Prioritizing Food Retailer Perspectives for Environmental Change in Food Stores to Encourage Healthy Dietary Purchases Among Low-Income Consumers in the United States

Supplemental Nutrition Assistance Program (SNAP)-authorized store environments could be improved to favor consumer purchase of healthy products. Engaging with the key intermediaries who can use marketing-mix and choice-architecture (MMCA) strategies to encourage low-income consumers to purchase healthy products aligned with the Dietary Guidelines for Americans (DGA), 2015-2020 is essential. This PhD research describes five investigations that explored the perspectives of food store owners, managers, and corporate or independent businesses (e.g., retailers) to inform healthy food retail approaches: (1) a systematic review of the literature (1980-2017) identified social-ecological influencers of food store retailers' decision-making and ability to use MMCA strategies to encourage healthy dietary purchases in the United States (US); (2) SNAP-authorized retailers' perceived feasibility and costs to implement healthy MMCA strategies in rural stores were assessed (n=29); (3) SNAP-authorized retailers' healthy food and beverage perceptions and DGA-aligned product offerings were documented; (4) prevalent SNAP-authorized food store retailers in the US and between two states were identified to inform settings where healthy food retail approaches could reach numerous SNAP consumers; (5) and the availability of corporate social responsibility commitments to use MMCA strategies to improve consumers' diet quality among prevalent SNAP-authorized food store chains was explored. The collective findings from the review and four studies were that multiple social-ecological factors (e.g., skills/knowledge, consumers, suppliers) influenced US retailers' decision-making and ability to use MMCA strategies that favor healthy products. Rural retailers perceived prompting and proximity (e.g., labeling and location) strategies as feasible and less costly compared to other MMCA strategies. Some misalignments of healthy food perceptions and food store availability were identified and indicated a need for trainings to enhance the success of healthy food retail programs. To reach numerous SNAP consumers, healthy food retail programs should target nontraditional (e.g., non-grocery) food stores with varied approaches by state. However, few prevalent SNAP-authorized retailers have made public, voluntary commitments to reduce obesity and may reflect a low readiness to engage in partnerships to establish healthy food retail environments. Future research should document approach to and the impact of using MMCA strategies to encourage healthier consumer purchases on business outcomes among diverse store contexts. Doctor of Philosophy Supplemental Nutrition Assistance Program (SNAP) consumers are low-income Americans who could benefit from exposure to store cues or marketing-mix and choice-architecture (MMCA) strategies that ‘make the healthy choice the easy choice’. However, food store owners, managers, and businesses (e.g. retailers) ultimately decide if they will initiate and continue MMCA changes. This research prioritized the retailer perspective to inform healthy food retail approaches. A systematic review of literature (1980-2017) explored multifaceted influencers of food store retailers’ decision-making and ability or willingness to use MMCA strategies to encourage healthier dietary purchases in the United States (US). Additionally, four original research investigations were conducted: (1) a mixed-methods and cross-sectional investigation in rural, central Virginia assessed SNAP-authorized retailers’ perceived feasibility and costs to implement MMCA strategies that encourage healthy consumer purchases in stores; (2) an investigation of SNAP-authorized retailers’ healthy food and beverage perceptions and healthy food store offerings informed healthy food retail approaches in this setting; (3) an examination of prevalent SNAP-authorized food store retailers in the US and between two US states informed targeted healthy food retail approaches that could benefit numerous SNAP consumers; and (4) the availability of corporate social responsibility commitments to use MMCA strategies to promote consumer health among prevalent SNAP-authorized food store chains was explored. Main findings of these investigations indicated that there are multiple factors (e.g., skills/knowledge, consumers, suppliers) that influence US retailers’ decision-making. Also, rural retailers perceived prompting and proximity (e.g., healthy food labeling and moving healthy foods to an ideal location) strategies as feasible and low cost. There were some misalignments of healthy food perceptions and food store availability, indicating a need for trainings to enhance the likelihood for healthy food retail programs to succeed. In approaching SNAP-authorized retailers for partnership opportunities, targeting nontraditional (e.g., non-grocery) settings may reach more consumers and varied approaches by state are warranted. However, many of these prevalent SNAP retailers lack publicly available commitments to reduce obesity which may hinder partnership approaches. Future work should document approach to and the impact of using MMCA strategies to encourage healthier consumer purchases on diet quality and business outcomes among diverse store contexts.