Scaling-Up Food Policies in the Pacific Islands: Protocol for Policy Engagement and Mixed Methods Evaluation of Intervention Implementation
Authors: Webster Jacqui , Waqa Gade , Thow Anne-Marie , Allender Steven , Lung Thomas , Woodward Mark , Rogers Kris , Tukana Isimeli , Kama Ateca , Wilson Donald , Mounsey Sarah , Dodd Rebecca , Reeve Erica , McKenzie Briar , Johnson Claire , Bell Colin 
Published: June 2020

Abstract
Background Non-communicable diseases (NCDs) have been declared a crisis in the Pacific Islands, and poor diets are a major contributor to this. The COVID-19 pandemic and resulting economic crisis will likely increase the burden on food systems, exacerbating this situation. Pacific Island leaders have been proactive in adopting a range of food policies and regulations to improve diets. This includes taxes and regulations on compositional standards for salt and sugar in foods or school food policies. Whilst there is increasing evidence for the effectiveness of such policies globally, there is a lack of local context-specific evidence about how to implement them effectively in the Pacific. Methods Our 5-year collaborative research project will advance knowledge of how to scale up food policy interventions in the Pacific Islands. The overall aim of this implementation science research project is to test the feasibility and effectiveness of policy interventions to reduce salt and sugar consumption in Fiji and Samoa, and to examine factors that will support sustained implementation. We will engage, as partners, government agencies and civil society in Fiji and Samoa, and support the design, implementation and monitoring of a range of evidence-informed interventions aiming to reduce salt and sugar consumption, in the context of on-going health and environmental challenges, such as COVID-19 and climate change. Specific objectives are to: (1) conduct a policy landscape analysis to understand the potential opportunities and challenges to strengthen policies for prevention of diet-related NCDs in Fiji and Samoa; (2) conduct repeat cross sectional surveys to measure dietary intake, food sources and diet-related biomarkers; (3) use Systems Thinking in Community Knowledge Exchange (STICKE) to strengthen implementation of policies to reduce salt and sugar consumption; (4) evaluate the impact, process and cost effectiveness of implementing these policies. Discussion The project will provide new evidence to support policy making, as well as developing a low-cost, high-tech, sustainable, scalable system for monitoring food consumption, the food supply and health-related outcomes.Contributions to the literature· Poor diets are one of the main contributors to non-communicable diseases. There is increasing evidence to show that food policy interventions (fiscal or regulatory) are an effective way of improving diets, globally. · This project will produce local context-specific evidence for the impact and cost-effectiveness of food policy interventions to improve diets in the Pacific Islands (Fiji and Samoa). It will also produce new insights into what is feasible and which factors contribute most to effective implementation in different contexts.· The findings will provide important insights into gaps in the implementation science literature on food policy implementation, particularly in Small Island Developing States. The project will also make an important contribution globally since the innovative methods of engaging policy makers and monitoring food and health developed through the project may be replicated elsewhere.