Development and Implementation of a Food Store-Based Intervention to Improve Diet in the Republic of the Marshall Islands

¹ an associate professor at the Center for Human Nutrition, Department of International Health at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
² a doctoral student in medical anthropology at the University of California, San Francisco in San Francisco, California.
³ the coordinator of a senior food program and also works as a nutrition consultant to local hunger relief agencies in San Francisco, California.
⁴ a newborn health program specialist with the Save the Children's Saving Newborn Lives initiative in Washington, DC.
⁵ a health economist and associate professor in the Department of Health Policy and Management at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
⁶ the coordinator of the Nutrition and Diabetes Prevention Program in the Marshall Islands.
⁷ associate professor in the Social and Behavioral Interventions Program in the Department of International Health at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
⁸ the director of Dean Services at Drexel University College of Medicine in Philadelphia, Pennsylvania.
⁹ professor and chair of the Department of Family Medicine and Community Health at the John A. Burns School of Medicine at the University of Hawaii in Mililani, Hawaii.

^* To whom correspondence should be addressed.

	Abstract

Effective approaches for the prevention and reduction of obesity and obesity-related chronic diseases are urgently needed. Food store-centered programs represent one approach that may be both effective and sustainable. The authors developed a food store-based intervention in the Marshall Islands using qualitative and quantitative formative research methods, including a store usage survey (n = 184) and in-depth interviews with large-store managers (n = 13), small-store managers (n = 7), customers (n = 10), and community leaders (n = 4). This process was followed up by development and piloting of specific intervention components and workshops to finalize materials. The final intervention combined mass media (newspaper articles, video, radio announcements) and in-store components (shelf labels, cooking demonstrations, posters, recipe cards) and had high store-owner support and participation. High levels of exposure to the intervention were achieved during the 10-week period of implementation. This model for developing food store-based interventions is applicable to other settings.

Key Words: diet, formative research, food stores, obesity, Micronesia

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