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A community-based system dynamics approach suggests solutions for improving healthy food access in a low-income urban environment.

ABSTRACT: Little is known about the mechanisms through which neighborhood-level factors (e.g., social support, economic opportunity) relate to suboptimal availability of healthy foods in low-income urban communities. We engaged a diverse group of chain and local food outlet owners, residents, neighborhood organizations, and city agencies based in Baltimore, MD. Eighteen participants completed a series of exercises based on a set of pre-defined scripts through an interactive, iterative group model building process over a two-day community-based workshop. This process culminated in the development of causal loop diagrams, based on participants' perspectives, illustrating the dynamic factors in an urban neighborhood food system. Synthesis of diagrams yielded 21 factors and their embedded feedback loops. Crime played a prominent role in several feedback loops within the neighborhood food system: contributing to healthy food being "risky food," supporting unhealthy food stores, and severing social ties important for learning about healthy food. Findings shed light on a new framework for thinking about barriers related to healthy food access and pointed to potential new avenues for intervention, such as reducing neighborhood crime.

SUBMITTER: Mui Y

PROVIDER: S-EPMC6516673 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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A community-based system dynamics approach suggests solutions for improving healthy food access in a low-income urban environment.

Mui Yeeli Y Ballard Ellis E Lopatin Eli E Thornton Rachel L J RLJ Pollack Porter Keshia M KM Gittelsohn Joel J

PloS one 20190514 5

Little is known about the mechanisms through which neighborhood-level factors (e.g., social support, economic opportunity) relate to suboptimal availability of healthy foods in low-income urban communities. We engaged a diverse group of chain and local food outlet owners, residents, neighborhood organizations, and city agencies based in Baltimore, MD. Eighteen participants completed a series of exercises based on a set of pre-defined scripts through an interactive, iterative group model building ...[more]

PMID: 31086409

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Project description: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.

Project description:BackgroundAffordability of healthy food is a key determinant of the diet-related health of First Nations Peoples. This systematic scoping review was commissioned by the Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council (NPYWC) in Central Australia to identify interventions to improve economic access to healthy food in First Nations communities in selected high-income, colonised countries.MethodsEight databases and 22 websites were searched to identify studies of interventions and policies to improve economic access to healthy food in First Nations communities in Australia, Canada, the United States or New Zealand from 1996 to May 2022. Data from full text of articles meeting inclusion criteria were extracted to a spreadsheet. Results were collated by descriptive synthesis. Findings were examined with members of the NPYWC Anangu research team at a co-design workshop.ResultsThirty-five publications met criteria for inclusion, mostly set in Australia (37%) or the US (31%). Interventions (n = 21) were broadly categorised as price discounts on healthy food sold in communities (n = 7); direct subsidies to retail stores, suppliers and producers (n = 2); free healthy food and/or food vouchers provided to community members (n = 7); increased financial support to community members (n = 1); and other government strategies (n = 4). Promising initiatives were: providing a box of food and vouchers for fresh produce; prescriptions for fresh produce; provision/promotion of subsidised healthy meals and snacks in community stores; direct funds transfer for food for children; offering discounted healthy foods from a mobile van; and programs increasing access to traditional foods. Providing subsidies directly to retail stores, suppliers and producers was least effective. Identified enablers of effective programs included community co-design and empowerment; optimal promotion of the program; and targeting a wide range of healthy foods, particularly traditional foods where possible. Common barriers in the least successful programs included inadequate study duration; inadequate subsidies; lack of supporting resources and infrastructure for cooking, food preparation and storage; and imposition of the program on communities.ConclusionsThe review identified 21 initiatives aimed at increasing affordability of healthy foods in First Nations communities, of which six were deemed promising. Five reflected the voices and experiences of members of the NPYWC Anangu research team and will be considered by communities for trial in Central Australia. Findings also highlight potential approaches to improve economic access to healthy foods in First Nations communities in other high-income colonised countries.Trial registrationPROSPERO CRD42022328326.

Project description:Background Animal source foods, especially fish is the most commonly consumed and an important source of macro and micronutrients in the diet of the urban low-income residents. The COVID-19 pandemic has disrupted the food environment in Bangladesh but little is known about how food access and food prices (affordability) have affected the purchase and consumption of fish. The objective of the study was to understand the impact of the first wave of the COVID-19 pandemic on urban food environment with a specific focus on fish consumption. Methods A cross-sectional survey was conducted among 586 homogeneous adults (288 females and 298 males) from separate households from five informal settlements in Dhaka city, Bangladesh during October-November 2020. Data were collected on: (1) food access and affordably; and (2) food purchase and fish consumption. The associations between food access, price, food purchase, and fish consumption were evaluated using path analysis. Results The majority of respondents reported that food access was more difficult, food prices increased, and food purchase decreased during the COVID-19 pandemic compared to pre-COVID (84–89% of respondents). Fish and meat were more difficult to access, more expensive and purchased less compared to other foods (74–91% of respondents). Compared to pre-COVID period, households consumed less fish during the COVID-19 pandemic, and reported compromised the variety and quality of fish. In the path analysis, food access was associated with food purchase (b = 0.33, p < 0.001). Food purchase was associated with quantity, variety, and quality of fish consumed. Food price was inversely associated with the quality of fish consumed (b = −0.27, p < 0.001). Conclusions The COVID-19 pandemic negatively affected the food environment, particularly food access, price (affordability), purchase, and consumption, especially of fish. Limited food access negatively affected the quantity, variety and quality of fish consumed. An increase in food prices directly affected the quality of fish consumed. Policy actions are essential to ensure equal access to nutritious foods, such as fish. These policies need to focus on diversity and quality along with preventing increases in food prices during emergencies to mitigate future threats to the nutrition and health of the urban low-income residents.

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A community-based system dynamics approach suggests solutions for improving healthy food access in a low-income urban environment.

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A community-based system dynamics approach suggests solutions for improving healthy food access in a low-income urban environment.

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