Multilevel Communications and access strategies to improve the food environment

描述（由申请人提供）：迫切需要创新和文化上适当的多层次卫生沟通干预措施来解决高风险人群（如低收入城市非洲裔美国人）的慢性病流行问题。然而，绝大多数传播战略侧重于教育个人消费者选择健康食品，而在贫穷的城市环境中，可负担得起的健康食品选择的可得性较低，大大限制了这些信息的影响。我们将与3家批发商和24家小型零售食品商店合作，在马里兰州巴尔的摩市开发和测试新策略，包括：1)针对批发商、零售商和低收入AA消费者的多层次健康沟通，旨在提高他们储存和/或购买健康食品的意愿；2)针对批发商和零售商的定价策略（基于业绩的津贴），以降低价格增加健康食品的库存；3)结合卫生传播和定价策略。将根据形成性研究和利益攸关方的投入，调整干预策略，以满足目标人群的需求。我们提出的工作是基于这方面的重要实地经验，包括开发评估工具来评估关键食品的库存和定价变化（在商店层面），以及社会心理因素、饮食摄入和食品购买行为（在消费者层面）。我们的研究有以下目的：1)与巴尔的摩食品环境的多个层面的代表（即当地批发商和零售食品店主）进行形成性研究，以选择关键食品进行促销，确定每个层面的适当沟通策略（如信息，渠道，材料），并选择最合适的定价方法（即基于绩效的津贴结构和规定）。2)以3家批发商、24家食品店（6家控制、6家卫生沟通、6家定价、6家合并）进行多层次方案试点，并通过详细的流程评估评估方案执行情况。3)评估试点计划对以下方面的影响：a)批发和零售层面促销食品的库存、定价、营销和销量；b)消费者层面的食品购买行为和相关心理社会变量（即自我效能感、意图、感知成本）（最终样本n=12名消费者/商店，总计288名）。拟议的研究通过寻求制定有效的，多层次的沟通策略来改善饮食和降低与饮食相关的慢性疾病的风险，直接解决了PA的目标。我们预计这一设计将展示多管齐下、多层次的健康沟通方法对肥胖和慢性疾病预防的价值，并将导致大规模的试验和知情政策，旨在改善低收入城市环境中的食物供应和负担能力。

DESCRIPTION (provided by applicant): Innovative and culturally appropriate multilevel health communications interventions are desperately needed to address the chronic disease epidemic in high-risk populations, such as low-income urban African Americans (AA). 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. We will work with 3 wholesalers and 24 small retail food stores to develop and test novel strategies in Baltimore, Maryland, including: 1) multilevel health communications alone directed at wholesalers, retailers and low-income AA consumers intended to enhance willingness to stock and/or purchase healthy foods; 2) pricing strategies (performance based allowances) directed at wholesalers and retailers to increase their stocking of healthy foods at reduced prices; and 3) combined health communications and pricing strategies. Intervention strategies will be tailored to meet the needs of the target populations based on formative research and stakeholder input. Our proposed work is based on significant field experience in this setting, including the development of evaluation tools to assess change in stocking and pricing of key foods (at the store level), and psychosocial factors, dietary intake, and food purchasing behaviors (at the consumer level). Our study has the following aims: 1) Conduct formative research with representatives of multiple levels of the Baltimore food environment (i.e., local wholesalers and retail food store owners) 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 pricing approach (i.e., performance based allowance structure and stipulations). 2) Pilot the multi-level program with three wholesalers and 24 food stores (6 control, 6 health communications only, 6 pricing only, 6 combined), and assess program implementation through detailed process evaluation. 3) Assess impact of the pilot program 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 (i.e., self-efficacy, intentions, perceived cost) at the consumer level (final sample n=12 consumers/store, 288 total). The proposed research directly addresses the objectives of the PA by seeking to develop effective, multilevel communication strategies to improve diet and reduce risk for diet-related chronic diseases. We anticipate this design will demonstrate the value of a multipronged and multilevel health communications approach to obesity and chronic disease prevention, and will lead to a large-scale trial and informed policies designed to improve food availability and affordability in low-income urban settings.