Evaluation of a pilot healthy eating intervention in restaurants and food stores of a rural community: a randomized community trial

Abstract

BackgroundResearch suggests that the food environment influences individual eating practices. To date, little is known about effective interventions to improve the food environment of restaurants and food stores and promote healthy eating in rural communities. We tested “Waupaca Eating Smart ” (WES), a pilot intervention to improve the food environment and promote healthy eating in restaurants and supermarkets of a rural community. WES focused on labeling, promoting, and increasing the availability of healthy foods.MethodsWe conducted a randomized community trial, with two Midwestern U.S. communities randomly assigned to serve as intervention or control site. We collected process and outcome data using baseline and posttest owner and customer surveys and direct observation methods. The RE-AIM framework was used to guide the evaluation and organize the results.ResultsSeven of nine restaurants and two of three food stores invited to participate in WES adopted the intervention. On a 0-4 scale, the average level of satisfaction with WES was 3.14 (SD=0.69) for restaurant managers and 3 (SD=0.0) for store managers. On average, 6.3 (SD=1.1) out of 10 possible intervention activities were implemented in restaurants and 9.0 (SD=0.0) out of 12 possible activities were implemented in food stores. One month after the end of the pilot implementation period, 5.4 (SD=1.6) and 7.5 (SD=0.7) activities were still in place at restaurants and food stores, respectively. The intervention reached 60% of customers in participating food outlets. Restaurant food environment scores improved from 13.4 to 24.1 (p < 0.01) in the intervention community and did not change significantly in the control community. Food environment scores decreased slightly in both communities. No or minimal changes in customer behaviors were observed after a 10-month implementation period.ConclusionThe intervention achieved high levels of reach, adoption, implementation, and maintenance, suggesting the feasibility and acceptability of restaurant-and food store-based interventions in rural communities. Pilot outcome data indicated very modest levels of effectiveness, but additional research adequately powered to test the impact of this intervention on food environment scores and customer behaviors needs to be conducted in order to identify its potential to promote healthy eating in rural community settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1469-z) contains supplementary material, which is available to authorized users.

What is the effectiveness of obesity related interventions at retail grocery stores and supermarkets? —a systematic review

“…No significant impact on calorie, sugar, or fat consumption64.3%medium Ho et al (2008) [53]CanadaThe Zhiiwapenewin Akino’maagewin: Teaching to Prevent Diabetes (ZATPD)Grocery stores in Remote communities in Canada and their low-income ethnic minority customersQuasi-experimental pretest/posttest evaluationFood-related behavioral and psychosocial outcomesReported significant change in knowledge among intervention participants. There was also a significant increase in frequency of healthy food acquisition among respondents in the intervention communities.50.0%high Rosecrans et al(2008) [54]CanadaThe Zhiiwapenewin Akino’maagewin: Teaching to Prevent Diabetes (ZATPD)Grocery stores in Remote communities in Canada and their low-income ethnic minority customersAssess fidelity, dose, reach and contextNumber of foods promoted, number and content of promotion materials, etc.Program implemented in- and out-of-store activities with moderate fidelity.60.4%high Dannefer et al (2012) [72]U.S.A.Healthy Bodegas55 corner stores in underserved urban neighborhoodsPre-post designNumber and type of foods stocked, etc.Participating stores significantly improved healthy food inventory; also moderate increase customer purchase of healthy foods.52.4%high Holmes et al (2012) [80]U.S.A.Healthy Kids CampaignUrban grocery store intervention targeting children and their parentsObservational time-series without comparisonSale of fruit and vegetablesSale of targeted foods including fruits and vegetables increased.52.1%high Ayala et al (2013) [66]U.S.A. Vida Sana Hoy y Mañana (Healthy Life Today and Tomorrow) Tiendas in central North Carolina and targeted mainly Hispanic customers of the tiendas.Cluster Randomized controlled trialsale of fruit and vegetablesModerate intervention effect in reported fruit and vegetable intake70.8%medium Caldwell et al (2008) [67]U.S.A.Colorado Healthy People 2010 Obesity Prevention Initiative.Stores in Colorado and various target groups including, older adults, high-risk individuals, and general community membersPre-post study designFruit and vegetable intakeSignificant increase in consumption of fruit and vegetables by intervention participants61.9%high Martínez-Donate et al (2015) [79]U.S.A.Waupaca Eat Smart (WES)601 customers at intervention & control supermarketsRandomized Community trial…”

“…Fifteen studies use quasi-experimental designs [28, 29, 52, 53, 55, 56, 65, 67–70, 72, 74–76], while twelve utilize randomized/cluster-randomized study designs [24, 26, 27, 57, 59, 60, 63, 64, 66, 73, 78, 79]. Moreover, most use self-reported data or dietary recalls, but some of the studies used electronic sales data [26–28, 56, 58–60, 68, 69, 73, 77, 80].…”

“…For instance, Bains et al [51] incorporated physical activity alongside the component targeting retail grocery shops. Other prevention programs used multiple settings and not just grocery stores [53, 79]. …”

Retail Environments as a Venue for Obesity Prevention

“…The majority of these studies modified menus to add healthier items, highlighted/promoted existing healthful items, minimized/removed less healthy items, and/or provided price reductions on healthier menu items. [92–95] Specific strategies implemented in restaurant interventions included promoting lower calorie meals and side dishes, promoting items with lean meats and low-fat dairy, and reducing the marketing of sugar-sweetened beverages, particularly on children’s menus [92–95]. Several of the interventions also featured social-marketing and promotion campaigns such as signage on tables/windows, flyers to the community, and/or social media pages or promotion.…”

Adopting healthier cooking oils: Findings from a qualitative study among independent food outlets in a rural district in Australia

“…Restaurants and fast food outlets are recognised as potential settings for health promotion interventions to facilitate access to healthier food options . The potential for Local Governments (Councils) in Australia to positively influence these food environments has been identified .…”