Development and evaluation of food environment audit instrument: AUDITNOVA

Borges, Camila Aparecida; Jaime, Patricia Constante

doi:10.11606/s1518-8787.2019053001316

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Saúde Pública 53 • 2019 • https://doi.org/10.11606/s1518-8787.2019053001316 copy

Development and evaluation of food environment audit instrument: AUDITNOVA

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To develop and assess the reliability of an instrument that enables auditing information on consumer food environment indicators, such as availability, price, promotional and advertising strategies, and quantity of brands available, using the food recommendations adopted by the Dietary Guidelines for the Brazilian Population as a theoretical basis.

METHODS

This is a methodological study in two phases: 1. development of the audit instrument and 2. assessment of its reliability and reproducibility . The Content Validity Index was estimated for each instrument item (>0.80 satisfactory). Inter-rater and test-retest reliability were assessed by percentage agreement and Kappa coefficients. Pearson’s correlation coefficient and Scatter-plots were used to measure the degree of linear correlation between two quantitative variables.

RESULTS

The Content Validity Index was 0.91. Inter-rater and test-retest reliability were mostly high (Kappa> 0.80), for food availability indicators. Among the items that measure advertising, Kappa values for inter-rater reliability ranged from 0.57 to 1.00 and for the test-retest ranged from 0.18 to 0.90. Prices and quantity of brands showed a positive linear correlation between measurements performed by researcher 1 and 2 and between visits 1 and 2.

CONCLUSIONS

AUDITNOVA is reliable for measuring aspects such as availability, price, quantity of brands, and advertising of foods available in the consumer food environment.

Item	Average CVI*	Change	Reasons for the change
Block 1 — Food availability, price, variety, and quality

Item 1. Which in natura /minimally processed foods does the market sell?	0.97	Inclusion of new in natura foods and division of food items according to supermarket sections	To audit in natura /minimally processed foods often consumed by the Brazilian population and to facilitate data collection
Item 2. Is FV section located near the store entrance?	0.97	None	-
Item 3. In natura /minimally processed foods: availability and price	0.89	Inclusion of options for price type (normal or promotional) and unit of measure (kg, dozen, unit) for FV; removal of food quality item	Units of measure variation hindering price collection; low ability to distinguish food quality
Item 4. Which culinary ingredients does the market sell?	0.89	Inclusion of new items; distribution of items by supermarket section	To audit culinary ingredients frequently consumed by the Brazilian population and to facilitate data collection
Item 5 Culinary Ingredients: Availability and Price	0.97	Inclusion of price type (normal or promotional), quantity of brands, most expensive and cheapest price; standardization of items	To audit more details of culinary ingredients
Item 6 Which processed foods does the market sell?	0.97	Inclusion of new items; distribution of items by supermarket section	To audit processed foods often consumed by the Brazilian population and to facilitate data collection
Item 7. Processed foods: availability and price	0.92	Inclusion of price type (normal or promotional), quantity of brands, most expensive and cheapest price; standardization of items	To audit more details of processed foods
Item 8. Which ultra-processed foods does the market sell?	0.94	Inclusion of new items; distribution of items by supermarket section	To audit ultra-processed foods often consumed by the Brazilian population and to facilitate data collection
Item 9. Ultra-processed foods: availability and price	0.90	Inclusion of price type (normal or promotional), quantity of brands, most expensive and cheapest price; standardization of items	To audit more details of ultra-processed foods

Block 2 – publicity and advertising

Item 1. Visual advertising encouraging FV purchase	0.88	Deleted and made into new items	New embedded items were able to capture the variability of advertisements
Item 2. Advertising type verified in FV section	0.89	Each type became a new questionnaire item	New embedded items were able to capture the variability of advertisements
Item 3. Appeal and reason for the advertising in the FV section	0.97	Each appeal and reason became a new item in the questionnaire.	New embedded items were able to capture the variability of advertisements
Item 4. Visual advertising that encourages the purchase of sugary drinks such as added sugar juices, nectars, and soft drinks.	0.94	Deleted and made into new items to evaluate ultra-processed advertising in general	New embedded items were able to capture the variability of advertisements
Item 5. Types of sugary drink advertisements	0.92	Deleted and made into new items to evaluate ultra-processed advertising in general	New embedded items were able to capture the variability of advertisements
Item 6. Appeal and reason for the advertising in the sugary drink section	0.89	The most relevant appeals and reasons became new items in the questionnaire.	New embedded items were able to capture the variability of advertisements
Item 7. Visual advertising encouraging the purchase of crackers, cookies and cornmeal snacks in the sections where these foods can be found.	0.92	Deleted and made into new items to evaluate ultra-processed advertising in general	New embedded items were able to capture the variability of advertisements
Item 8. Crackers/Cookies/Cornmeal snacks: Types of Advertisements	0.86	Deleted and made into new items to evaluate ultra-processed advertising in general	New embedded items were able to capture the variability of advertisements
Item 9. Appeal and reason for the advertising in the cookie/cracker/snack section	0.86	The most relevant appeals and reasons became new items in the questionnaire.	New embedded items were able to capture the variability of advertisements
Item 10. Are there any health promotion or advertising messages related to food and health in the establishment?	0.83	No changes, but applied to in natura /minimally processed and ultra-processed foods	This theme applies to many types of healthy and unhealthy foods
Item 11. Write down the messages	0.81	Deleted	New embedded items were able to capture the variability of advertisements
Item 12. Do the checkout aisles have magazines/posters/folders with news about fad diets, superfoods, diet versus light and/or other food and health news?	0.97	None	-
Item 13. Do the checkout aisles sell chocolates, treats, soft drinks, energy drinks or other types of ultra-processed products?	0.92	Each food was detailed in a new item.	More detailed characterization of the checkout aisle
Item 14. Do the checkout aisles have ultra-processed food advertising?	0.94	None	-
Total CVI of the instrument	0.91	-	-

Types of Foods Available	Inter-rater reliability			Test-retest reliability

	n	agreement %	Kappa	n	agreement %	Kappa
In natura /Minimally Processed Foods	72	59.7	0.55	41	55.8	0.52
Orange	73	100.0	1.00	41	92.7	0.88
Banana	73	94.5	0.72	41	82.9	0.72
Formosa papaya	72	100.0	1.00	41	78.5	0.61
Fuji apple	73	93.1	0.70	41	90.2	0.79
Watermelon	72	97.2	0.93	41	85.4	0.74
Other fruits	73	98.6	0.85	41	97.6	0.94
Tomato	73	93.1	0.83	41	90.2	0.84
Onion	73	98.6	0.85	41	92.7	0.84
Lettuce	73	100.0	1.00	41	87.8	0.78
Carrot	73	98.6	0.90	41	78.0	0.64
Zucchini	73	91.8	0.75	41	87.8	0.79
Chayote	73	98.6	0.91	41	92.7	0.86
Mix of parsley, spring onion, and cilantro	73	95.9	0.88	41	82.9	0.71
Other vegetables	73	97.3	0.78	41	92.7	0.86
Potato	73	98.6	0.90	41	85.4	0.72
Cassava	73	98.6	0.97	41	65.8	0.44
Other roots and tubers	73	94.5	0.64	41	95.1	0.90
Sweet corn	73	94.5	0.87	41	73.2	0.57
Eggs	73	94.5	0.84	41	75.6	0.6
Other eggs	73	97.3	0.90	41	85.4	0.74
Prime beef	73	100.0	1.00	41	87.8	0.81
Choice beef	73	98.6	0.97	41	87.8	0.81
Chicken	73	98.6	0.96	41	80.5	0.68
Chicken Breast	73	98.6	0.85	41	95.1	0.90
Fish	73	98.6	0.93	41	100.0	1.00
Cow milk	73	100.0	1.00	41	97.6	0.95
Pinto beans	73	100.0	1.00	41	95.1	0.91
Black turtle beans	73	100.0	1.00	41	90.2	0.82
White rice	73	100.0	1.00	41	97.6	0.95
Wheat flour	73	100.0	1.00	41	100.0	1.00
Cassava flour	73	98.6	0.79	41	87.8	0.73
Spaghetti	73	98.6	0.93	41	100.0	1.00
Raw peanut	73	90.4	0.70	41	75.6	0.56
500 ml Water	73	100.0	^a	41	97.6	0.95
5-liter gallon Water	73	100.0	1.00	41	73.2	0.55
Culinary Ingredients	73	93.1	0.87	41	70.7	0.64
Butter	73	100.0	1.00	41	92.7	0.86
Soybean oil	73	100.0	^a	41	95.1	0.89
Olive oil	73	100.0	1.00	41	97.6	0.93
Refined salt	73	98.6	0.79	41	100.0	1.00
Sanding Sugar	73	94.5	0.88	41	80.5	0.68
White Sugar	73	100.0	^a	41	100.0	1.00
Processed foods	73	94.5	0.89	41	68.3	0.61
Bacon	73	98.6	0.91	41	92.7	0.86
Dried meat	73	97.3	0.93	41	80.5	0.70
Cheese	73	100.0	^a	41	97.6	0.94
Canned Corn	73	100.0	1.00	41	97.6	0.95
Tomato purée	73	100.0	1.00	41	100.0	1.00
Canned Sardines	73	98.6	0.79	41	97.6	0.95
Bread roll	73	100.0	1.00	41	82.9	0.68
Ultra-Processed Foods	73	82.2	0.76	41	61.0	0.57
Hot dog sausage	73	100.0	1.00	41	95.1	0.91
Pork Sausage	73	93.1	0.80	41	90.2	0.82
Fermented milk	73	98.6	0.95	41	92.7	0.86
Instant noodle	73	98.6	0.88	41	90.2	0.80
Ready-made seasoning	73	100.0	1.00	41	100.0	1.00
Sliced bread	73	97.3	0.78	41	90.2	0.79
Breakfast Cereals	73	98.6	0.88	41	97.6	0.94
Frozen pizza	73	100.0	1.00	41	95.1	0.90
Ice cream	73	98.6	0.94	41	85.4	0.73
Regular Can Soda^a	73	100.0	1.00	41	100.0	1.00
Regular 2-liter Soda^b	73	100.0	1.00	41	100.0	1.00
Zero/zero sugar/diet soda	73	100.0	1.00	41	97.6	0.94
Nectar	73	100.0	1.00	41	100.0	1.00
Fruit juice drink	73	100.0	1.00	41	100.0	1.00
Cornmeal snacks	73	100.0	1.00	41	100.0	1.00
Sandwich cookie	73	100.0	^a	41	100.0	^a
Chocolate	73	95.9	0.80	41	92.7	0.85
Candies	73	97.3	0.94	41	97.5	0.96

Indicators of availability of food groups and price type according to NOVA	Inter-rater reliability			Test-retest reliability

	n	agreement %	Kappa	n	agreement %	Kappa
FV at the store entrance	73	95.9	0.92	41	97.6	0.95
Food groups sold
In natura /minimally processed Foods	73	100.0	*	41	100.0	*
Culinary ingredients	73	100.0	*	41	100.0	*
Processed foods	73	100.0	*	41	100.0	*
Ultra-processed Foods	73	100.0	*	41	100.0	*
Primarily sold food groups
In natura /minimally processed foods	73	75.3	0.69	41	90.2	0.78
Culinary ingredients	73	97.3	0.75	41	95.1	0.88
Processed foods	73	87.7	0.36	41	95.1	0.90
Ultra-processed Foods	73	91.8	0.78	41	100.0	1.00
Price type (normal or promotional)
In natura /minimally processed Foods	73	93.0	0.90	41	93.6	0.89
Culinary ingredients	73	81.1	0.77	41	82.1	0.78
Processed foods	73	71.4	0.61	41	70.4	0.58
Ultra-Processed Foods	73	61.7	0.56	41	52.6	0.48

Types of Advertisements and Advertising Strategies	Inter-rater reliability			Test-retest reliability

	n	agreement %	Kappa	n	agreement %	Kappa
Checkout aisle advertisements
In natura /minimally processed food advertisements of different types	73	89.0	0.57	41	90.2	0.77
UPF food advertising of different types	73	93.1	0.81	41	92.7	0.83
Tabloid	73	94.5	0.90	41	94.5	0.90
Folder or leaflet	73	98.6	0.88	41	95.1	0.79
Approaches in physical space
In natura food flags	73	87.7	0.65	41	87.8	0.72
In natura food banner/posters	72	84.7	0.60	41	82.5	0.52
In natura food displays	73	89.0	0.65	41	87.8	0.46
In natura food tabloids	73	87.7	0.75	41	65.8	0.39
In natura food recipes folder/leaflet	73	91.8	0.65	41	90.2	0.55
UPF food displays	73	100.0	1.00	41	95.2	*
UPF food promotional islands	73	86.3	0.67	41	68.3	0.37
UPF food endcaps	73	82.2	0.66	41	72.5	0.48
UPF food tasting counters	73	97.3	0.74	41	95.1	*
Message types and consumer appeals
Food functional property with in natura food	73	98.6	0.95	41	87.8	0.72
Physical activity and in natura food	73	98.6	0.66	41	95.1	0.62
Wellness, good mood, self-esteem with in natura /minimally processed food	73	91.8	0.62	41	92.7	0.70
Health claim with in natura food	72	95.8	0.84	41	82.9	0.72
Appeal to practicality with in natura /minimally processed food	73	94.5	0.68	41	92.7	0.67
Highlight in in natura /minimally processed food flavor, odor, color, or texture	72	94.4	0.84	41	87.8	0.48
Health and wellness claim with UPF food	73	86.3	0.72	41	78.0	0.58
Appeal for practicality with UPF food	73	84.9	0.62	41	56.1	0.23
Functional property with UPF	73	84.9	0.68	41	72.5	0.41
Highlight in UPF food flavor, odor, color, or texture	73	90.4	0.80	41	65.8	0.43
Advertisements about tastings, giveaways, promotions, and releases
Take 3, pay 2 with in natura food	73	98.6	*	41	97.6	*
In natura /minimally processed product launches	72	98.6	*	41	*	*
Natura/minimally processed giveways or tie-in sales	73	95.9	0.64	41	*	*
UPF free samples	73	98.6	*	41	95.6	*
Take 3, pay 2 with UPF	73	87.7	0.71	41	78.0	0.46
UPF releases	73	78.1	0.62	41	53.6	0.18
UPF giveaways or tie-in sales	73	79.4	0.61	41	73.2	0.46
Advertising in general with culinary ingredients	73	86.3	0.70	41	61.0	0.18
Processed food advertising in general	73	80.8	0.65	41	61	0.20
Advertisements outside the establishment
Advertising in general with in natura /minimally processed foods	73	90.4	0.70	41	78.0	0.61
Advertising in general of culinary ingredients	73	94.5	0.77	41	80.5	0.66
Advertising of processed foods in general	73	94.5	0.82	41	75.6	0.58
UPF advertising outside the establishment	73	93.1	0.85	41	78.5	0.60

Quantitative variables	Inter-rater			Test-retest

	Mean (SD) Researcher 1	Mean (SD) Researcher 2	r	Mean (SD) Visit 1	Mean (SD) Visit 2	r
In natura /minimally processed food price	5.34 (1.51)	5.28 (1.42)	0.98	5.51 (1.26)	5.35 (1.47)	0.82
Price of ingredients	7.17 (2.68)	7.15 (2.61)	0.99	7.12 (2.66)	7.11 (2.86)	0.90
Processed food price	16.14 (8.41)	16.34 (8.59)	0.97	15.09 (4.23)	15.04 (4.28)	0.65
Ultra-processed food price	6.85 (1.53)	6.67 (1.59)	0.95	6.93 (1.60)	6.63 (1.36)	0.84
Minimally processed food brands	3.45 (1.19)	3.51 (1.62)	0.75	3.91 (1.73)	3.46 (1.10)	0.47
Ingredient Brands	3.88 (2.05)	3.85 (2.01)	0.98	3.91 (1.89)	4.01 (2.09)	0.93
Processed food brands	3.09 (1.18)	3.10 (1.23)	0.96	3.35 (1.15)	3.13 (1.20)	0.89
Ultra-processed food brands	4.19 (1.35)	4.00 (1.21)	0.97	4.32 (1.06)	4.24 (1.11)	0.92

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Camila Aparecida Borges Avenida Dr. Arnaldo, 715 01246-904 São Paulo, SP, Brasil E-mail: camila.borges@usp.br