Healthy food environments for healthy food choices in childhood and adolescence: overcoming the challenges to implementing effective obesity prevention initiatives in Brazil

Background

This project aims to support the adoption and implementation of evidence-based initiatives that promote healthier food choices among vulnerable adolescents, within food retail environments at the municipality-level in Brazil, and to measure the impact of the initiatives implemented. The impact of the initiatives implemented will be determined by assessing the frequency of purchase of products considered ultra-processed, and the frequency of purchase of products considered minimally processed or unprocessed (at adolescent level); and by the healthiness of the food retail environment determined using the Consumer Food Environment Healthiness Score (at retail venue level).

Aims

Specific project aims, guided by an implementation science framework, are:

• To identify actions, stakeholders and institutions involved in the implementation of food retail initiatives of PROTEJA, across study municipalities in São Paulo State (Aim 1, Exploration phase);

• To identify the opportunities and challenges at the systemic, organizational and individual level that might support or hinder the implementation and uptake of the food retail initiatives (Aim 2, Preparation phase);

• To implement, monitor and evaluate the food retail initiatives of PROTEJA in study municipalities (Aim 3, Implementation phase);

• To review actions and improve the scalability of PROTEJA’s food retail initiatives based on impact of the implementation (Aim 4, Sustainment phase).

Project plan

The project will be implemented in 4 phases, in 7 study municipalities, using a mixed-methods approach.

The Exploration Phase will identify the study municipalities, stakeholders and institutions that would be involved in the implementation of food retail initiatives, across study municipalities, using mainly qualitative methods.

The Preparation Phase will focus on finalizing the food retail initiatives and their implementation plans using a co-creation approach with study stakeholders. It will also build support for the food retail initiatives among adolescents. Baseline data on study outcomes will be collected from adolescents and by mapping the retail venues, at all intervention and control sites using quantitative tools.

In the Implementation Phase, intervention plans will be pilot tested, and the food retail initiatives will be implemented for 6 months in the intervention sites, and monitored during this time. Data on process indicators at the retail venue level, the retail management level and the adolescent level, will also be collected. At the end of the implementation period, data from adolescents and retail venues will be collected again, from both the intervention and control sites. A difference-in-differences approach will be used to estimate the impact of the initiatives implemented.

The final Sustainment Phase of the project will review actions and improve the scalability of the food retail initiatives based on impact of their implementation.

This implementation research project therefore will use evidence-based strategies, developed and implemented in close collaboration with stakeholders, to target unhealthy purchase patterns of adolescents, while ensuring sustained stakeholder engagement and equitable partnerships.

Principal investigators

Team members

Funding organisations

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