The African urban food environment framework for creating healthy nutrition policy and interventions in urban Africa

Abstract

This study developed, validated, and evaluated a framework of factors influencing dietary behaviours in urban African food environments, to inform research prioritisation and intervention development in Africa. A multi-component methodology, drawing on concept mapping, was employed to construct a framework of factors influencing dietary behaviours in urban Africa. The framework adapted a widely used socio-ecological model (developed in a high-income country context) and was developed using a mixed-methods research approach that comprised: i. Evidence synthesis consisting of a systematic review of 39 papers covering 14 African countries; ii. Qualitative interview data collected for adolescents and adults (n = 144) using photovoice in urban Ghana and Kenya; and iii. Consultation with interdisciplinary African experts (n = 71) from 27 countries, who contributed to at least one step of the framework (creation, validation/evaluation, finalisation). The final framework included 103 factors influencing dietary behaviours. Experts identified the factors influencing dietary behaviours across all the four levels of the food environment i.e. the individual, social, physical and macro levels. Nearly half (n = 48) were individual-level factors and just under a quarter (n = 26) were at the macro environmental level. Fewer factors associated with social (n = 15) and physical (14) environments were identified. At the macro level, the factors ranked as most important were food prices, cultural beliefs and seasonality. Factors ranked as important at the social level were household composition, family food habits and dietary practices. The type of food available in the neighbourhood and convenience were seen as important at the physical level, while individual food habits, food preferences and socioeconomic status were ranked highly at the individual level. About half of the factors (n = 54) overlap with those reported in an existing socio-ecological food environment framework developed in a high-income country context. A further 49 factors were identified that were not reported in the selected high-income country framework, underlining the importance of contextualisation. Our conceptual framework offers a useful tool for research to understand dietary transitions in urban African adolescents and adults, as well as identification of factors to intervene when promoting healthy nutritious diets to prevent multiple forms of malnutrition.

Individual‐level drivers of dietary behaviour in adolescents and women through the reproductive life course in urban Ghana: A Photovoice study

“…Existing socioecological models of dietary behaviours and systematic review evidence from Africa (Gissing et al, 2017 ; Story et al, 2008 ) were used to identify factors, biological, demographic, cognitions (e.g., knowledge and preferences) and practices (e.g., skills and behaviours), influencing dietary behaviours at the individual level. The African Food Environment framework, an expert validated framework created to help prioritize research and intervention development in Africa, was also consulted and used to structure the reporting of our results (Osei‐Kwasi et al, 2021 ).…”

“…A range of models and frameworks have been developed to understand the drivers of food choice and how food environments can influence individual‐level dietary behaviours (Marijn Stok et al, 2018 ; Osei‐Kwasi et al, 2021 ; Story et al, 2008 ; Turner et al, 2018 ). This paper will contribute to the growing evidence on the influence of individual‐level factors on dietary behaviours in Africa across the different dimensions of the food environment.…”

Benchmarking policy goals and actions for healthy food environments in Ethiopia to prevent malnutrition in all its forms using document analysis

“…We developed a theoretical framework for our study (figure 1) based on the food environment domains of the INFORMAS Food-EPI framework, 26 which we complemented with insights from other food environment frameworks in order to cover all relevant domains of the food environment in the Ethiopian context. [40][41][42][43][44][45] INFORMAS identifies seven different food environment domains in the Food-EPI tool, encompassing food composition and processing, labelling, promotion, provision, retail, prices, trade and investment. 26 Based on the assumption that these domains are largely shaped by government action regarding the accessibility, availability and affordability of healthy food choices, the Food-EPI tool has been used to rate policy actions in countries against global benchmarks, which are based on international best practice examples relevant for each of the food environment domains.…”

“…We developed a theoretical framework for our study (figure 1) based on the food environment domains of the INFORMAS Food-EPI framework,26 which we complemented with insights from other food environment frameworks in order to cover all relevant domains of the food environment in the Ethiopian context 40–45. INFORMAS identifies seven different food environment domains in the Food-EPI tool, encompassing food composition and processing, labelling, promotion, provision, retail, prices, trade and investment 26.…”

“…Food safety was identified as an important domain of the food environment, given its influence on consumers’ food consumption 40–42. Frameworks developed for the African and LMIC food environment also highlighted food safety and its importance with regard to the sanitation and hygiene of vendors, food adulteration and contamination, especially in informal retail in African urban food environments 43 44. Food-EPI studies in Ghana and Kenya integrated food safety as good practice examples of either trade or retail 27 28.…”