Multilevel communications and access strategies to improve the food environment.
Innovative and culturally appropriate multilevel health communications interventions are desperately needed to address the chronic disease epidemic in high-risk populations. However, the vast majority of communications strategies have focused on educating individual consumers about healthy food choices, while in poor urban settings the lower availability of affordable healthy food choices greatly limits the impact of these messages.
The overarching goal of this study is to develop, implement, and evaluate a pilot multi-level communications and pricing intervention to improve access to and consumption of healthy foods in low-income areas of Baltimore City, Maryland.
The pilot study is a randomized controlled trial designed to evaluate the effectiveness of in-store health communications and pricing strategies on access, purchase, and consumption of healthier foods and associated consumer psychosocial variables. We will work with 24 small stores in low-income areas of East and West Baltimore City and 3 wholesalers that serve these stores. Communications only, pricing only, and combined strategies will begin with the food wholesaler and will be passed to the retailer and consumer, and will be tested and evaluated at all three levels.
- Conduct formative research with representatives of multiple levels of the Baltimore food environment (i.e., local wholesalers, retail food store owners, and consumers) in order to select key foods for promotion, determine appropriate communication strategies (e.g., messages, channels, materials) for each level, and select the most appropriate healthy food price reduction strategies.
- Pilot the multi-level program with 3 wholesalers and 24 food stores (6 control, 6 health communications only, 6 pricing only, 6 combined), and assess program implementation through detailed process evaluation.
- Assess impact of multilevel health communications only, pricing only and combined strategies on a) the stocking, pricing, marketing, and sales volume of promoted foods at wholesale and retail levels, and b) food purchasing behaviors and associated psychosocial variables (self-efficacy, intentions) at the retail and consumer levels, and c) consumer dietary patterns and food source use, and household food security.