Advances in methods and metrics in measuring food environments and implications for healthy food choices

Background and objectives: Given their highly dynamic and informal attributes, food environments in low- and middle-income countries (LMICs) are traditionally difficult to characterise. Further, the concept of food environment encompasses multiple constructs making measurement, to underpin effective policy actions, difficult. The objective of this presentation is to provide an overview of the state-of-the-art developments in methods and metrics to measure and characterise food environments to underpin effective actions for healthy food environments. Methods: This presentation will include a critical evaluation of food environment methods and metrics and will introduce the latest food environment experience survey tool (FEST), which is currently being piloted in India, Indonesia and Senegal. This tool, developed under the UKRI-GCRF Action Against Stunting Hub, aims to (i) characterise the extent to which nutrient-dense foods are available and affordable within different food environments, and (ii) explore the relative importance of external and personal food environment domains on household food choices. Results: Existing measures have trade-offs between contextual understanding and scale. Food-system interventions to improve diet quality require actionable data about food environments that is sensitive to context, can be collected at scale, and adaptable for specific foods and food groups of interest. Cognitive testing of FEST highlighted variable levels of understanding around food environment constructs and prompted the adoption of additional contextual information. The results of pilot testing will be available by June 2022 and the presentation will include the results of pilot testing in all three countries and our approach to FEST metric development. Conclusions: Rapid advancements in developing, testing, and establishing cross-contextual equivalence of food environment metrics are critically needed to underpin effective policy actions. While geospatial tools and observational surveys have gained prominence, promising methods (quantitative and mixed-methods) and metrics to assess how people experience food environments and which constructs of food environments are important for food choices in diverse contexts are rapidly emerging.