Multi-level Communications and Access Strategies to Improve the Food Environment
Condition: Obesity
MeSH terms: Obesity
Study type: Interventional

Summary: 
      The overarching goal of B'More Healthy Retail Rewards (BHRR) is to develop, implement, and
      evaluate a pilot multi-level communications and pricing intervention to improve access to and
      consumption of healthy foods in low-income areas of Baltimore City, Maryland. BHRR has three
      primary aims: (1) to conduct formative research with representatives of multiple levels of
      the Baltimore food environment (i.e., local wholesalers, retail food store owners, and
      consumers) in order to select key foods for promotion, and determine appropriate
      communications and healthy food price reduction strategies, (2) to pilot the multi-level
      program with 2 local wholesale stores, and 24 small corner stores and their customers, and
      assess program implementation through detailed process evaluation, and (3) to assess impact
      of multilevel health communications and pricing strategies, combined and separately, on
      consumer dietary patterns and food source use, food purchasing behaviors, psychosocial
      variables, food security, and individual weight and height.
    

Detailed description: 
      Innovative and culturally appropriate multilevel health communications interventions are
      desperately needed to address the chronic disease epidemic in high-risk populations, such as
      low-income urban African Americans. However, the vast majority of communications strategies
      have focused on educating individual consumers about healthy food choices, while in poor
      urban settings the lower availability of affordable healthy food choices greatly limits the
      impact of these messages. The study team worked with 1 wholesaler and 24 small retail food
      stores to develop and test novel strategies in Baltimore, Maryland, including: 1) multilevel
      health communications alone directed at wholesalers, retailers and low-income African
      American consumers intended to enhance willingness to stock and/or purchase healthy foods; 2)
      pricing strategies (performance based allowances) directed at wholesalers and retailers to
      increase their stocking of healthy foods at reduced prices; and 3) combined health
      communications and pricing strategies. Intervention strategies were tailored to meet the
      needs of the target populations based on formative research and stakeholder input. This
      research study is based on significant field experience in this setting, including the
      development of evaluation tools to assess change in stocking and pricing of key foods (at the
      store level), and psychosocial factors, dietary intake, and food purchasing behaviors (at the
      consumer level). There are 3 main study aims:

        1. Formative research with representatives of multiple levels of the Baltimore food
           environment (i.e., local wholesalers and retail food store owners) in order to select
           key foods for promotion, determine appropriate communication strategies (e.g., messages,
           channels, materials) for each level, and select the most appropriate pricing approach
           (i.e., performance based allowance structure and stipulations).

        2. Pilot the multilevel program with three wholesalers and 24 food stores (6 control, 6
           health communications only, 6 pricing only, 6 combined), and assess program
           implementation through detailed process evaluation.

        3. Assess impact of the pilot program on a) the stocking, pricing, marketing, and sales
           volume of promoted foods at wholesale and retail levels, and b) food purchasing
           behaviors and associated psychosocial variables (i.e., self-efficacy, intentions,
           perceived cost) at the consumer level (final sample n=12 consumers/store, 288 total).

      The proposed research seeks to develop effective, multilevel communication strategies to
      improve diet and reduce risk for diet-related chronic diseases. The study team anticipates
      this design will demonstrate the value of a multi-pronged and multilevel health
      communications approach to obesity and chronic disease prevention, and will lead to a
      large-scale trial and informed policies designed to improve food availability and
      affordability in low-income urban settings.
    

Intervention name(s): Communications; Pricing; Combined (Communications & Pricing)
Intervention type(s): Other; Other; Other
Intervention description(s): Communication materials were used to promote healthier items to consumers in corner stores.; The pricing incentives were used to help promote sales of healthier food items.; Communications with Pricing incentives were used to promote the sale/consumption of healthier foods.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: multi-level intervention; price discounts; communication; low income population; dietary intervention; obesity prevention; store-based intervention