Objective and Perceived Access to Healthy Foods: a Mixed Methods Study Using on Field Measures, GIS...
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Transcript of Objective and Perceived Access to Healthy Foods: a Mixed Methods Study Using on Field Measures, GIS...
Julia Díez, Roberto Valiente, Ana María Olea, Carmen
Ramos, and Manuel Franco
Objective and perceived access
to healthy foods: a mixed
methods study using on field
measures, GIS and Photovoice
PhotoVoice is a project co-funded by
in collaboration with
http://hhhproject.eu
Objective and perceived access to
healthy foods: Background
• Low-income groups live in neighborhoods with less
available and affordable fresh fruits&vegetables
• Engaging residents may improve the understanding of
local food environments and help designing effective
interventions
• Mixed methods research may help to better
understand perceived barriers and facilitators to
healthy eating.
http://hhhproject.eu
Objective and perceived
access to healthy foods: Aim
To identify barriers and opportunities for
accessing healthy foods using mixed methods:
1. In-store assessments
2. GIS
3. Photovoice
http://hhhproject.eu
Objective and perceived access
to healthy foods: Methods
Study context
- Urban poor area, comprising one administrative
neighborhood (≈ 35000 pop.) in Madrid (Spain).
- 12 residents (31-72) participated in evaluating their
local food environment through Photovoice.
Los Rosales
(study area)
Madrid
municipality
Foreign-born 24.8%
Unemployment 18.7%
Low educational level 28.7%
Car ownership 36.1%
http://hhhproject.eu
Objective and perceived access
to healthy foods: Methods
1. In-store assessments
• We used an adapted version of the NEMS-s survey,
developed and validated by Glanz et al.
• NEMS-S survey examines the availability, quality and
cost of healthy food options versus less-healthier foods
• Outcome Healthy Food Availability Index (from -7 to
49)
• Field audits were conducted within a random sample of
a 50% of each food store type
• In-store audits lasted a mean of 7.13 minutes (SD: 4.03,
range: 2-17 min.)
http://hhhproject.eu
Objective and perceived access
to healthy foods: Methods
2. GIS
• We obtained the most up-to-date data on the retail food
environment from Madrid City Council´s database
• We calculated “Healthy Food Availability Index” average
scores per store type (high, medium, and low) with
kernel density analysis
• We calculated potential residents´ walking access to
food stores with a high HFAI score by means of a street
network analysis
http://hhhproject.eu
Objective and perceived access
to healthy foods: Methods
3. Photovoice
• 12 residents met in small group
discussion over one and a half
month
• They took photographs of positive
and negative aspects of their local
food environment
• Residents critically discussed and
identified themes that emerged
from their photographs and
narratives
http://hhhproject.eu
Objective and perceived access
to healthy foods: Analysis
Residents identified 17 relevant physical
and social features
Healthy food availability index (HFAI)
score (-7 to 49): availability, quality and
cost
Walking access with a street network
analysis.
http://hhhproject.eu
Objective and perceived access
to healthy foods: Results
http://hhhproject.eu
Economic crisis and poverty
• 33% of the neighborhood food stores
were found permanently closed
• Participants highlighted lack of
economic opportunities and unequal
distribution of resources
Marketing
• Placement and promotions were not
objectively measured
• Participants noted a high exposure to
fast food at supermarkets
Objective and perceived access
to healthy foods: Barriers
http://hhhproject.eu
Objective and perceived access
to healthy foods: Opportunities
Small neighborhood stores and public markets
• 59.4% of food stores were traditional stores (mean
HFAI 10.84); 34.4% corner stores (mean HFAI 33.6);
and 6.2% supermarkets (mean HFAI ranged 36.5)
• Residents highlighted traditional food stores as offering
healthier, better quality of products and better customer
service
Walkability
• 78.7% of residents can access high healthy food stores
within 5 minutes, and 98.7% within less than 10 min.
• Grocery shopping was mentioned as an opportunity to
be physically active for elderly residents
http://hhhproject.eu
Theme 3: Food retailers
http://hhhproject.eu
Objective and perceived access to healthy foods: Conclusions
By combining quantitative and qualitative methods,
we developed 7 concrete community-generated and
place-based interventions promoting a healthier
local food environment.