Julia Díez, Roberto Valiente, Ana María Olea, Carmen

Ramos, and Manuel Franco

Objective and perceived access

to healthy foods: a mixed

methods study using on field

measures, GIS and Photovoice

PhotoVoice is a project co-funded by

in collaboration with

http://hhhproject.eu

Objective and perceived access to

healthy foods: Background

• Low-income groups live in neighborhoods with less

available and affordable fresh fruits&vegetables

• Engaging residents may improve the understanding of

local food environments and help designing effective

interventions

• Mixed methods research may help to better

understand perceived barriers and facilitators to

healthy eating.

http://hhhproject.eu

Objective and perceived

access to healthy foods: Aim

To identify barriers and opportunities for

accessing healthy foods using mixed methods:

1. In-store assessments

2. GIS

3. Photovoice

http://hhhproject.eu

Objective and perceived access

to healthy foods: Methods

Study context

- Urban poor area, comprising one administrative

neighborhood (≈ 35000 pop.) in Madrid (Spain).

- 12 residents (31-72) participated in evaluating their

local food environment through Photovoice.

Los Rosales

(study area)

Madrid

municipality

Foreign-born 24.8%

Unemployment 18.7%

Low educational level 28.7%

Car ownership 36.1%

http://hhhproject.eu

Objective and perceived access

to healthy foods: Methods

1. In-store assessments

• We used an adapted version of the NEMS-s survey,

developed and validated by Glanz et al.

• NEMS-S survey examines the availability, quality and

cost of healthy food options versus less-healthier foods

• Outcome Healthy Food Availability Index (from -7 to

49)

• Field audits were conducted within a random sample of

a 50% of each food store type

• In-store audits lasted a mean of 7.13 minutes (SD: 4.03,

range: 2-17 min.)

http://hhhproject.eu

Objective and perceived access

to healthy foods: Methods

2. GIS

• We obtained the most up-to-date data on the retail food

environment from Madrid City Council´s database

• We calculated “Healthy Food Availability Index” average

scores per store type (high, medium, and low) with

kernel density analysis

• We calculated potential residents´ walking access to

food stores with a high HFAI score by means of a street

network analysis

http://hhhproject.eu

Objective and perceived access

to healthy foods: Methods

3. Photovoice

• 12 residents met in small group

discussion over one and a half

month

• They took photographs of positive

and negative aspects of their local

food environment

• Residents critically discussed and

identified themes that emerged

from their photographs and

narratives

http://hhhproject.eu

Objective and perceived access

to healthy foods: Analysis

Residents identified 17 relevant physical

and social features

Healthy food availability index (HFAI)

score (-7 to 49): availability, quality and

cost

Walking access with a street network

analysis.

http://hhhproject.eu

Objective and perceived access

to healthy foods: Results

http://hhhproject.eu

Economic crisis and poverty

• 33% of the neighborhood food stores

were found permanently closed

• Participants highlighted lack of

economic opportunities and unequal

distribution of resources

Marketing

• Placement and promotions were not

objectively measured

• Participants noted a high exposure to

fast food at supermarkets

Objective and perceived access

to healthy foods: Barriers

http://hhhproject.eu

Objective and perceived access

to healthy foods: Opportunities

Small neighborhood stores and public markets

• 59.4% of food stores were traditional stores (mean

HFAI 10.84); 34.4% corner stores (mean HFAI 33.6);

and 6.2% supermarkets (mean HFAI ranged 36.5)

• Residents highlighted traditional food stores as offering

healthier, better quality of products and better customer

service

Walkability

• 78.7% of residents can access high healthy food stores

within 5 minutes, and 98.7% within less than 10 min.

• Grocery shopping was mentioned as an opportunity to

be physically active for elderly residents

http://hhhproject.eu

Theme 3: Food retailers

http://hhhproject.eu

Objective and perceived access to healthy foods: Conclusions

By combining quantitative and qualitative methods,

we developed 7 concrete community-generated and

place-based interventions promoting a healthier

local food environment.