Plentiful, affordable, healthy food: does your grocery store measure up?

FEAT-S was developed to address the limitations of previous tools, such as Health Canada’s National Nutritious Food Basket, which measured only two dimensions of grocery shopping: availability and price.

This narrow lens was deemed no longer sufficient—particularly for First Nations, which have high rates of food insecurity, obesity and diabetes.

The goal was to “develop a more robust tool to describe food retail environments and assess the interactions between food availability in a community and health problems in the population,” Mobetty said.

The research team started with the National Nutritious Food Basket, which contained 57 nutritious foods, and expanded it by adding 13 ultra-processed foods, for a total of 70 products. Ultra-processed foods are not recommended by Canada’s Food Guide but are widely consumed.

FEAT-S also broadens the analysis by evaluating six dimensions of the food retail environment instead of just two: availability, price, quality, variety, shelf space and the promotion of food items.

The team tested FEAT-S through a four-step validation process, including trial runs in Montreal and Kanesatake, a Mohawk community west of the city. An evaluation by nine food environment experts yielded a very high content validity index of 0.92. The reliability and usability of the tool were then assessed through user testing. 

While FEAT-S is designed for all Canadian communities, the study focused on First Nations, which are “heavily dependent on food from grocery stores because access to traditional Indigenous foods has become difficult for a number of reasons, including soil and water contamination, the effects of climate change and government restrictions on access to some lands,” Mobetty explained. 

Previous studies have reported that some First Nations “complain about the food sold in grocery stores, which is of lower quality and very expensive,” Mobetty continued.

“To understand the interactions between food security and health in First Nations, it is important to know what foods they have access to. What foods are available around them? How far do they have to go to get them and can they afford to buy them? And what is the quality of these foods?”

The research team is now collecting field data in several First Nations communities as part of the FEHNCY study. After obtaining band council approval, they decide which stores to evaluate based on a preliminary questionnaire in which respondents report where they most frequently shop for groceries. 

“People sometimes travel hundreds of kilometres to an urban centre to stock up,” said researcher Ariane Lafortune. FEAT-S can be used to compare the food retail environment in the community with the big city, where access to food is assumed to be easier.

The researchers visit stores equipped with FEAT-S loaded on a tablet and a tape measure to gauge shelf space. After training, it takes an average of approximately one hour and 15 minutes to enter the information for one store on the tablet. 

Sometimes, adjustments must be made for local circumstances. For example, at one small store, the prices weren’t displayed. In that case, the researchers had to put all 70 items in a shopping cart and take them to the cash register to be scanned.

The study is ongoing and initial results are now coming in. Contrary to what one might expect, all types of food are not always pricier in remote communities, Mercille reported, although that is often the case. In one community, for example, the 13 ultra-processed foods were all more expensive inside the village than outside.

Interpreting the observations requires collaboration. “When we measure the food retail environment, we don’t do it alone,” Mercille said. “It isn’t done in a vacuum. The observations have to be interpreted together with the community.”

For example, if fruit is cheap, it could be a strategy by retailers “to promote rapid product turnover to prevent it from going bad.”

The detailed profiles of food retail environments produced using FEAT-S are expected to generate solid data to support future public policy.