Adaptation and Validation of the Nutrition Environment Measures Survey in Stores (NEMS‐S) in Costa Rica

Abstract

Overweight and obesity affect 21.4% of children, 20.8% of adolescents and close to 60% of adults in Costa Rica. The nutrition environment, which includes the social, political and environmental factors that influence the access to food, might play an important role in the development of obesity, as evidence suggests that local food stores are associated with unhealthy eating patterns.An array of instruments and measures have been developed and validated to assess food environment. The objective of this study is to adapt and validate the Nutrition Environment Measures Survey for Stores (NEMS‐S) in Costa Rica.The original NEMS‐S was translated to Spanish (and renamed IMANEA), and its food categories were adapted to the Costa Rican context. The instrument was pre‐tested in a selection of food stores different from our study sample, and changes were made in formatting and food categories. The resulting instrument was used to assess 29 food stores on three non‐consecutive days by two evaluators. The food store sample included supermarkets, “minisupers” (e.g. convenience stores), and “pulperías” (e.g. corner store). Specialized food stores such as pastries, farmer's markets, and butchery shops were excluded since they only offer a limited type of food.Food stores were assessed in La Union de Cartago for seven food categories. Inter‐rater and intra‐rater reliability were measured through intra‐class coefficient (ICC). Construct validity was determined using known‐groups method through Student's t‐test. All food categories had an ICC between 0.55 and 0.70, except the vegetables category (ICC=0.83), which suggests moderate to excellent reliability.The IMANEA represents the first adapted and validated instrument designed to measure nutrition environment in food stores in Costa Rica. It could be used as a tool in future obesity research, as well as an instrument to develop interventions that encourage healthy eating through the modification of the nutrition environment in food stores. Furthermore, IMANEA could complement research assessing food security and could be used as a reference in other developing countries of the region.