Healthy and sustainable food-zones in regional neighborhoods

The majority of the Dutch population does not have a healthy and sustainable diet. Diet is influenced by a variety of factors, among which the food environment. A supportive food environment has been identified as crucial to meet a healthy and sustainable diet. While effective elements of food environment interventions or policies to improve diets are available, sustained implementation in the real life context is lacking. Previous studies have often used top-down approaches to develop interventions, rather than co-creating interventions that respond to the local context and needs. Also, the literature lacks insight into the implementation process of food environment interventions in real-life contexts. Yet, co-creation methods and implementation research are essential to ensure that interventions will be successfully taken up by the local context and sustained over time. The goal of this innovative research is to determine how healthy and sustainable food environments can be co-created, implemented and sustained in Dutch neighborhoods in the region Foodvalley. Four studies will be conducted, which are briefly described below: Study 1: A comprehensive method to identify food cues in the external neighbourhood food environment RQ: How can food cues of the external neighbourhood food environment be identified to reflect the residents’ (subjective) and scientists’ (objective) perspective? The aim of study 1 is to develop a method to evaluate the food cues present in the external neighbourhood food environment. In order to obtain a comprehensive overview of these food cues, the method developed will allow to combine information about the food cues as perceived by residents to influence food choices and the food cues identified by researchers. Hence, the external neighbourhood food environment will be evaluated subjectively and objectively. The similarities and differences between the subjective and objective results of the food environment evaluation will then be studied for a comprehensive understanding of the food cues present in the external neighbourhood food environment. For the subjective analysis, an app will be used for residents to take pictures of external food cues, which they will analyse together during one of the co-creation sessions, using the method of photovoice. For the objective analysis, the researchers will take pictures of external food cues and GIS-based methods will be used to analyse the characteristics of food outlets present in the external neighbourhood food environment. Study 2: Group Model Building to understand the factors impacting the neighbourhood food environment and to identify systemic actions for a positive transition RQ: What are current systemic facilitators of- and barriers for healthier and more sustainable neighbourhood food environments and through which systemic actions can a positive transition occur? (case study Veenendaal and Wageningen – baseline study) The aim of this study is to understand what factors influence the neighbourhood food environment and through which systemic actions these factors can be adapted to trigger the transition towards healthier and more sustainable food environments. This will be done using group model building techniques over the course of multiple co-creation sessions with end users, stakeholders, and researchers. This research question will be addressed in two case studies: a neighbourhood in the municipality of Veenendaal and one in the municipality of Wageningen. Study 3: Healthier and more sustainable neighbourhood food environments – how to implement and maintain actions for a positive transition RQ: What are barriers to- and facilitators of sustained implementation of the co-created interventions for healthier and more sustainable neighbourhood food environments? (case study Veenendaal and Wageningen - follow-up study) The aim of study 3 is to gain insight in facilitators and barriers to implement short and long-term actions for a transition towards healthier and more sustainable neighbourhood food environments. Depending on the intervention that has been developed during the co-creation sessions and the strategies to implement the intervention, the stakeholders will proceed to implementing change in the food environment. The CFIR and the framework by Leask and colleagues (2019) will be used to evaluate the implementation process. Data for the implementation research or process evaluation will be gathered at different times: The research team will facilitate monthly meetings with the stakeholders involved in the implementation of the intervention to encourage mutual support and learning. 12 months after the start of the implementation, an evaluation meeting will be organised with the local actors to evaluate the implementation and effects of the intervention. Strategies to improve the implementation will also be discussed. Study 4: Realising a healthy and sustainable food environment with local government and private stakeholders – lessons learned from a high-traffic public space RQ: What factors influence the realisation of ambitions for a healthy and sustainable food environment when local government and private stakeholders collaborate? – lessons learned from a high-traffic public space The aim of study 4 is to explore the determinants for the creation of a healthy and sustainable food environment when local government and other actors of the food system collaborate. This will be done using the development of the new Ede-Wageningen train station as a case study. The collaborative governance approach will be used to study the collaboration processes between local government and private actors of the food system and how this steers actions towards the creation of healthy and sustainable food environments. Beyond the collaborative processes, I will assess how stakeholder/contextual factors shape the process and actions implemented (e.g. stakeholders ambition, vision on successes, goal setting etc), and in turn how this is interlinked with collaborative processes. The project is part of the “Regio Deal Foodvalley”, track 2: "Nutrition and Health”, work package 2: the food environment.