Purpose

1) Identify, using Photovoice, community perceptions of urban factors associated with dietary behaviors.

2) Generate community-driven policy recommendations to improve the food environment.

Methods

Madrid residents from two low-income neighborhoods engaged in collecting, analyzing, and disseminating their results in this Heart Healthy Hoods (HHH) Photovoice project. In a first phase, 24 residents engaged in a Photovoice project where they took photographs on their local food environment. These photographs served as prompts to elicit their health concerns and be­liefs regarding food environment determinants of dietary behaviors. In a second phase, residents translated their results into more concrete recommendations to improve their local food environment. Finally, we organized a nominal group session including participants, researchers, public health practitioners and local policymakers to discuss and prioritize the previouosly proposed policy recommendations.

Results

Participants took 163 photographs and selected 31 as the ones best reflecting their local food environment. They identified 30 categories, which emerged from

these photographs and their corresponding narratives. Out of these, they generated a set of 12 policy recommendations related to their food environment. Some related to the political (e.g., regulation of street vending) and the economic environment (e.g., the cost of gluten-free foods). Regarding the physical environment, they suggested increasing the availability of organic foods in the neighborhood while restricting the availability of unhealthy products within vending machines in their worksites. In relation to the sociocultural environment, participants discussed the social meaning of grocery shopping, stating the need to support local small retailers and public markets.

Madrid photovoice team also offered trainings and helped conducting lived food environment projects in Baltimore and Bilbao. Lived food environment research conducted in Madrid, also included qualitative approaches in combination with geospatial and mapping analyses. 

Conclusions

Residents’ direct experiences in combination with other stakeholders’ views as researchers, public health professionals and local policymakers, contributed adapting nutrition related diseases prevention approaches to real-world local needs. Since nutrition related diseases as diabetes and obesity do affect disproportionally vulnerable populations, interventions that include community engagement and build local capacity are key to address urban health disparities.

Purpose

Kenya is experiencing rapid urbanisation leading to changes in food environments, which are associated with changing diets and related non-communicable diseases (NCDs).  The aim of our study was to identify which drivers in these social and physical food environments influence dietary behaviours among urban dwellers in Nairobi.

Methods

We used participatory photography (Photo voice), with men/women (n=48) aged ≥13 years living in a low income neighbourhood in Nairobi. Participants took photographs representing: places where they eat; things that make eating healthy difficult/easy; and a person/things that influence what they eat. Participants told the ‘stories’ of their photographs during in-depth interviews. NVivo was used for thematic analysis drawing on principles of socio-ecological theory.  

Results

The photographs and interviews with the participants revealed that poor hygiene, environmental sanitation, food contamination and adulteration were key concerns regarding foods sold in the neighbourhood. While quality and food preparation methods were major considerations in decisions on food purchase and consumption, money was a major barrier to accessing good quality healthy foods. In the home environment, urban farming supplemented household food needs. Within the social food environment, family and food vendors were key influencers of dietary behaviours. Preferences of children, spouses and parents were important drivers of food purchases/consumption. Food vendors’ hospitality and services including credit, packaging and subsidized prices also influenced dietary behaviours.

Conclusions

The findings highlight the continuing challenges of poor food hygiene and food safety alongside unhealthy diets associated with NCDs in urban areas. Enforceable food safety legislation is essential in lowering this risk. Urban farming could be promoted to address financial barriers that influence access to healthy diets.

Impact on policy/ actions

Our findings strengthened the evidence on urban farming as a source of affordable, healthier foods which has consequently been incorporated into the National Healthy Diets and Physical Activity Resource/Training Manual. The Nairobi County Government has committed to consider i) food hygiene and safety and ii) food vendors as a driver of dietary behaviours, in the ongoing development of the five year county nutrition action plan (CNAP).

Purpose

Within Australia, major inequities exist between rural, regional and metropolitan areas including chronic disease risk profiles, access to healthcare and to a fresh, healthy, affordable food supply. We explored living in the food environment of a 7000 square kilometre municipality in rural Australia. Four elements were investigated: whole of community food supply audit; comparative pricing study; a multi-factor evaluation of health promoting food outlets; and an exploration of the impact of life in a largely unhealthy rural food environment.

Methods

Multiple validated methods were used to understand the food environment and this lived experience. The Nutrition Environment Measurement (NEMS) tools for stores and restaurants were used to determine food availability. The Australian Standardised Affordability Pricing (ASAP) tool assessed food affordability and comparative pricing. Understanding local food environments utilised complexity and co-design principles informed by community-based systems dynamics. Community readiness to change interviews along with ethnographic research provided insight into the lived experience of local food environments and impacts on individuals and families.

Results

The availability of healthy food was very limited and the quality of fresh food was highly variable. Healthier choices, such as wholegrain versus white bread, were usually more expensive. Cross-cutting themes from these multiple methods emerged: community members voiced a demand for healthier foods, suppliers voiced reluctance to supply healthier foods due to concern with falling profit margins and product waste. Separately rural businesses supported each other, for example a supermarket did not supply meat to ensure a viable local butcher. With support of key leaders and co-design principles, catering policies were introduced across local government, health services and agreements with local food retailers to trial healthier options and reduce portion sizes. The creation of a health promoting café inside the health service contributed to a ‘therapeutic landscape’ that showcased healthy environments. This research further highlighted rural policy inequities.

Conclusion 

This lived experience of limited choice, higher prices, and poorer quality produce requires stronger policies to underpin change. The loyalty observed for locally owned food outlets provide great opportunities to secure healthier food supply to improve the health of rural communities.