Making Healthy, Economical Food Choices in Disadvantaged Neighborhoods
By Leah Chapman, MPH
The MANAGER TOP intervention (French for “eating great”) took place in 4 discount stores (2 intervention and 2 control) in the 14th and 15th districts in Marseille, France. Assignment to treatment or control groups was not random. The target population was low-income residents from disadvantaged neighborhoods with high unemployment rates.
The goal of the intervention was to use shelf labeling and various marketing strategies (signage, prime placement, and taste testing) to increase the purchase of healthy, economical foods.
An exploratory study in this population revealed that people were concerned about price, taste, diet quality, cooking practices, and meal preparation when considering food purchases. Using these findings, they designed a combination of shelf labels for healthy, economical foods; posters and leaflets explaining the shelf labeling system; prime placement of healthy, economical foods; a taste testing booth; and leaflets specifically focused on canned fish, pulses (edible seeds of plants), and eggs.
The materials were designed in collaboration with an advertising agency and customized to the target population based on positive aspects of food, such as appetizing pictures of foods, preparation tips, recipes, and simplified nutrition information. All intervention materials were pre-tested in a group of neighborhood residents and improvements were made. There were no price reductions in the promoted items and the stores’ staff were not involved in the implementation or data collection.
The intervention occurred in 3 phases throughout 2014 with the visual identity of MANGER TOP campaign, labeling system, and taste-testing booth beginning in January, February, and April, respectively.
The researchers used the INCA 2 French food composition survey to determine foods that were of good nutritional quality, inexpensive, and sources of at least two nutrients. A total of 180 products were promoted, including milk; plain yogurt; eggs; fresh, canned, or frozen fruits and vegetables; canned or frozen fish; soups; pulses; fruit compotes; and fruit juices.
Data Collection and Analysis:
The researchers used generalized linear mixed modeling to analyze detailed monthly store purchasing records from 6,525 member customers, including data from both before and after the intervention. They also tested for interactions between the type of store and the year, as well as between the individual store and year. Additionally, the researchers conducted two-minute exit surveys and 15-minute in-depth surveys among intervention stores.
The MANGER TOP intervention did not have a significant impact on total food purchases of the promoted items. However, the intervention did have a positive effect on purchases of promoted fruits, vegetables, and starches. The surveys indicated that the MANGER TOP intervention raised awareness of the labeling system over time. Additionally, the intervention improved the understanding of the labeling system in some customers.
A social marketing intervention aimed at increasing the visibility and attractiveness of healthy, economical foods, such as MANGER TOP, may improve food purchasing behaviors in disadvantaged neighborhoods.