Social institutions of local markets to drive dietary changes in at-risk communities

Markets are community health assets where traders sell a variety of cheap, fresh produce. Ethnic minorities and economically disadvantaged groups often purchase food from local markets offering affordable and culturally familiar foods. There is untapped potential to promote public health in a novel and unique way by working with local markets.
The aim: To explore the potential for local markets to promote sustainable healthy eating among communities at risk of nutrition related disease with a particular emphasis on exploring how best to increase the consumption of fruits and vegetables and reduce the consumption of sugar, salt and fats.
Research Methods: Developing the method will be part of my learning outcomes and will be guided theoretically (SDH and asset based approaches to prevention)1,2 and methodologically by the MRC Complex Intervention guidance3.
1. A review of the literature on market based nutrition related public heath interventions will refine the research questions. Exemplar practices for community partnerships will be identified as these will be vital in informing how best to establish and evaluate community partnerships.
2. A mapping exercise will be conducted to identify local markets within proximity of deprived neighbourhoods (as defined by quintiles 4 and 5 of the Index of Multiple Deprivation). I will explore 2 markets with different population mix (e.g. high and low ethnic diversity) for in depth fieldwork.
3. Concept mapping workshops will be conducted in each market to develop a conceptual (logic) model of implementation. A stakeholder panel will be recruited by purposive sampling to take part in semi-structured interviews, the concept mapping exercise and to advise throughout on the process of intervention development. Multidimensional scaling and hierarchical cluster analysis will then be used to visually summarise the relationships among the strategies. Cluster maps will illustrate how categories within cluster groups were rated on importance and changeability. Go zone graphs will show which concepts and ideas were most important and feasible, as rated by the stakeholders.
4. Intervention development & evaluation will use the findings from the concept mapping. I will collaborate with KCL Science Gallery to develop the digitalised materials. Small scale testing of delivery will be explored with 2 traders (e.g. fruit and vegetable trader, barber) over a 10-week period. Qualitative interviews and digital questionnaires will provide in-depth information on the effectiveness of the intervention.
5. Process and outcome measures will use the RE-AIM framework (reach, effectiveness, adoption, implementation and maintenance). It will be important to evaluate the potential support of partners for sustainability. I will explore using a cost benefit and analysis and a Sustainability Tool4.
Chapter Outlines: Chapter 1 - Introduction; Chapter 2 - Literature Review on Markets and public health interventions; and on exemplar practices for community partnerships; Chapter 3 - Methods - intervention development; Chapter 4 - Mapping of communities and markets - deprivation and diversity; Chapter 5 -Community engagement and concept mapping - conceptual model for promoting healthy diets; Chapter 6 - Small scale evaluation of digitalised nutrition intervention promoted in 2 market settings; Chapter 7: Discussion including costs and benefits. Chapters 5-7 will provide the basis for 3 peer reviewed papers. Timeline: Y1 Masters in Public Health (including a dissertation on community partnerships and market based public heath interventions.); Y2 Reviews and setting up of partnerships; Y3 Empirical work - intervention development; and reporting; Y4 Completion of thesis, feedback to communities, and submission of 3 papers.