Multilevel Communications and access strategies to improve the food environment

描述(由申请人提供)：迫切需要创新的和文化上适当的多层次卫生交流干预措施，以解决高风险人群中的慢性病流行问题，例如低收入的城市非裔美国人(AA)。然而，绝大多数传播战略侧重于教育个人消费者关于健康食品的选择，而在贫穷的城市环境中，负担得起的健康食品选择的可获得性较低，大大限制了这些信息的影响。我们将与3家批发商和24家小型零售食品店合作，在马里兰州巴尔的摩开发和测试新策略，包括：1)仅针对批发商、零售商和低收入AA消费者的多层次健康沟通，旨在提高库存和/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(基于绩效的津贴)，以降低价格增加他们的健康食品库存；以及3)结合健康沟通和定价策略。干预战略将根据形成性研究和利益攸关方的投入量身定做，以满足目标人群的需求。我们建议的工作是基于在这一背景下的大量实地经验，包括开发评估工具，以评估关键食品(在商店层面)的库存和定价变化，以及心理社会因素、饮食摄入量和食品购买行为(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级别的代表(即当地批发商和零售食品店老板)进行形成性研究，以选择关键的食品进行促销，确定每个级别的适当沟通策略(例如，消息、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)与3家批发商和24家食品店(6家控制、6家健康沟通、6家定价、6家联合)试行多层次计划，并通过详细的流程评估来评估计划的实施情况。3)评估试点计划对a)批发和零售层面的促销食品的库存、定价、营销和销售量的影响，以及b)消费者层面的食品购买行为和相关的心理社会变量(即自我效能、意图、感知成本)(最终样本n=12个消费者/商店，总计288个)。拟议的研究直接解决了PA的目标，试图制定有效的、多层次的沟通战略，以改善饮食并降低与饮食相关的慢性病的风险。我们预计，这一设计将展示多管齐下和多层次的健康沟通方法在肥胖和慢性病预防方面的价值，并将导致旨在改善低收入城市环境中食品供应和负担能力的大规模试验和知情政策。 公共卫生相关性：拟议的研究将开发和试点创新的多层次沟通干预措施，以改善批发商、零售商和消费者层面的食品环境。我们的干预措施将结合传播战略和活动，以改善低收入城市环境中获得健康食品的机会(即价格和可获得性)。这些干预措施旨在最终降低城市非裔美国人的肥胖率，这将极大地降低全国肥胖相关慢性病的发病率和医疗成本。

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. PUBLIC HEALTH RELEVANCE: The proposed study will develop and pilot an innovative multilevel communications intervention to improve the food environment at the wholesaler, retailer and consumer levels. Our interventions will combine both communications strategies and activities to improve access (i.e., prices and availability) to healthy foods in low- income urban settings. The interventions are aimed at ultimately reducing the prevalence of obesity among urban African Americans, which will greatly decrease rates of obesity-related chronic diseases and health care costs nationally.