Food Retail Outlets Research Articles

The promotion of ultra-processed foods in modern retail food outlets in rural and urban areas in Kenya.

To assess the availability and marketing of ultra-processed foods (UPF) in modern retail food outlets (supermarkets and minimarts) in Kenya and associated factors. This cross-sectional study was conducted in Kenya from August 2021 to October 2021. Variables included the geographic location and the socio-economic status (SES) levels, the food items displayed for sale and advertised in the stores, and locations in the stores such as the entrance. Three counties in Kenya (Nairobi - urban, Mombasa - coastal tourist and Baringo - rural). Each county was stratified into high and low SES using national poverty indices. Food outlets that offered a self-service, had at least one checkout and had a minimum of two stocked aisles were assessed. Of 115 outlets assessed, UPF occupied 33 % of the cumulative shelf space. UPF were the most advertised foods (60 %) and constituted 40 % of foods available for sale. The most commonly used promotional characters were cartoon characters (18 %). UPF were significantly more available for sale in Mombasa (urban) compared to Baringo (rural) (adjusted prevalence rate ratios (APRR): 1·13, 95 % CI 1·00, 1·26, P = 0·005). UPF advertisements were significantly higher in Mombasa ((APRR): 2·18: 1·26, 3·79, P = 0·005) compared to Baringo and Nairobi counties. There was a significantly higher rate of advertisement of UPF in larger outlets ((APRR): 1·68: 1·06, 2·67 P = 0·001) compared to smaller outlets. The high marketing and availability of UPF in modern retail outlets in Kenya calls for policies regulating unhealthy food advertisements in different settings in the country.

Associations of Neighborhood Food Retail Environments with Weight Status in a Regional Pediatric Health System.

Background: There have been mixed findings on the relationships between childhood obesity and macroscale retail food environments. The current study investigates associations of the neighborhood retail food environment with changes in children's weight status over 6 years in the Kansas City Metropolitan area. Methods: Anthropometrics and home addresses were collected during routine well-child visits in a large pediatric hospital (n = 4493; >75% were Black or Latinx children). Children had measures collected during two time periods ([Time 1] 2012-2014, [Time 2] 2017-2019). Establishment-level food environment data were used to determine the number of four types of food outlets within a 0.5-mile buffer from the children's residence: supermarkets/large grocery stores, convenience stores/small grocery stores, limited-service restaurants, and full-service restaurants. Children who moved residences between periods were "movers" (n = 1052). Associations of baseline and changes in food environment status with Time 2 weight status were assessed using mixed-effects models. Results: Movers who experienced no change in the number of convenience stores or small grocery stores within a 0.5-mile of their home had increased likelihoods of having overweight/obesity and less favorable BMIz changes, compared with movers who experienced a decrease in convenience stores/small grocery stores within a 0.5-mile distance. No associations were observed among nonmovers. Conclusion: Findings suggest that moving to an area with fewer unhealthy retail food outlets (e.g., convenience stores) is associated with a lower risk of obesity in children. Future research is needed to determine whether larger-scale changes to the retail food environment within a neighborhood can support children's healthy weight.

Evaluation of physico-chemical quality and occurrence of Salmonella in water from food retail outlets

Salmonella is one among the most important biological contaminants in drinking water that possess safety hazards to human life. Faecal contamination of the water, indirectly from the household sewage discharge, municipal sewage etc. attributes to the repeated detection of Salmonella in water. This study aimed to investigate the occurrence of Salmonella and physico- chemical quality evaluation of samples of water collected from food retail outlets of Thrissur and Kollam districts. A total of 50 water samples (25 each from Thrissur and Kollam districts) used for cooking purpose were collected over a period of six months, March to August 2023. Water samples were subjected to comparative evaluation of physico-chemical qualities viz., pH, turbidity, total dissolved solids (TDS) and hardness. Collected water samples were examined for Salmonella spp. by conventional culture method and PCR. Genus specific and virulence genes of the isolates were detected using polymerase chain reaction. The occurrence of Salmonella spp. in samples of water collected from Thrissur was 24 per cent whereas in Kollam district it was only four per cent. The overall occurrence of Salmonella spp. in samples of water collected from both districts was 14 per cent. Physico-chemical parameters of water samples viz., pH, turbidity, total dissolved solids and hardness were within the BIS prescribed standards. The molecular characterisation of Salmonella spp. detected 16S rRNA in all isolates but invA and spvA genes were detected only in 14.28 per cent of the isolates. Hence proper disinfection of water and food sanitation in the retail outlets will help to minimize the risk of foodborne pathogens Keywords: Salmonella, water, physico-chemical quality, food retail outlets

Retailer processes centred on the food market as the main determinate of business models in the context of retail size

In today's competitive environment, retail food outlets need to keep pace with changing consumer behaviour and technological change. Due to the impact of digitalisation, they are gradually starting to use new forms of interaction with consumers, suppliers, employees and other stakeholders, which affects the food retail business in many ways. Many digitization-related activities are well known but are slow to be implemented in the practice of food retail operations, depending on the specific size type of retail format. The paper aims to provide an overview of business models based on the size of food retail operations and on the identification of selected activities aimed at increasing competitiveness and creating value for customers. The survey sample comprised 250 stores whose managers were questioned by means of a semi-structured interview in March–April 2022. The authors discuss 30 identified components of 40 purposes in this study which could increase the efficiency of retailers' business models. A number of philosophical (a comprehensive examination of the criteria for selecting a theory and processing the theory) as well as mathematical statistical methods are used in the model, such as reliability rate estimation, factor analysis of binary data, cluster analysis, and the like. The study provides an overview of the application of selected digitalisation-related components in the business models of established food retail outlets of different size groups in the Slovak capital Bratislava.

Food safety concerns and purchase choices among poor households in the urbanising global south: the case of Dhaka, Bangladesh

This article looks into the daily food shopping practices of poor urban households in Dhaka, Bangladesh. A practice theory-based approach is used to explore their coping strategies in response to food safety concerns. By applying an exploratory sequential mixed-method approach, two groups of shoppers are compared: recently arrived migrants and established residents, as recently arrived migrants are expected to face an unfamiliar food shopping environment and therefore need to reconsider their daily food shopping practices. The results describe the elements of food shopping practices: food items, retail outlets, affordability, social networks, and relations to work. We identified the absence of freshness, undesirable substances, and the need for more information about the production process as the primary food safety concerns. Among both shopper groups, the harmful consequence of applying the chemical 'formalin' to food is considered the most prominent food safety concern. Major coping strategies include identifying (un)safe food, proactive selection, and establishing and maintaining social relationships. The two groups have similarities and differences in using skills and competencies to mitigate their food safety concerns in everyday shopping practices. Recently arrived migrants have to adapt to urban lifestyles and reconfigure their food safety concerns into their daily food shopping practices.

Benchmarking the university campus food environment and exploring student perspectives about food insecurity and healthy eating: a case study from Australia

ObjectiveTo benchmark the university food environment and explore students’ experiences with food insecurity and healthy eating in order to inform interventions to improve access and affordability of healthy foods for university students.DesignA food environment audit was conducted on the university campus using the Uni-Food tool from April to May 2022 and was comprised of three main components, university systems and governance, campus facilities and environment, and food retail outlets. A qualitative study design was also used to conduct focus groups and semi-structured interviews with students to explore key themes regarding their experiences with food insecurity and healthy eating.SettingMacquarie University, Australia.ParticipantsFor the food environment audit 24 retail outlets on campus and for the qualitative component 29 domestic and international students enrolled at Macquarie University.ResultsThe university only scored 27% in total for all components in the food environment audit. The results showed the need for better governance and leadership of the food environment. The qualitative component suggested that the main barriers to accessing healthy foods were related to availability, pricing, and knowledge of healthy foods. Future intervention ideas included free fruits and vegetables, food relief, discounts, improved self-catering facilities, education, and increased healthy food outlets.ConclusionsImproving governance measures related to healthy eating on campus are a core priority to strengthen the food environment and students identified pricing and availability as key issues. These findings will inform effective and feasible interventions to improve food security and healthy eating on campus.

Exploring the prospective acceptability of a healthy food incentive program from the perspective of people with type 2 diabetes and experiences of household food insecurity in Alberta, Canada.

FoodRx is a 12-month healthy food prescription incentive program for people with type 2 diabetes (T2DM) and experiences of household food insecurity. In this study, we aimed to explore potential users' prospective acceptability (acceptability prior to program use) of the design and delivery of the FoodRx incentive and identify factors influencing prospective acceptability. We used a qualitative descriptive approach and purposive sampling to recruit individuals who were interested or uninterested in using the FoodRx incentive. Semi-structured interviews were guided by the theoretical framework of acceptability, and corresponding interview transcripts were analysed using differential qualitative analysis guided by the socioecological model. Individuals living in Alberta, Canada. In total, fifteen adults with T2DM and experiences of household food insecurity. People who were interested in using the FoodRx incentive (n 10) perceived it to be more acceptable than those who were uninterested (n 5). We identified four themes that captured factors that influenced users' prospective acceptability: (i) participants' confidence, views and beliefs of FoodRx design and delivery and its future use (intrapersonal), (ii) the shopping routines and roles of individuals in participants' social networks (interpersonal), (iii) access to and experience with food retail outlets (community), and (iv) income and food access support to cope with the cost of living (policy). Future healthy food prescription programs should consider how factors at all levels of the socioecological model influence program acceptability and use these data to inform program design and delivery.

Drone Food Delivery: A Solution to Crowding During the Global COVID-19 Pandemic

The COVID-19 pandemic has altered the retail landscape and introduced new risks for customers. Customers, in turn, are increasingly turning toward technology to reduce pandemic-associated risks. This study investigates the impact of crowding at food retail outlets on customers’ willingness to utilize drone food delivery. Data were collected using an online survey and analyzed using covariance-based structural equation modeling. The results confirm that crowding is positively associated with social withdrawal tendency and mortality threat. Perceived vulnerability and perceived severity act as moderators to strengthen the positive association of crowding with mortality threat and social withdrawal tendency. Social withdrawal tendency and mortality threat, in turn, are positively associated with customers' attitudes toward drone delivery. A positive attitude toward drone delivery positively impacts customer willingness to utilize drone delivery, while a negative attitude has a negative impact. This study provides novel insights into technology adoption driven by crowding as an environmental factor during a global pandemic. It also offers evidence that technology adoption is driven by threat perceptions. Our findings have important implications for retailers, who can consider drone food delivery as a possible solution to reduce customers' threat perception.

Exploring the influence of sensory brand recognition on brand loyalty within the quick service restaurant industry: an analysis of branded food retailers in Kerala

In today's competitive business landscape, organized retail establishments are facing formidable challenges from online counterparts, while fast-food retailers are also facing the pressure. The rise in popularity of online food delivery apps has compelled organized restaurant businesses to swiftly adapt and innovate to thrive in this new business environment. When customers order food through online, the differentiating factor primarily is the taste of the food. However, when customers physically visit a restaurant, their experience is influenced by four additional sensory elements present in the retail outlet: sight, smell, sound, and touch. These sensory elements are intentionally employed by companies to position and distinguish their brand from competitors. This study intends to investigate how these sensory components affect consumers' perceptions of quality, which in turn affect purchase intentions. The study focuses on a selection of internationally recognized retail food outlets, with a significant presence across the globe, that have established locations in three major cities in Kerala: Kochi, Trivandrum, and Kozhikode

A systematic review of the implementation of healthy food retail interventions in settings with multiple food retail outlets (complex food retail settings).

Complex food retail settings, where multiple food retail outlets operate in close proximity are common. Despite their ubiquity, there remains a significant knowledge gap regarding healthy food retail interventions implemented within these settings. Furthermore, understanding the factors affecting the implementation of interventions in these settings remains limited. This systematic review aimed to (1) identify and describe complex food retail settings where interventions were implemented to promote the healthiness of foods purchased, (2) synthesise the evidence on the effectiveness of the interventions implemented, and (3) identify enablers and barriers to the implementation of the interventions in these settings. Four databases, namely, MEDLINE Complete, Global Health, Embase, and Business Source Complete, were searched until December 2022. The Effective Public Health Practice Project quality assessment tool was used. Six studies reported on the implementation of interventions promoting healthy food purchases across multiple food retail outlets. Three studies each described two complex food retail settings: university and hospital. Interventions including promotion and promotion plus price improved the healthiness of foods purchased. There was limited description of institutional food policies, conceptual frameworks, formative research, or evaluation outcomes to inform the implementation of interventions in these settings. No study analysed enablers and barriers to the implementation of interventions. No study identified their settings as complex food retail settings. There is limited evidence describing complex food retail settings, their impact on intervention effectiveness, and associated enablers or barriers. Investigating factors influencing the effectiveness of interventions implemented within complex food retail settings is critical to support their implementation at scale.

Which Program Implementation Factors Lead to more Fruit and Vegetable Purchases? An Exploratory Analysis of Nutrition Incentive Programs across the United States

BackgroundNutrition incentive (NI) programs help low-income households better afford fruits and vegetables (FVs) by providing incentives to spend on FVs (e.g., spend $10 to receive an additional $10 for FVs). NI programs are heterogeneous in programmatic implementation and operate in food retail outlets, including brick-and-mortar and farm-direct sites. ObjectiveThis study aimed to explore NI program implementation factors and the amount of incentives redeemed. MethodsA total of 28 NI projects across the United States including 487 brick-and-mortar and 1078 farm-direct sites reported data between 2020 and 2021. Descriptive statistics and linear regression analyses (outcome: incentives redeemed) were applied. ResultsTraditional brick-and-mortar stores had 0.48 times the incentives redeemed compared with small brick-and-mortar stores. At brick-and-mortar sites, automatic discounts had 3.47 times the incentives redeemed compared with physical discounts; and auxiliary services and marketing led to greater redemption. Farm-direct sites using multilingual and direct promotional marketing had greater incentives redeemed. ConclusionsTo our knowledge, this is the first national study to focus on NI program implementation across sites nationwide. Factors identified can help inform future programming and research.

Development of a Scoring Tool for Australian Rural Food Retail Environments.

Current tools scoring the healthiness of food retail outlets do not reflect outlets found in rural locations. This study aimed to adapt pre-existing Australian scoring tools to represent non-metropolitan areas. Rural nutrition experts were identified, and a modified Delphi technique was used to adapt two pre-existing, food-scoring tools in five iterative stages. Stages included identifying all relevant outlets, providing a description and score for each, ensuring consistency between outlet scores and pre-existing, metro-centric tools, and providing instructions for correct use. Six rural nutrition experts were identified and engaged in the modified Delphi technique. The final tool consisted of 12 categories of food outlets and listed 35 individual outlets. Consistent with pre-existing Australian tools, scores ranged from +10 to -10 and included descriptions reflective of rural retail outlets. Scores were based on whether the majority of foods offered within the outlet were consistent with foods recommended in national health guidelines. The developed tool was designed to accommodate the diverse nature of food retail outlets found in non-metropolitan areas. This study assists in explaining the link between the food environment and health in populations living rurally.

BMI and the Food Retail Environment in Melbourne, Australia: Associations and Temporal Trends.

Research into the link between food environments and health is scarce. Research in this field has progressed, and new comprehensive methods (i.e., incorporating all food retail outlets) for classifying food retail environments have been developed and are yet to be examined alongside measures of obesity. In this study, we examine the association and temporal trends between the food environment and BMI of a repeated cross-sectional sample of the adult population between 2008 and 2016. Methods: Food retail data for 264 postal areas of Greater Melbourne was collected for the years 2008, 2012, 2014, and 2016, and a container-based approach was used to estimate accessibility to supermarkets, healthy and unhealthy outlets. Data on BMI for postal areas was obtained from the Victorian Population Health Survey (n = 47,245). We estimated the association between the food environment and BMI using linear mixed models. Results indicated that BMI increased as accessibility to healthy outlets decreased by up to -0.69 kg/m2 (95%CI: -0.95, -0.44). BMI was lower with high and moderate access to supermarkets compared to low access by -0.33 kg/m2 (-0.63, -0.04) and -0.32 kg/m2 (-0.56, -0.07), and with high access to unhealthy outlets compared to low access (-0.38 kg/m2: -0.64, -0.12) and moderate access (-0.54 kg/m2: -0.78, -0.30). Conclusion: Our results show that increasing access and availability to a diverse range of food outlets, particularly healthy food outlets, should be an important consideration for efforts to support good health. This research provides evidence that Australia needs to follow suit with other countries that have adopted policies giving local governments the power to encourage healthier food environments.

Developing Co-Creation Research in Food Retail Environments: A Descriptive Case Study of a Healthy Supermarket Initiative in Regional Victoria, Australia.

Research into the co-creation of healthy food retail is in its early stages. One way to advance co-creation research is to explore and understand how co-creation was applied in developing, implementing, and evaluating a heath-enabling initiative in a supermarket in regional Victoria, Australia. A case study design was used to explore and understand how co-creation was applied in the Eat Well, Feel Good Ballarat project. Six documents and reports related to the Eat Well, Feel Good Ballarat project were analyzed with findings from the focus groups and interviews. Motivations to develop or implement health-enabling supermarket initiatives differed among the participants. Participants considered that initial negotiations were insufficient to keep the momentum going and to propose the value to the retailers to scale up the project. Presenting community-identified needs to the supermarket helped gain the retailer's attention, whilst the co-design process helped the implementation. Showcasing the project to the community through media exposure kept the supermarket interested. Retailers' time constraints and staff turnover were considered significant barriers to partnership building. This case study contributes insights into applying co-creation to health-enabling strategies in food retail outlets using two co-creation frameworks.

How the Situational Factors Impact the Consumers to Buy Food and Grocery Products Impulsively: A Study Conducted in the Organized Retail Formats of Kolkata

Impulsive purchasing is quickly becoming one of the highly observable behaviour for an increasing number of Indian consumers. Situational factors as experienced by the consumers inside an organized retail format affect the consumers to purchase different food and grocery products impulsively. These situational factors are impacted by a number of socio-economic and technological issues such as increase in online transaction facilities, unavailability of time to shop leisurely, increase in disposable income, financial independence of young shoppers, peer pressure, nuclear family structure etc. Food and grocery retailers might capitalize this change of buying pattern among tech-savvy and time pressed urban consumers by offering a range of technological facilities along with a decent service quality. This research studies the impact of the various situational factors eliciting impulsive buying behaviour among the consumers in the organized retail food and grocery outlets in Kolkata, through consumer survey by a standardized questionnaire.

Resilience and vulnerabilities of urban food environments in the Asia‐Pacific region

Rapid urbanisation in the Asia-Pacific region is associated with complex changes to urban food environments. The impact of changing food environments on food purchasing and consumption and the diets and nutritional status of vulnerable groups, especially women and young children, is not well researched in low- and middle-income country cities. This paper aimed to examine: the risks and opportunities for healthy diets for low income populations offered by modernising urban centres; the concept of food deserts in relation to urban food environments in the Asia-Pacific region and how these could be mitigated; and measures to strengthen the resilience of food environments in the region using a case study of the impact of COVID-19 on informal food vendors. Our findings indicate that the dynamic changes in urban food environments in the Asia- Pacific region need to be understood by examining not only modern retail food outlets but also wet markets and informal food outlets, including street foods. Efforts should be made to ensure both modern and traditional outlets provide complementary platforms for convenient, affordable and accessible nutritious foods for urban populations. The resilience of urban food environments to environmental, physical and socio-economic shocks can be strengthened by shortening food supply chains and maximising food production in cities. Support mechanisms targeting urban informal food outlets and street vendors can also strengthen resilience and improve food security. Further research is needed on the impact of urbanising food environments on consumer choices, preferences, diets and health outcomes.

Food environment around schools and adolescent consumption of unhealthy foods in Addis Ababa, Ethiopia.

Adolescent diets may be influenced by the retail food environment around schools. However, international research to examine associations between the proximity of retail food outlets to schools and diet provides equivocal support for an association. This study aims to understand the school food environment and drivers for adolescents' consumption of unhealthy foods in Addis Ababa, Ethiopia. Mixed-methods research was conducted, 1200 adolescents (10-14 years) from randomly selected government schools were surveyed, along with vendors within 5-min' walk of the schools and focus group discussions (FGDs)with adolescent groups. Mixed-effect logistic regression investigated the relationship between the number of vendors around the schools and the consumption of selected unhealthy foods. Thematic analysis was used to summarize findings from the FGDs. Consumption of sweets and sugar-sweetened beverages (S-SSB)and deep-fried foods (DFF)at least once a week was reported by 78.6% and 54.3% of the adolescents, respectively. Although all schools were surrounded by food vendors selling DFF and S-SSB,consumption was not associated with the number of vendors available around the school. However, adolescents' awareness and perception of healthy food, and their concerns about the safety of foods in the market, influenced their dietary choices and behaviours. Lack of financial resources to purchase food as desired also played a role in their selection of food and eating habits. Reported unhealthy food consumption is high among adolescents in Addis Ababa. Thus, further research is warranted to come up with school-based interventions that promote access and healthy food choices among adolescents.

The Social Exclusion Perspective of Food Insecurity: The Case of Blacked-Out Food Areas

The United Nations Global Agenda for Sustainable Development, particularly through Goal 2, simultaneously seeks to end hunger, achieve food security, improve nutrition and promote sustainable agriculture. Therefore, it is crucial to focus on the agricultural production system and on consumption conditions. This means that ‘access’ to food should be determined with respect to the three dimensions of economic, physical and solidarity access to a quantity of food that fulfils both people’s nutritional needs and environmentally responsible consumption patterns. In Italy, 9.9% of the total population, i.e., six million people, live in a state of food insecurity. In Rome, 9.4% of the population lives in a condition of material deprivation, and applications for Citizens’ Income have increased, as well as food aids which amounted to EUR 20 million in 2020. The relationships between the cost of healthy and sustainable diets (which would cost 60% more than a staple diet) and the increasing economic difficulties people are facing, have prompted a focus on the multidimensional nature of food security, with particular emphasis on people’s ability to access food. In this paper, analyzing the Metropolitan City of Rome (Italy) as a case study, we present a pilot and innovative work on an affordability index to healthy and sustainable diet. A geospatial analysis highlights areas where economic difficulties in accessing food overlap with the shortage/absence of food retail outlets and with a lack of solidarity networks (e.g., civil society food distribution initiatives), allowing a new concept to come into focus, namely the blacked-out food areas. This concept helps to identify those areas in which people are socially excluded and cannot enjoy the same substantive food-related choices as people in other areas. The research outcomes provide insights into the geographical areas and neighborhoods characterized by critical access to healthy and sustainable food, providing crucial information for the planning and implementation of targeted social policies to tackle food insecurity.

Analyzing differences between spatial exposure estimation methods: A case study of outdoor food and beverage advertising in London, Canada.

Exposure assessment in the context of mobility-oriented health research often is challenged by the type of spatial measurement technique used to estimate exposures to environmental features. The purpose of this study is to compare smartphone global positioning system (GPS), shortest network path mobility, and buffer-based approaches in estimating exposure to outdoor food and beverage advertising among a sample of 154 teenagers involved in the SmartAPPetite study during 2018 in London, Ontario, Canada. Participants were asked to report their home postal code, age, gender identity, ethnicity, and number of purchases they had made at a retail food outlet in the past month. During the same time period, a mobile phone application was used to log their mobility and specifically record when a participant was in close proximity to outdoor advertising. The results of negative binomial regression modelling reveal significant differences in estimates of advertising exposure, and the relationship to self-reported purchasing. Spatial exposure estimation methods showed differences across regression models, with the buffer and observed GPS approaches delivering the best fitting models, depending on the type of retail food outlet. There is a clear need for more robust research of spatial exposure measurement techniques in the context of mobility and food (information) environment research.

"Some are healthy and others not": Characterization of vended food products by Accra-based food retailers.

Increasing the availability of healthy foods within food retail outlets can improve consumers' food environments. Such actions or inactions by food retailers may affect people's food purchasing and consumption behavior. This study explored Accra-based food retailers' perceptions and appreciation of "healthiness of food" as a concept. It also documented measures that food retailers adopt to encourage healthy food choices. In-person semi-structured interviews were conducted with owners and managers of Accra-based supermarkets (n = 7) and corner stores (n = 13) in March 2021. The interviews were recorded, transcribed, coded, and analyzed thematically. The retailers' understanding of healthy food, or lack thereof, is exemplified by such expressions as "health, absence of disease, longevity, balanced diet, diversity, sanitation, and certification." A handful of retailers described what they sell as "products that meet consumer needs," "harmless," or "generally good." Very few retailers described the food they sell as "junk," high in sugar, fat, and salt, or energy-dense but nutrient poor foods, or as food that could pose some health risk to consumers. However, some retailers indicated that they advise their customers against the overconsumption of some foods. Overall, Accra-based retailers have a fair understanding of what constitutes healthy food - exhibiting limited knowledge of the connection between very salty, very sugary, and very fatty foods and health outcomes. Retailers in Accra require interventions that improve their food, health, and nutrition literacy. Improving retailers' food and nutrition literacy may improve the availability of healthier options in food retail outlets in Accra.