TitleEvaluation of a pilot healthy eating intervention in restaurants and food stores of a rural community: a randomized community trial.
Publication TypeJournal Article
Year of Publication2015
AuthorsMartinez-Donate, AP, Riggall, AJosie, Meinen, AM, Malecki, K, Escaron, AL, Hall, B, Menzies, A, Garske, G, F. Nieto, J, Nitzke, S
JournalBMC Public Health
Date Published02/2015
KeywordsAdult, Aged, Feasibility Studies, Feeding Behavior, Female, Food Industry, Food Labeling, Food Supply, Health Promotion, Humans, Male, Middle Aged, Midwestern United States, Pilot Projects, Residence Characteristics, Restaurants, Rural Population, Surveys and Questionnaires

BACKGROUND: Research suggests that the food environment influences individual eating practices. To date, little is known about effective interventions to improve the food environment of restaurants and food stores and promote healthy eating in rural communities. We tested "Waupaca Eating Smart " (WES), a pilot intervention to improve the food environment and promote healthy eating in restaurants and supermarkets of a rural community. WES focused on labeling, promoting, and increasing the availability of healthy foods.

METHODS: We conducted a randomized community trial, with two Midwestern U.S. communities randomly assigned to serve as intervention or control site. We collected process and outcome data using baseline and posttest owner and customer surveys and direct observation methods. The RE-AIM framework was used to guide the evaluation and organize the results.

RESULTS: Seven of nine restaurants and two of three food stores invited to participate in WES adopted the intervention. On a 0-4 scale, the average level of satisfaction with WES was 3.14 (SD=0.69) for restaurant managers and 3 (SD=0.0) for store managers. On average, 6.3 (SD=1.1) out of 10 possible intervention activities were implemented in restaurants and 9.0 (SD=0.0) out of 12 possible activities were implemented in food stores. One month after the end of the pilot implementation period, 5.4 (SD=1.6) and 7.5 (SD=0.7) activities were still in place at restaurants and food stores, respectively. The intervention reached 60% of customers in participating food outlets. Restaurant food environment scores improved from 13.4 to 24.1 (p < 0.01) in the intervention community and did not change significantly in the control community. Food environment scores decreased slightly in both communities. No or minimal changes in customer behaviors were observed after a 10-month implementation period.

CONCLUSION: The intervention achieved high levels of reach, adoption, implementation, and maintenance, suggesting the feasibility and acceptability of restaurant-and food store-based interventions in rural communities. Pilot outcome data indicated very modest levels of effectiveness, but additional research adequately powered to test the impact of this intervention on food environment scores and customer behaviors needs to be conducted in order to identify its potential to promote healthy eating in rural community settings.

Alternate JournalBMC Public Health
PubMed ID25885704
PubMed Central IDPMC4331304
Grant ListRC2 HL101468 / HL / NHLBI NIH HHS / United States
1 RC2 HL101468 / HL / NHLBI NIH HHS / United States
5UL 1RR025011 / RR / NCRR NIH HHS / United States