Geographical access to healthy foods and residents´ perceptions: a mixed methods study using GIS, on field measures and PhotoVoice

Several studies have highlighted the value of investigating people´s perceptions of the neighborhood food environments vs. objective measures. Qualitative research may help to better understand perceived barriers and... [ view full abstract ]

Several studies have highlighted the value of investigating people´s perceptions of the neighborhood food environments vs. objective measures. Qualitative research may help to better understand perceived barriers and facilitators to healthy eating. We aimed to gain a deeper understanding of how low-income residents perceive their neighborhood food environment and its related barriers and facilitators combining GIS, in-store assessments and the participatory action research method of Photovoice. This mixed methods study was conducted in Madrid (Spain), with twelve adults aging 40-75, residents in one low-income neighborhood. Participants photographed, discussed and analyzed both positive and negative aspects of their food environment. We combined data from their photographs and discussions with objective food environment measures based on GIS and in-store field audits. We categorized availability, quality and price of healthy foods, using an overall healthy food availability index (HFAI) score (-7 to 49), and calculated resident´s walking access with a street network analysis. A total of 114 food stores were identified and half of them were surveyed. 59.4% were traditional stores, 34.4% corner stores, and 6.2% supermarkets. The mean HFAI scores for these store types ranged from 36.5 for supermarkets to 33.6 and 10.84 for corner stores and traditional stores, respectively. 97.8% of residents lived within less than 10 minutes from a high healthy food store. Participants highlighted that traditional food stores offered healthier, with better quality of products and service whereas supermarkets were seen as promoters of marketing unhealthy foods. Supporting traditional stores would facilitate healthy food access, while enhancing social cohesion within neighbors. Identified barriers were “economic crisis”, “lack of leisure facilities” and “the wide availability of energy dense foods at low prices”. The combination of quantitative and qualitative methods conceptualizing barriers and facilitators to healthy eating generated concrete targets for interventions promoting a healthier neighborhood food environment.