Small Food Store Retailers’ Willingness to Implement Healthy Store Strategies in Rural North Carolina

Abstract

Access to supermarkets is lacking in many rural areas. Small food stores are often available, but typically lack healthy food items such as fresh produce. We assessed small food store retailer willingness to implement 12 healthy store strategies to increase the availability, display, and promotion of healthy foods and decrease the availability, display, and promotion of tobacco products. Interviews were conducted with 55 small food store retailers in three rural North Carolina counties concurrently with store observations assessing current practices related to the strategies. All stores sold low-calorie beverages, sugar-sweetened beverages, candy and cigarettes. Nearly all sold smokeless tobacco and cigars/cigarillos, and 72% sold e-cigarettes. Fresh fruits were sold at 30.2% of stores; only 9.4% sold fresh vegetables. Retailers reported being most willing to stock skim/low-fat milk, display healthy snacks near the register, and stock whole wheat bread. About 50% were willing to stock at least three fresh fruits and three fresh vegetables, however only 2% of stores currently stocked these foods. Nearly all retailers expressed unwillingness to reduce the availability of tobacco products or marketing. Our results show promise for working with retailers in rural settings to increase healthy food availability in small food stores. However, restrictions on retail tobacco sales and marketing may be more feasible through local tobacco control ordinances, or could be included with healthy foods ordinances that require stores to stock a minimum amount of healthy foods.

A systematic review of factors that influence food store owner and manager decision making and ability or willingness to use choice architecture and marketing mix strategies to encourage healthy consumer purchases in the United States, 2005–2017

“…This review analyzes the perspectives of 788 retailers, across a range of food store formats [32] including grocery/supermarkets [44, 50, 53, 56, 58, 59, 67–69] convenience [44, 50, 51, 60, 67–69, 71, 74], club or wholesale [62, 66], dollar [60], drug [50, 60], small food/corner [44, 46, 49, 52, 54, 56, 57, 60–66, 70–73], and specialty/ethnic stores [45, 47, 48, 55] (Additional file 1: Table S1). The foods and beverages of research focus were most commonly fruits, vegetables, and DGA-aligned [1] healthier alternatives to popular consumer products (Additional file 1: Table S1).…”

“…Study quality of many of the quantitative articles ( n = 9) were rated poorly, scoring as either negative [53, 56, 62, 63, 66, 69, 73] or neutral [45, 71]. Scores of qualitative research ( n = 22) were in majority positive and ranged from 0 to 10.…”

“…The time and space required to install infrastructure is a challenge and may require interventionist assistance.Gittelsohn, 2012 [49]A produce display improved perceptions of the store atmosphere. The creation of a pleasant store atmosphere was of business interest.O’Malley, 2013 [54]Interventionist assistance would be required to implement changes.Song, 2011 [57]Store atmosphere was perceived to improve as a result of establishing trust.Profile: Food Store Inventory, n = 11Andreyeva, 2011 [44]Enhancing the store’s inventory is of interest to enhance product variety.Budd, 2017 [62]There were mixed results regarding whether retailers would sustain the stocking of promoted foods post-intervention.Caspi, 2015 [60]Products such as fresh fruit and low-fat milk were perceived to be low-profit items in comparison to other healthy products that were perceived as average profit items (not high profit).D’Angelo, 2016 [71]The following percentages of participants noted willingness to stock these items: 74%, low-fat dairy; 66%, whole grain bread; ~ 51%, three varieties each of fresh fruits and vegetables; 40%, frozen produce; ~ 40%, pre-cut fresh fruits and vegetables.DeFosset, 2017 [63]Variety and affordability were the most important stocking indicators and 75% considered offering healthy products a high priority.Gittelsohn, 2012 [49]Current store inventory informed food purchasing needs. Perishable foods were the greatest challenge with regard to predicting sales and thus ordering needs.Gravlee, 2014 [50]Few healthy products were currently available in stores, as indicated by participants.…”

Best Practices and Innovative Solutions to Overcome Barriers to Delivering Policy, Systems and Environmental Changes in Rural Communities

“…In terms of infrastructure as barrier to health living, one study among eight southeastern rural communities in the U.S. found that rural communities lack policies and programs to support safe places to be active, especially sidewalks or policies related to schools, allowing the community to use their facilities outside of school hours (such as shared use policies) [ 22 ]. Additionally, access to healthy foods in rural communities is limited, as residents have greater exposure to retail food outlets that sell a limited selection of healthy food items [ 23 , 24 , 25 , 26 ]. Fortunately, research has suggested that healthy retail initiatives in small food stores, which can be supported by SNAP-Ed, can be a strategy to improve the quality of food in stores [ 27 , 28 ].…”

Novel Sales Tracking Method to Evaluate a Healthy Corner Store Intervention

“…Nearly 6,500 Kinston residents live in classified food deserts (Economic Research Service, USDA, 2017). The research team selected Kinston as the intervention site because of existing community-academic partnerships, the large percentage of people living in food deserts, and previous formative research on food availability in corner stores (D'Angelo et al, 2017).…”