Piloting Market Food Environment Assessments in LMICs: A Feasibility Assessment and Lessons Learned.

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Food environments are rapidly changing in low- and middle-income countries (LMICs), leading to dietary shifts. Many gaps exist in the measurement of food environments in LMICs making it difficult to characterize the linkages between food environments and diets. The objective of this study was to examine the feasibility of implementing USAID Advancing Nutrition's Market Food Environment Assessment (MFEA)-a suite of 7 non-resource intensive food environment assessments. We implemented the MFEA package in 4 countries (Liberia, Honduras, Nigeria, and Timor-Leste) and assessed the feasibility of implementing the package by conducting a descriptive analysis, using both qualitative and quantitative data of enumerators' feedback collected through training evaluations, feedback forms, detailed notes from meetings, and final reports from in-country partners. Overall, we found it feasible to implement the MFEA, some assessments being easier to implement and more practical than others. Several key themes related to the MFEA implementation were identified across the countries, including: the potential for vendors to be hesitant to engage in assessments; the importance of ascertaining buy-in from local officials; the need to shift toward electronic, rather than paper-based, data collection; difficulties in selecting markets; the time constraints of conducting some of the assessments; and the need for better alignment between the instructions, data collection, and data analysis sheets. The package of food environment assessments, with minimal additional refinement, can be used to characterize market food environments in LMIC settings to inform context-specific interventions.