Objective. To validate an audio-video (AV) method of food journaling, in a free-living scenario, compared to direct, weighed food assessment. Design and Setting. Data were collected in a cafeteria. Meals, selected by participants (n=30), were documented using the AV method: participants video-recorded their tray while audio-recording a description of their selected meal, after which the research team digitally weighed each food item and created an itemized diary record of the food. Variables Measured. Data from the AV method and from the weighed food diaries were transcribed and entered into a nutrition software analysis program (Nutribase Pro 10.0). Nutrient outputs were compared between the two methods including kilocalories, macronutrients, and selected micronutrients. Analyses. Using mean scores for each variable, Wilcoxon signed-rank test and Spearman’s correlation coefficients were conducted. Interclass correlation coefficient (ICC) was calculated for absolute agreement between the two methods to assess interrater reliability. Results. With the exception of Vitamin E and total weight, nutrient values were highly correlated between methods and were statistically significant given alpha = 0.05, power = 0.95, and effect size of 0.70. Conclusions. The AV method may be a meaningful alternative to diary recording in a free-living setting.

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Healthcare organizations engage in continuous quality improvement to improve performance and value-for-performance, but the pathway to change is often rooted in challenging the way things are “normally” done. In an effort to propel system-wide change to support healthy eating, Nova Scotia Health developed and implemented a healthy eating policy as a benchmark to create a food environment supportive of health. This article describes the healthy eating policy and its role as a benchmark in the quality improvement process. The policy, rooted in health promotion, sets a standard for healthy eating and applies to stakeholders both inside and outside of health. We explain how the policy offers nutrition but also cultural benchmarks around healthy eating, bringing practitioners throughout Nova Scotia Health together and sustaining collaborative efforts to improve upon the status quo.

IntroductionPoor diet is a leading preventable risk for the global burden of non-communicable disease. Robust measurement is needed to determine the effect of COVID-19 on dietary intakes and consumer purchasing, given the widespread changes to consumer food environments and economic precarity. The research objectives are as follows: (1) describe dietary intakes of foods, beverages and nutrients of concern during the COVID-19 pandemic; (2) quantify change in diet during COVID-19 as compared with prepandemic, previously captured in the provincial samples of the population-representative 2015 Canadian Community Health Survey-Nutrition and (3) examine how household purchasing practices predict dietary intakes during COVID-19.Methods and analysesObservational study of diet, using a population-based stratified probability sampling strategy allocated via dual-frame (landline and cellphone) calls to random-digit dialled numbers, followed by age-sex group quotas. The base population comprises the four provinces of the Atlantic region of Canada, jurisdictions with an excess burden of pre-existing dietary risk, compared with the rest of Canada. Our aim is n=1000 to obtain reliable estimates at a regional level to describe intakes and compare with prepandemic baseline. Data collection entails 12 weeks participation: (1) enrolment with sociodemographics (key dietary risk predictors such as age, sex, gender, pre-COVID-19 income, employment, household composition, receipt of economic relief, rural residence); (2) two 24hour diet recalls using the online ASA-24 Canada 2018 tool; and (3) online uploads of household food purchase receipts over the 12 weeks enrolled. Participation incentives will be offered.Ethics and disseminationThis research protocol received funding from the Canadian Institutes of Health Research (FRN VR5 172691) and ethics review approval from the Dalhousie University Research Ethics Board. Study protocol and instruments and a de-identified dataset will be made publicly available. We will submit the findings to peer-reviewed journals, as well as conferences geared towards scientific and decision-maker audiences.

Background Unhealthy food environments are key factors in diet-related disease risk. Many audit methods have been designed for the retail food environment, but weaknesses of existing methods include: validity in study methods and design, and heterogeneity in adaptation and analysis methods. This paper describes the development and validation of a novel protocol for designing store audit instruments - the Store Environment Assessment (SEA) Tool. Methods This research involved four steps: 1. a scoping review of consumer food environment audit tools; 2. classify key variables from the literature; 3. use the variables to design a protocol for development of audit instruments tailored to local contexts and research questions; and 4. validate the protocol by designing and validating a sample audit tool based on Canada's Food Guide (2019). Results Variables from the literature included: Product (availability, variety, size, reference), Price, Promotion, Placement-accompanied by: definition, type of variable, range of values, scale of measurement, and measurement outcome. The protocol has seven steps: identify dietary guideline criteria; conduct content analysis; define setting; align research questions with scale and scope; variable selection; audit tool design; and validation strategy. The protocol was used to design a store audit instrument for Canadian jurisdictions, based on Canada's Food Guide, and validated against the gold standard, Nutrition Environment Measures Survey (NEMS). Discussion The SEA protocol can strengthen researchers and practitioners' capacity to use structured guidelines to develop geographically and socio-demographically relevant Store Environment Assessments, and avoid heterogeneity arising from ad hoc adaptations of tools such as NEMS. Our methodological approach can support greater consistency, feasibility, and rigour of food environment audits for diverse public health research and practice objectives. Key messages Researchers and practitioners will be able to utilize the SEA tool protocol, using jurisdictional food and nutrition criteria, to better assess 4Ps related to food, in retail food environments. The variables and measurement outcomes included in the SEA tool protocol will support public health practitioners in developing relevant interventions to support healthy consumer food purchasing.