initiatives. METHODS: Systematic review of six databases from inception to September 2021. Screening and quality assessment were carried out by two authors independently. Studies were included if they were conducted in food retail stores, used a collaborative model, and aimed to improve the healthiness of the food retail environment. Studies excluded were implemented in restaurants, fast food chains, or similar or did not utilize some form of collaboration. Extracted data included the type of stakeholders engaged, level of engagement, stakeholder motivation, and barriers and enablers of the co-creation process. FINDINGS: After screening 6951 articles by title and abstract, 131 by full text, 23 manuscripts that describe 20 separate studies from six countries were included. Six were implemented in low-income communities and eight among Indigenous people groups. A common aim was to increase access to, and availability of, healthy products. A diverse range of co-creation approaches, theoretical perspectives, and study designs were observed. The three most common stakeholders involved were researchers, corporate representatives or store owners, and governments. CONCLUSIONS: Some evidence exists of the benefits of co-creation to improve the healthiness of food retail environments. The field may benefit from structured guidance on the theory and practice of co-creation.