Development of a Formal Protocol to Map the Community Food Environment Using Direct Observation: a Case Study in Urban Guatemala

Abstract

BackgroundMeasures of the community nutrition environment are important to understanding the food environment, which affects individual diet.ObjectiveTo develop a formal protocol to improve the reliability of using direct observation to map the food environment in Guatemala.MethodsFour teams of two raters were asked to walk two thoroughfares in urban Quetzaltenango, Guatemala. Each team consisted of one rater from Guatemala and one non‐Guatemalan. All teams read the mapping protocol and explored the area prior to mapping. Data was collected in a step‐wise fashion. The first team collected data and revised the mapping protocol that was then utilized by the next team. The validity of direct observation in mapping a community food environment in Quetzaltenango was determined by comparing the inter‐team concordance on each subsequent use of the protocol; and compared to data previously collected without a protocol.ResultsThe inter‐team reliability improved with the use of a formal protocol and mixed‐ethnicity teams. On one street, the inter‐team reliability improved to 76% using the revised protocol from 67% with the original protocol; compared to 60% without a protocol. On the other street in which 40% of the food establishments were mobile vendors, the improvement in inter‐team reliability was modest.ConclusionsIn Guatemala, street‐mapping correspondence saturates at a certain point with or without considering the ambulatory aspects of carts and street vendors. A formal protocol and mixed teams that include a rater native to the country of interest improve the use of direct observation as a reliable low‐cost method to map the community food environment.