Background: Food environments are rapidly changing in low- and middle-income countries (LMICs), leading to dietary shifts. Many gaps exist in the measurement of food environments in LMICs making it difficult to characterize the linkages between food environments and diets.
Objective: The objective of this study was to examine the feasibility of implementing USAID Advancing Nutrition's Market Food Environment Assessment (MFEA)-a suite of 7 non-resource intensive food environment assessments.
Methods: We implemented the MFEA package in 4 countries (Liberia, Honduras, Nigeria, and Timor-Leste) and assessed the feasibility of implementing the package by conducting a descriptive analysis, using both qualitative and quantitative data of enumerators' feedback collected through training evaluations, feedback forms, detailed notes from meetings, and final reports from in-country partners.
Results: Overall, we found it feasible to implement the MFEA, some assessments being easier to implement and more practical than others. Several key themes related to the MFEA implementation were identified across the countries, including: the potential for vendors to be hesitant to engage in assessments; the importance of ascertaining buy-in from local officials; the need to shift toward electronic, rather than paper-based, data collection; difficulties in selecting markets; the time constraints of conducting some of the assessments; and the need for better alignment between the instructions, data collection, and data analysis sheets.
Conclusions: The package of food environment assessments, with minimal additional refinement, can be used to characterize market food environments in LMIC settings to inform context-specific interventions.
Testing the feasibility of implementing a package of 7 assessments to measure factors influencing food access in low-resource settings.
Keywords: assessments; food environment; low- and middle-income countries; methods.
Why was the study done? We know that there is a relationship between the availability, affordability, and acceptability of the foods that populations have access to and their diets. In resource-poor settings, the foods that people have access to are rapidly changing, leading to shifts in diet and nutrition outcomes. To better understand the connection between the environments from which people access food and their diets, we need to be able to measure factors influencing food access in diverse settings. However, the ways we can measure factors influencing food access in low-income settings are often unclear. We completed this study to test the feasibility of implementing a package of 7 assessments that measured market access, food availability, food affordability, promotion of food, the desirability of fruits and vegetables, among others in 4 countries (Liberia, Honduras, Nigeria, and Timor-Leste) to understand if this package of assessments could be used by practitioners to inform their in-country activities related to improving food access and diets.What did the researchers do? We implemented the 7 assessments in different market settings in 4 countries. We then asked the in-country research team implementing the assessments to evaluate what worked, what didn't work, and what needed more clarity in terms of the implementation of the assessments.What did researchers find? We found that overall, the assessments were feasible to implement across the different settings but that some assessments were more labor intensive than others. The research teams implementing the assessments identified aspects of the assessments that were difficult to implement as well as those that were straightforward.What do the findings mean? The findings have provided insight into the feasibility of implementing the 7 assessments and indicated further changes that were needed to refine the assessments to make it easy for practitioners to use them to inform their own work.