The effectiveness and value-for-money of an intervention supporting healthy food changes in local government food retail outlets

Multicomponent local government (LG) capacity building intervention (the Intervention): The Intervention is a 3-year multicomponent intervention to improve the healthiness of the food environment in Victorian LG owned/ managed facilities. The Intervention will include a two-year implementation period followed by a one-year maintenance period. The Intervention will involve 3 to 9 LG managed/owned facilities per LG. The RCT will compare outcomes for non-seasonal sport and recreation facilities (the most common type of council-owned facility that includes a food outlet) only. LGs may also engage other LG owned and/or operated food outlets in facilities such as seasonal sporting facilities, libraries, arts centres and community centres in the Intervention but these won’t be part of the RCT evaluation. The reason for engaging other non RCT sites is to expand LG influence in these novel settings, and to generate learnings for future research in those settings. The Intervention will involve local government project officers drafting healthy food retail policy and supporting their progress through council. Project officers will also refine and implement changes in facilities in partnership with facility management towards the goal of achieving the Victorian Government Healthy Choices guidelines (‘The Guidelines’). The Guidelines were chosen as the benchmark as many Victorian LGs already use them, and they align well with interstate standards. The Guidelines provide targets relating to the ‘4Ps’ of marketing to discourage customer purchases of less healthy ‘red’ food and drinks and encourage purchases of healthier ‘green’ and ‘amber’ options: Price (e.g. removing meal deals that include ‘red’ options), Promotion (e.g. appealing signage advertising healthier options), Placement (e.g. placing ‘green’ options at eye-level), and Products available (e.g. reducing the range of ‘red’ options and increasing the range of tasty ‘green’ alternatives). At the facility level, a LG project officer will work with staff and management to progress towards implementing the Guidelines. The project officer will offer support such as changing recipes, sourcing healthier suppliers, training facility staff, developing customer communications material, and conducting in-store audits and sales data collection. Decisions about which aspects of the Guidelines to address, and in what order, will be decided at the LG- and facility-level by the project officer and facility manager, with advice from Nutrition Australia’s Healthy Eating Advisory Service (HEAS) on feasibility, and maintaining customer satisfaction and outlet profitability. These decisions will occur at baseline outlet assessment, and ongoing throughout the project based on Monitoring and Feedback (see below). Planned in-store changes (Intervention ‘targets’) for each facility will be based on a number of factors including sales data in year preceding the Intervention (e.g., to identify high selling ‘red’ items that could be replaced with a ‘green’ or ‘amber’ alternative); baseline in-store food environment assessments using the Store Scout app, including assessment of current progress towards the Guidelines ‘red’, ‘amber’, ‘green’ availability targets; facility resourcing and infrastructure; customer base preferences; and supplier arrangements. A modified version of the Store Scout app (Jaenke et al., 2020) will be used to assess the current use of the 4Ps of marketing to promote ‘red’, ‘amber’, and ‘green’ items in each outlet. It provides a score on the healthiness of the food environment from 0 (least healthy) to 100 (healthiest). The key elements of the support model which will enable LG policy and facility-level changes include: (1) Human resource support: a LG project officer for three years to assist with implementation, as well as (2) Training; (3) Tools; (4) Technical Assistance; (5) Peer networking; (6) and Monitoring and Feedback. The key actions included in each element are detailed below, but specific elements of each component of the support model will be refined in a series of workshops with recruited LGs and HEAS prior to the beginning of the RCT. Human Resourcing: At the LG-level, the project officer will co-ordinate and draft policies to embed long-term changes, e.g., updating facility lease agreements to provide food consistent with the Guidelines. In the first two years, salary support will assume a 4 hours/ week base (time for administration, evaluation, policy development, and training and other capacity-building exercises) + 4 hours/ week per facility (total funding 3 to 5 days per week depending on number of engaged facilities). In the third year of the RCT (maintenance period), human resourcing support will be halved to 2 hours/ week per facility (total 2 to 3 days per week). During the maintenance year, training and other intervention components will continue at the same frequency and intensity as described below. Training: HEAS will provide training for project officers and other relevant LG staff, with assistance from researchers and other partners. Training will include data collection, council cross-sectoral planning, stakeholder engagement, policy development, health promotion and business skills and in-store marketing. Training will include a variety of modes including online and in-person seminars, short videos, worksheets, and group discussions. Training will be delivered at staggered intervals, e.g., 4 hours every 6 months during the three-year Intervention. Number of training sessions attended by each participant will be recorded. Tools and technical assistance: HEAS will provide LGs with technical assistance including their FoodChecker classification tool (used to classify food and drinks according to the Guidelines) and six-monthly telephone check-ins on progress. LGs will also be provided with access to additional implementation tools, example policies, marketing materials, and additional evaluation tools that may be of interest to LGs or facilities such as customer survey templates and case studies. We will survey project officers in the Intervention group at the end of the RCT (end of third maintenance year), to collect data on which tools were used and how useful participants found them. Peer networking: HEAS will facilitate face-to-face and online project officer communities of practice between study project officers meeting and sharing ideas, at least every 6 months. The face-to-face meetings are likely to be linked to the training sessions, i.e. approximately 4 hours every 6 months. Face-to-face will be the preferred method of networking but may need to be online subject to COVID-19 travel restrictions or participants’ convenience. The online peer support (e.g. via Facebook group) will be approximately 30mins per week. Number of peer networking sessions attended by each participant will be recorded. Monitoring and feedback (and fidelity assessment): Six-monthly feedback on sales and in-store audit data (collected by LG project officers with assistance from the research team) will be provided to Intervention LGs to demonstrate how they are tracking towards intervention targets, and change in display and sales of ‘red’, ‘amber’ and ‘green’ items to indicate if the intervention is working to change consumer behaviour, as well as financial outcomes to indicate the impact on the business of changes. This will allow sites to make iterative changes to improve Intervention effectiveness and reduce unintended consequences (e.g., profit loss). The reconsideration of facility targets and tailored Interventions is expected to occur at six-monthly timepoints. The Intervention sample size will involve a target of 6 local governments (20 local government facilities). Stakeholder interviews: Semi-structured stakeholder interviews will be conducted by the research project manager and/or PhD student at the end of the 3-year RCT. Interviews will be up to 1 hour in length and will include the first 20 willing participants to comprise a purposive sample of Intervention local government retail outlet staff, local government project officers and managers, and other stakeholders. Interviews will ask stakeholders about perceived Intervention costs, benefits, acceptability, implementation infrastructure required for scale-up, and perceived ability of the Intervention to be sustained long-term. Interview questions and analysis will be guided by the Intervention Scalability Assessment Tool (Lee at al., 2020). References Jaenke R, Van Den Boogaard C, McMahon E, Brimblecombe J. Development and pilot of a tool to measure the healthiness of the in-store food environment. Public Health Nutr. 2021 Feb;24(2):243-52. Lee K, Milat A, Grunseit A, Conte K, Wolfenden L, Bauman A. The Intervention Scalability Assessment Tool: a pilot study assessing five interventions for scalability. Public Health Res Pract. 2020;30(2):e3022011.