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      Using Novel Multimethod Evaluation Approaches to Understand Complex Food System Interventions: Insights from a Supply Chain Intervention Intended to Improve Nutrition

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          Abstract

          Background

          A “food system” approach to improve diet quality by intervening within areas such as food supply chains is gaining prominence. However, evidence of such interventions’ impact, and understanding of appropriate methods to evaluate them, is lacking.

          Objectives

          We present an impact evaluation of an intervention that aimed to increase consumption of nutritious foods by supporting food-producing firms in Kenya. In doing so, we demonstrate how multiple methods, including those from other disciplines, can be used to evaluate a complex food systems intervention.

          Methods

          Four methods focused on food-producing firms and their management, including a survey of intervention participants ( n = 83 individuals), a “laboratory-in-the-field” experiment ( n = 83 individuals), baseline/endline data on firm performance ( n = 71 firms), and semistructured interviews ( n = 19 firms). Three methods focused on consumers in neighborhoods targeted by a supported firm: a randomized field experiment tested effects of making a supported product exhaustively available on consumers’ purchases and consumption ( n = 1295 consumers); 3 discrete choice experiments ( n = 1295 consumers) tested factors influencing consumers’ willingness to pay for foods with relevant characteristics.

          Results

          Among firms, we saw suggestive evidence of increased networking and business relationships, while laboratory-in-the-field experiments indicated the intervention might foster cooperation among participants. Qualitative interviews suggested that the intervention enabled firms to increase production, improve management, increase revenues, and lower costs. Baseline/endline data confirmed a positive effect only on the launch of new products and hiring workers. In the field experiment, consumption of the supported product increased in areas where it was made available relative to a control group, but this did not increase overall consumption of the food type or dietary diversity.

          Conclusions

          Results showed positive signs of the intervention improving firm-level outcomes but limited impact on consumers’ diet quality. The evaluation also demonstrates how diverse methods can be used to evaluate complex interventions.

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          Most cited references77

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          Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?

          The Lancet, 382(9890), 452-477
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            Trust, Reciprocity, and Social History

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              Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis

              Context: It is well established in the literature that healthier diets cost more than unhealthy diets. Objective: The aim of this review was to examine the contribution of food prices and diet cost to socioeconomic inequalities in diet quality. Data Sources: A systematic literature search of the PubMed, Google Scholar, and Web of Science databases was performed. Study Selection: Publications linking food prices, dietary quality, and socioeconomic status were selected. Data Extraction: Where possible, review conclusions were illustrated using a French national database of commonly consumed foods and their mean retail prices. Data Synthesis: Foods of lower nutritional value and lower-quality diets generally cost less per calorie and tended to be selected by groups of lower socioeconomic status. A number of nutrient-dense foods were available at low cost but were not always palatable or culturally acceptable to the low-income consumer. Acceptable healthier diets were uniformly associated with higher costs. Food budgets in poverty were insufficient to ensure optimum diets. Conclusions: Socioeconomic disparities in diet quality may be explained by the higher cost of healthy diets. Identifying food patterns that are nutrient rich, affordable, and appealing should be a priority to fight social inequalities in nutrition and health.
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                Author and article information

                Contributors
                Journal
                Curr Dev Nutr
                Curr Dev Nutr
                Current Developments in Nutrition
                American Society for Nutrition
                2475-2991
                25 May 2024
                June 2024
                25 May 2024
                : 8
                : 6
                : 103776
                Affiliations
                [1 ]Department of Agricultural, Food, and Resource Economics, Michigan State University, East Lansing, MI, United States
                [2 ]Department of Political Economy and Moral Science, University of Arizona, Tucson, AZ, United States
                [3 ]Knowledge Leadership Team, Global Alliance for Improved Nutrition, Geneva, Switzerland
                [4 ]Results for Development, Washington, DC, United States
                [5 ]School of Public Health, University of Michigan, Ann Arbor, MI, United States
                [6 ]Knowledge Leadership Team, Global Alliance for Improved Nutrition, Washington, DC, United States
                [7 ]Africa Regional Office, Helen Keller International, Dakar, Senegal
                Author notes
                [* ]Corresponding author. snordhagen@ 123456gainhealth.org
                Article
                S2475-2991(24)01710-4 103776
                10.1016/j.cdnut.2024.103776
                11228647
                38979104
                cbf0ea95-e3d5-4a7b-947d-c3e8cab148e3
                © 2024 The Authors

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 31 December 2023
                : 18 April 2024
                : 9 May 2024
                Categories
                Research Methodology / Study Design

                methods,project impact,complex interventions,supply chain,smes,kenya,food environment

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