Suitability of Data-Collection Methods, Tools, and Metrics for Evaluating Market Food Environments in Low- and Middle-Income Countries

Abstract

Globalization is transforming food environments in low- and middle-income countries (LMICs) with implications for diets and nutrition. However, most food-environment assessments were developed for use in high-income countries. We evaluated the suitability of 113 data-collection assessments (i.e., methods, tools, and metrics) for eight dimensions of informal and formal market food environments for diverse contexts of LMICs. We used a scoring exercise and a survey of experts (n = 27). According to the scoring exercise, 10 assessments (8 methods, 1 tool, and 1 metric) were suitable without modification for informal markets. Suitability for formal markets was markedly higher, with 41 assessments (21 methods, 14 tools, and 6 metrics) found suitable without modification. Experts considered availability, accessibility, price, and affordability the most important dimensions of market food environments to evaluate in LMICs. Market-basket analysis and vendor audits (which include inventories) were ranked as the most suitable methods to assess multiple dimensions of market food environments, including availability, price, affordability, vendor and product characteristics, marketing, and regulation. Gaps in relevant assessments were found for convenience and desirability. Results demonstrate the need for the development, adaptation, and validation of assessments relevant for informal markets in a diverse range of LMIC contexts to support diets, nutrition, and health globally.

What North American retail food environment indices miss in Guatemala: Cultural considerations for the study of place and health

“…Our findings add empirical evidence to commentaries questioning the suitability of RFEI/mRFEI outside higher-income country contexts ( Ahmed et al, 2021 ), showing inadequacies in capturing retailer types, retailer healthiness, and cultural aspects of retail food environments.…”

“…At the same time, public health commentators have questioned the suitability of RFEI/mRFEI outside higher-income country contexts where people rely on many different kinds of retailers in addition to the supermarkets, farmers markets, corner stores, and fast-food restaurants the tools measure ( Ahmed et al, 2021 ). While the RFEI and mRFEI have been applied to other countries ( Chew et al, 2020 ; Zhang & Huang, 2018 ; Mitchell et al, 2011 ), the tools have not been validated to measure food retail accessibility and healthiness outside the U.S. and Canada.…”

A mixed‐method systematic review and meta‐analysis of the influences of food environments and food insecurity on obesity in high‐income countries

“…For example, rural households in LMICs usually obtain foods from informal market food environments which have limited schedules and highly seasonal food offerings. In contrast, consumers in high‐income countries mainly access formal market food environments, such as supermarkets, restaurants, and fast‐food chains (Ahmed et al, 2021 ).…”

Food Systems Evaluation Methods and Sustainability Assessment

“…Along with this framework, developing, testing, and validating standardized instruments and metrics to profile food environments in LMICs is crucial for understanding the diverse, complex and dynamic food environment that exists in these contexts. These standardized instruments and metrics can provide a comprehensive picture of the food environment by measuring and analyzing key indicators of food availability, accessibility, affordability, and quality (Ahmed et al, 2021). This can lead to informed evidence-based policies and interventions aimed at improving food security and nutrition outcomes (Ohri-Vachaspati and Leviton, 2010;Nguyen B. et al, 2021).…”