Social institutions of local markets to drive dietary changes in at-risk communities

市场是社区卫生资产，商贩在这里出售各种廉价的新鲜农产品。少数民族和经济上处于不利地位的群体经常从当地市场购买食品，这些市场提供价格合理且文化上熟悉的食品。通过与当地市场合作，以新颖和独特的方式促进公共卫生的潜力尚未开发。目的：探索当地市场在面临营养相关疾病风险的社区中促进可持续健康饮食的潜力，特别强调探索如何最好地增加水果和蔬菜的消费，减少糖、盐和脂肪的消费。研究方法：开发方法将是我学习成果的一部分，并将在理论上指导（SDH和基于资产的预防方法）1,2，并在方法上由MRC复杂干预指南3.1。对以市场为基础的营养相关公共卫生干预措施的文献回顾将完善研究问题。将确定社区伙伴关系的范例做法，因为这些做法对于告知如何最好地建立和评价社区伙伴关系至关重要。2. 将进行一项测绘工作，以确定贫困社区（按多重贫困指数的四分位数和五分位数定义）附近的当地市场。我将探索2个不同人口组合的市场（如高和低种族多样性）进行深入的实地调查。3. 将在每个市场举办概念绘图讲习班，以制定实施的概念（逻辑）模型。将通过有目的的抽样招募一个利益相关者小组，参加半结构化访谈、概念绘图工作，并在整个干预发展过程中提供建议。多维尺度和层次聚类分析将用于可视化地总结策略之间的关系。集群图将说明如何根据重要性和可变性对集群组中的类别进行评级。Go区域图将显示哪些概念和想法是最重要和可行的，由利益相关者评价。4. 干预发展和评估将使用概念图的结果。我会与九龙科学馆合作开发数码资料。将在10周的时间内与2个贸易商（例如水果和蔬菜贸易商，理发师）进行小规模的交付测试。定性访谈和数字问卷将提供有关干预有效性的深入信息。过程和结果措施将使用RE-AIM框架（覆盖面、有效性、采用、实施和维护）。评估合作伙伴对可持续性的潜在支持将是重要的。我将探索使用成本效益分析和可持续性工具4。章节大纲：第一章-引言；第2章-市场与公共卫生干预的文献综述；以及社区伙伴关系的范例实践；第3章-方法-干预发展；第4章-社区和市场地图-匮乏和多样性；第5章-社区参与和概念绘图-促进健康饮食的概念模型；第6章-在两种市场环境中推广的数字化营养干预的小规模评估；第七章：讨论，包括成本和收益。第5-7章将提供3篇同行评议论文的基础。Y1公共卫生硕士（包括一篇关于社区伙伴关系和基于市场的公共卫生干预的论文）；Y2审查和建立伙伴关系；Y3实证工作-干预发展；和报告;Y4完成论文，反馈给社区，提交3篇论文。

Markets are community health assets where traders sell a variety of cheap, fresh produce. Ethnic minorities and economically disadvantaged groups often purchase food from local markets offering affordable and culturally familiar foods. There is untapped potential to promote public health in a novel and unique way by working with local markets. The aim: To explore the potential for local markets to promote sustainable healthy eating among communities at risk of nutrition related disease with a particular emphasis on exploring how best to increase the consumption of fruits and vegetables and reduce the consumption of sugar, salt and fats. Research Methods: Developing the method will be part of my learning outcomes and will be guided theoretically (SDH and asset based approaches to prevention)1,2 and methodologically by the MRC Complex Intervention guidance3.1. A review of the literature on market based nutrition related public heath interventions will refine the research questions. Exemplar practices for community partnerships will be identified as these will be vital in informing how best to establish and evaluate community partnerships. 2. A mapping exercise will be conducted to identify local markets within proximity of deprived neighbourhoods (as defined by quintiles 4 and 5 of the Index of Multiple Deprivation). I will explore 2 markets with different population mix (e.g. high and low ethnic diversity) for in depth fieldwork. 3. Concept mapping workshops will be conducted in each market to develop a conceptual (logic) model of implementation. A stakeholder panel will be recruited by purposive sampling to take part in semi-structured interviews, the concept mapping exercise and to advise throughout on the process of intervention development. Multidimensional scaling and hierarchical cluster analysis will then be used to visually summarise the relationships among the strategies. Cluster maps will illustrate how categories within cluster groups were rated on importance and changeability. Go zone graphs will show which concepts and ideas were most important and feasible, as rated by the stakeholders. 4. Intervention development & evaluation will use the findings from the concept mapping. I will collaborate with KCL Science Gallery to develop the digitalised materials. Small scale testing of delivery will be explored with 2 traders (e.g. fruit and vegetable trader, barber) over a 10-week period. Qualitative interviews and digital questionnaires will provide in-depth information on the effectiveness of the intervention.5. Process and outcome measures will use the RE-AIM framework (reach, effectiveness, adoption, implementation and maintenance). It will be important to evaluate the potential support of partners for sustainability. I will explore using a cost benefit and analysis and a Sustainability Tool4. Chapter Outlines: Chapter 1 - Introduction; Chapter 2 - Literature Review on Markets and public health interventions; and on exemplar practices for community partnerships; Chapter 3 - Methods - intervention development; Chapter 4 - Mapping of communities and markets - deprivation and diversity; Chapter 5 -Community engagement and concept mapping - conceptual model for promoting healthy diets; Chapter 6 - Small scale evaluation of digitalised nutrition intervention promoted in 2 market settings; Chapter 7: Discussion including costs and benefits. Chapters 5-7 will provide the basis for 3 peer reviewed papers. Timeline: Y1 Masters in Public Health (including a dissertation on community partnerships and market based public heath interventions.); Y2 Reviews and setting up of partnerships; Y3 Empirical work - intervention development; and reporting; Y4 Completion of thesis, feedback to communities, and submission of 3 papers.