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.

Food availability, perceived food environment and social norm perceptions of healthy and vegetarian food consumption at a public music festival in the Netherlands: a cross-sectional study.

Objective: To gain insight into the food availability, the perceived food environment, and social norm perceptions in favour of healthy and vegetarian food consumption at a festival. Design: Two cross-sectional substudies were conducted to audit food and beverages at the festival, and to measure visitors' perceptions of the festival food environment (accessibility, affordability, availability, diversity, quality) and their social norms perceptions via a mobile survey. Setting: Public music festival, the Netherlands. Sample: 75 food stands and 153 adult festival visitors. Results: 75 food stands offered 627 food and beverage items, of which 92.4% were not supportive of a healthy diet. Of all food items, 46.6% were vegetarian (including 20% fries). Participants especially perceived the festival food environment as unsupportive of healthy choices. They also had weak descriptive and injunctive social norm perceptions in favour of healthy and vegetarian food consumption. However, they had stronger descriptive (t(152)=-5.5; p<0.001) and injunctive norm perceptions (t(152)=-4.5; p<0.001) of vegetarian food consumption (mean descriptive social norm perception=2.42; SD=0.82; mean injunctive social norm perception=3.14; SD=0.78), than healthy food consumption (mean descriptive social norm perception=2.10; SD=0.76; mean injunctive social norm perception=2.93; SD=0.78). Participants had stronger injunctive than descriptive social norm perceptions of healthy (t(152)=-12.4; p<0.001) and vegetarian (t(152)=-11.3; p<0.001) food consumption. Participants' perceived food environment and their perception of social norms were positively correlated. Conclusion: The festival's food environment appears unsupportive of healthy and vegetarian food consumption. The limited availability of healthy and vegetarian food coincided with weak social norm perceptions encouraging their consumption, particularly descriptive norms that arise from observing others. The food environment may stand in the way of developing descriptive norms for the consumption of healthy and vegetarian food, as people can only see others consume food that is available. Implementation of public event policies could support healthier, more sustainable festivals.