Adaptation and Validation of the Chinese Version of the Nutrition Environment Measurement Tool for Stores

Abstract

Changes in lifestyle and food environment have created a heavy burden of obesity and chronic disease in China. However, measurements of the food environment have been rarely reported in China or other countries with similar food cultures; this measurement shortage is partially due to the lack of valid and reliable measurement tools. The aim of the present study was to adapt and validate a Chinese version of the Nutritional Environment Measurement Survey for Stores (C-NEMS-S). Categories and items of the NEMS-S were culturally adapted to fit the Chinese population and included grains, dry beans, starchy tubers, vegetables, fruits, seafood, meat and poultry, dietary oils, milk, bread, instant noodles, and beverages. A scoring sheet for each food category was created to measure availability, quality, and pricing. Then, the C-NEMS-S was validated in 10 large-sized supermarkets and 10 convenience stores in Shenyang, China. Two trained raters performed their evaluations separately at the same store. The intra-class correlation coefficient (ICC) of the availability composite score was 0.98. All food measures had a moderate or good ICC (0.41 to 1.00). The kappa for each food measure ranged from 0.52 to 1.00. C-NEMS-S was able to show the difference in healthy food availability between large-sized supermarkets and convenience stores, as well as the price differences between healthier options and regular options. Large-sized supermarkets had a significantly higher total score (p < 0.001) and healthier option availability for all food measures (all items were statistically significant (p < 0.05), except sugar-free beverages). Healthier options cost more than regular options for grains, milk, bread, and instant noodles (from 4% to 153%). The adapted C-NEMS-S can be used to measure the consumer food environment in stores in China.

Adaptation and Evaluation of the Nutrition Environment Measures Survey in Stores to Assess Mediterranean Food Environments (NEMS-S-MED)

“…Moreover, our adapted NEMS-S-MED tool should be replicated in other Mediterranean cities to ensure validity and reliability in other settings. Yet, the sample of stores included in this study ( n = 43) is similar to previous studies adapting the NEMS-S audit tool in China, Brazil, or Canada ( n = 20, 44, and 55, respectively) [ 17 , 18 , 19 ].…”

“…Second, we assessed construct validity. We compared the NEMS-MED scoring across types of food stores with known differences regarding the foods they carry according to the original NEMS-S and previous research [ 18 , 19 ]. We hypothesized that supermarkets would have greater availability of healthy foods, while convenience stores would have the lowest availability of healthy foods, based on previous research [ 24 ].…”

“…Yet, assessing the retail food environment is context-dependent [ 15 ]. As such, researchers have adapted the NEMS-S tool for use in several studies conducted in Australia [ 16 ], Canada [ 17 ], China [ 18 ], Brazil [ 19 ], or Paraguay [ 20 ]. Mediterranean retail food environments present specific characteristics, including trust in small retailers, as opposed to the large reliance of retail chains of supermarkets in the U.S and other Anglo-Saxon countries [ 21 , 22 ].…”

Development and Application of Healthiness Indicators for Commercial Establishments that Sell Foods for Immediate Consumption

“…Among the few studies that present summary measures, the complete or adapted tool of the Nutritional Environment Measures Survey (NEMS) has been the most widely used in studies to assess the consumer food environment [ 22 , 25 , 41 , 42 , 43 ]. NEMS uses a composite indicator that assesses the availability of healthy food choices, prices, and quality of foods, attributing points to the healthy food options based on a combination of the three dimensions analyzed.…”

“…There are versions of the instrument both for the assessment of the retail food trade and the assessment of establishments that sell foods for immediate consumption. The complexity of the tool’s implementation, the subjectivity of the quality assessment, and the proposal to assess only the presence of healthy food options (overlooking the presence of unhealthy options) have been some of the barriers to the use of different versions of the NEMS [ 22 , 41 ].…”