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Increasing the Sale of Healthy Foods: The Implementation and Sustainability of a Supermarket Intervention in Baltimore City

Sep 30, 2015

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Supermarket interventions have been offered as one way to improve healthy food purchasing and consumption. While several studies of this approach have assessed effectiveness, few have evaluated program process and implementation and the key components of an intervention’s success. Researchers from the Johns Hopkins Center for a Livable Future (CLF) and the Johns Hopkins Bloomberg School of Public Health recently sought to fill this gap, conducting a process evaluation of the Eat Right - Live Well! (ERLW) campaign, a multi-component intervention delivered in a large supermarket in an underserved community in Baltimore.

Their analyses focused on the fidelity, reach, and dose of the intervention; how barriers and facilitators affected the intervention; and whether the intervention was sustainable. The study findings are reported in a recent issue of Health Promotion Practice

According to the research team, the ERLW intervention was implemented with varied success. In-store and community process measures showed largely positive results. High fidelity was achieved for a number of indicators, including stocking and in-store advertising of promoted, healthy items, while the labeling of these items demonstrated moderate fidelity. Taste tests had moderate reach and low dose but were still effective in engaging customers. Community events were well attended, achieving both high reach and dose, with participants responding positively to messages.

In addition, the current study points to the central role that storeowners play in a program’s sustainability. While employee training did not show significant effects and storeowner support was not enough to guarantee full implementation, “exceptional support from the storeowner [did] lead to sustainability of [campaign] components.”

Together these results suggest that it is feasible for multi-component interventions to increase the availability and promotion of healthy foods in a large supermarket environment. Importantly, the findings also recognize ways to improve impact. According to Anne Palmer, co-author of the study and director of the Food Communities and Public Health Program at CLF, “These results point to tangible suggestions for improving the implementation, effectiveness, and sustainability of supermarket based interventions. In particular, intervention strategies should focus on commonly purchased items, and behavioral and environmental changes should be based on community input. Buy-in from store executives, managers and employees should also be cultivated to sustain intervention components.”

Ryan Lee, lead author of the study and a CLF-Lerner Fellow notes, "Few studies have been able to conduct such a comprehensive intervention in a supermarket of this size, so measuring implementation was important to assess feasibility and to guide future research."

“Process Evaluation of a Comprehensive Supermarket Intervention in a Low-Income Baltimore Community,” was written by.Ryan M. Lee, Jessica D. Rothstein, Jessica Gergen, Drew A. Zachary, Joyce C. Smith, Anne M. Palmer, Joel Gittelsohn, and Pamela J. Surkan.