Perceived barriers and facilitators to participating in the North Carolina Healthy Food Small Retailer Program: a mixed-methods examination considering investment effectiveness

Abstract

Objective: The North Carolina (NC) Legislature appropriated funds in 2016-2019 for the Healthy Food Small Retailer Program (HFSRP), providing small retailers located in food deserts with equipment to stock nutrient-dense foods and beverages. The study aimed to: (1) examine factors facilitating and constraining implementation of, and participation in, the HFSRP from the perspective of storeowners; and (2) measure and evaluate the impact and effectiveness of investment in the HFSRP. Design: This analysis uses both qualitative and quantitative assessments of storeowner perceptions and store outcomes, as well as two innovative measures of policy investment effectiveness. Qualitative semi-structured interviews and descriptive quantitative approaches including monthly financial reports and activity forms, and end-of-program evaluations were collected from participating HFSRP storeowners. Setting: Eight corner stores in North Carolina that participated in the two cohorts (2016-2018; 2017-2019) of the HFSRP. Participants: Owners of corner stores participating in the HFSRP. Results: All storeowners reported that the HFSRP benefitted their stores. In addition, the HFSRP had a positive impact on sales across each category of healthy food products. Storeowners reported that benefits would be enhanced with adjustments to program administration and support. Specific suggestions included: additional information regarding which healthy foods and beverages to stock; inventory management; handling of perishable produce; product display; modified reporting requirements; and a more efficient process of delivering and maintaining equipment. Conclusions: All storeowners reported several benefits of the HFSRP and would recommend that other storeowners participate. The barriers and challenges they reported inform potential approaches to ensuring success and sustainability of the HFSRP and similar initiatives underway in other jurisdictions.

Encouraging Healthier Food and Beverage Purchasing and Consumption: A Review of Interventions within Grocery Retail Settings

“…Six studies evaluated single-component interventions in which stores increased their stock of healthy foods and beverages ( Table 2 ) [ 32 , 33 , 34 , 35 , 36 , 37 ]. None of the studies evaluating increased stocking interventions were experimental.…”

“…For example, the North Carolina Healthy Food Small Retailer Program (HFSRP) is an intervention in which small food stores were provided with up to $25,000 to spend on refrigeration units to increase their stocking of healthy foods and beverages (e.g., fresh fruits and vegetables, lean meats, whole grains, etc.) [ 32 , 33 , 35 , 36 ]. Results of quasi-experimental studies evaluating this intervention demonstrate that after one year of implementation, Healthy Food Supply (HFS) scores, a measure of availability of healthy items within a store, increased by 3.13 points between baseline and follow-up among HFSRP stores, whereas HFS scores decreased by 0.44 points in control stores.…”

“…Additionally, 4 of 6 articles assessing increased stocking interventions collected objective purchasing data. Of the studies evaluating increased stocking interventions, four were conducted in stores that explicitly served SNAP customers [ 32 , 33 , 36 , 37 ], and one was located in a low-income community that likely served SNAP customers [ 34 ].…”

A Commentary on the Healthy Community Stores Case Study Project: Implications for Retailers, Policy, and Future Research

“…The retail literature also suggests that the supply chain for unhealthy foods (i.e., salty and sweet snacks, sugar-sweetened beverages) in small store settings is more robust than that of healthier options (i.e., fresh produce); unhealthier products can often be delivered to the store (whereas it is often not possible, or more expensive to have healthier items delivered), and vendors may offer incentives for purchasing these products [ 36 , 37 , 38 ]. Larger product vendors often have minimum order requirements which can be challenging to manage for small stores, especially for healthy perishable items that can spoil and detract from the business bottom line [ 36 , 37 , 39 ]. Stores can work together in collaboration with vendors to obtain multiple vendor options (traditional and non-traditional, such as local producers, gleaners, donors) and improve the supply chain of healthy foods to smaller stores, which could be supported by policies that incentivize these relationships.…”

“…Stores can work together in collaboration with vendors to obtain multiple vendor options (traditional and non-traditional, such as local producers, gleaners, donors) and improve the supply chain of healthy foods to smaller stores, which could be supported by policies that incentivize these relationships. Perhaps focusing on local store–vendor relationships would lend itself to collaboration and be of interest to local policy-makers interested in improving healthy food access in their communities [ 39 ], as well as at the federal level where input is currently being solicited for better supporting small, mid-sized, and independent processors [ 40 ]. In addition, having multiple avenues for sourcing food may increase a store’s resiliency during supply chain interruptions such as those experienced during the COVID-19 pandemic [ 41 ].…”