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      Reducing Retail Merchandising of Discretionary Food and Beverages in Remote Indigenous Community Stores: Protocol for a Randomized Controlled Trial

      , BSc, Grad Dip Nutr & Diet, MPH, PhD 1 , 2 , , , BSc, Grad Dip Nutr & Diet, MPH, PhD 2 , 3 , , M Nutr Diet, PhD 2 , , PhD 4 , 2 , , BApSci(Human Movement), BSci(Hons), BEd, MEpi, PhD 2 , 5 , , PhD 6 , , BND 7 , , PhD 8 , , PhD 9 , 10
      (Reviewer), (Reviewer)
      JMIR Research Protocols
      JMIR Publications
      randomized controlled trial, indigenous population, food supply, diet

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          Discretionary food and beverages (products high in saturated fat, added sugars, and salt) are detrimental to a healthy diet. Nevertheless, they provide 42% of total energy and account for 53% of food and beverage expenditure for remote living Aboriginal and Torres Strait Islander Australians, contributing to the excessive burden of chronic diseases experienced by this population group.


          The aim of this study is to test an intervention to reduce sales of discretionary products, in collaboration with the Arnhem Land Progress Aboriginal Corporation (ALPA), which operates 25 stores in very remote Australia, by reducing their merchandising and substituting with core products in remote Australian communities.


          We will use a community-level randomized controlled pragmatic trial design. Stores randomized to the intervention group will be supported by ALPA to reduce merchandising of 4 food categories (sugar, sugar-sweetened beverages, sweet biscuits, and confectionery) that together provide 64% of energy from discretionary foods and 87% of total free sugars in very remote community stores. The remaining stores (50% of total) will serve as controls and conduct business as usual. Electronic store sales data will be collected at baseline, 12-weeks intervention, and 24-weeks postintervention to objectively assess the primary outcome of percent change in purchases of free sugars (g/megajoule) and secondary business- and diet-related outcomes. Critical to ensuring translation to improved store policies and healthier diets in remote Indigenous Australia, we will conduct (1) an in-depth implementation evaluation to assess fidelity, (2) a customer intercept survey to investigate the relationship between customer characteristics and discretionary food purchasing, and (3) a qualitative study to identify policy supports for scale-up of health-enabling policy action in stores.


          As of August 2018, 20 stores consented to participate and were randomized to receive the intervention or continue usual business. The 12-week strategy ended in December 2018. The 24-week postintervention follow-up will occur in May 2019. Trial results are expected for 2019.


          Novel pragmatic research approaches are needed to inform policy for healthy retail food environments. This research will greatly advance our understanding of how the retail food environment can be used to improve population-level diet in the remote Australian Aboriginal and Torres Strait Islander context and retail settings globally.

          Trial Registration

          Australian New Zealand Clinical Trials Registry ACTRN12618001588280; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375933 (Archived by WebCite at http://www.webcitation.org/76dbQEmwN)

          International Registered Report Identifier (IRRID)


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          Most cited references21

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          Nudging consumers towards healthier choices: a systematic review of positional influences on food choice.

          Nudging or 'choice architecture' refers to strategic changes in the environment that are anticipated to alter people's behaviour in a predictable way, without forbidding any options or significantly changing their economic incentives. Nudging strategies may be used to promote healthy eating behaviour. However, to date, the scientific evidence has not been systematically reviewed to enable practitioners and policymakers to implement, or argue for the implementation of, specific measures to support nudging strategies. This systematic review investigated the effect of positional changes of food placement on food choice. In total, seven scientific databases were searched using relevant keywords to identify interventions that manipulated food position (proximity or order) to generate a change in food selection, sales or consumption, among normal-weight or overweight individuals across any age group. From 2576 identified articles, fifteen articles comprising eighteen studies met our inclusion criteria. This review has identified that manipulation of food product order or proximity can influence food choice. Such approaches offer promise in terms of impacting on consumer behaviour. However, there is a need for high-quality studies that quantify the magnitude of positional effects on food choice in conjunction with measuring the impact on food intake, particularly in the longer term. Future studies should use outcome measures such as change in grams of food consumed or energy intake to quantify the impact on dietary intake and potential impacts on nutrition-related health. Research is also needed to evaluate potential compensatory behaviours secondary to such interventions.
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            The Interplay Among Category Characteristics, Customer Characteristics, and Customer Activities on In-Store Decision Making

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              Supermarket and Grocery Store–Based Interventions to Promote Healthful Food Choices and Eating Practices: A Systematic Review

              Introduction Increasingly high rates of obesity have heightened interest among researchers and practitioners in identifying evidence-based interventions to increase access to healthful foods and beverages. Because most food purchasing decisions are made in food stores, such settings are optimal for interventions aimed at influencing these decisions. The objective of this review was to synthesize the evidence on supermarket and grocery store interventions to promote healthful food choices. Methods We searched PubMed through July 2012 to identify original research articles evaluating supermarket and grocery store interventions that promoted healthful food choices. We categorized each intervention by type of intervention strategy and extracted and summarized data on each intervention. We developed a scoring system for evaluating each intervention and assigned points for study design, effectiveness, reach, and availability of evidence. We averaged points for each intervention category and compared the strength of the evidence for each category. Results We identified 58 articles and characterized 33 interventions. We found 7 strategies used alone or in combination. The most frequently used strategy was the combination of point-of-purchase and promotion and advertising (15 interventions); evidence for this category was scored as sufficient. On average, of 3 points possible, the intervention categories scored 2.6 for study design, 1.1 for effectiveness, 0.3 for reach, and 2 for availability of evidence. Three categories showed sufficient evidence; 4 showed insufficient evidence; none showed strong evidence. Conclusion More rigorous testing of interventions aimed at improving food and beverage choices in food stores, including their effect on diet and health outcomes, is needed.

                Author and article information

                JMIR Res Protoc
                JMIR Res Protoc
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                March 2019
                29 March 2019
                : 8
                : 3
                : e12646
                [1 ] Department of Nutrition, Dietetics and Food Monash University Notting Hill Australia
                [2 ] Menzies School of Health Research Darwin Australia
                [3 ] School of Public Health The University of Queensland Herston Australia
                [4 ] Deakin University Geelong Australia
                [5 ] Alliance for Research in Exercise, Nutrition and Activity University of South Australia Adelaide Australia
                [6 ] School of Planning, Faculty of Environment University of Waterloo Waterloo, ON Canada
                [7 ] Arnhem Land Progress Aboriginal Corporation Darwin Australia
                [8 ] Department of Marketing Monash University Caulfield Australia
                [9 ] Dalhousie University Halifax, NS Canada
                [10 ] University of Toronto Toronto, ON Canada
                Author notes
                Corresponding Author: Julie Brimblecombe julie.brimblecombe@ 123456monash.edu
                Author information
                ©Julie Brimblecombe, Megan Ferguson, Emma McMahon, Anna Peeters, Edward Miles, Thomas Wycherley, Leia M Minaker, Khia De Silva, Luke Greenacre, Catherine Mah. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 29.03.2019.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org.as well as this copyright and license information must be included.

                : 31 October 2018
                : 9 January 2019
                : 21 January 2019

                randomized controlled trial,indigenous population,food supply,diet


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