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健康传播干预措施，以解决高风险人群中的慢性病流行，如低收入的城市非洲裔美国人（AA）。然而，绝大多数宣传战略的重点是教育个人消费者选择健康食品，而在贫穷的城市环境中，负担得起的健康食品选择较少，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，在马里兰州的巴尔的摩开发和测试新的战略，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宣传，旨在提高储存和/或购买健康食品的意愿;（2）定价策略（基于业绩的津贴）针对批发商和零售商，以降低价格增加健康食品的库存;（3）健康传播与定价策略相结合。将根据形成性研究和利益攸关方的投入，调整干预战略，以满足目标人群的需要。我们提出的工作是基于在这种情况下，包括评估工具的开发，以评估库存变化和定价的关键食品（在商店层面），和心理社会因素，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层次的代表进行形成性研究（即，本地批发商和零售食品店老板）为了选择用于促销的关键食品，确定适当的通信策略（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)在3家批发商和24家食品商店（6家控制、6家仅健康沟通、6家仅定价、6家合并）中试行多层次计划，并通过详细的流程评估评估计划执行情况。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、营销和销售量，以及B）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）在消费者层面（最终样本n=12消费者/商店，共288）。拟议的研究直接解决了PA的目标，寻求制定有效的，多层次的沟通策略，以改善饮食和降低与饮食相关的慢性疾病的风险。我们预计，这种设计将证明多管齐下和多层次的健康传播方法对肥胖和慢性病预防的价值，并将导致大规模的试验和明智的政策，旨在改善低收入城市环境中的食品供应和可负担性。

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.