Measuring nutrition environments: a comparison between instrument evaluation in developed and developing countries.
Abstract
Background: Nutrition environments can either be supportive or detrimental to population health. Healthy nutrition environments are equally important in both developed and developing regions, however rapidly urbanizing areas of the developing world are facing the double burden of nutrition as they deal with both hunger and obesity simultaneously. A number of instruments aimed at measuring nutrition environments have been created and evaluated, though most of this evaluation has taken place in developed settings.
Methods: A literature review was undertaken in order to identify journal articles that evaluate instruments that measure nutrition environments and assess their applicability to different settings. Two separate searches returned 48 relevant articles with 20 included in this review. Eighteen articles were from developed settings. Most included articles reported testing of reliability and validity of the measurement instruments.
Discussion: There is a lack of literature describing the measurement of nutrition environments in developing cities, however the NEMS instrument developed by Glanz et al. has been implemented in Brazil. Instruments measuring nutrition environments have several shortcomings, and caution should be used when extrapolating results about the environment to the behaviour of individuals.
Recommendations: Based on this review it appears that the NEMS instruments is the most likely to be successfully modified to unique settings, and could be implemented in developing cities to measure their nutrition environment. The indicator foods used in the modified instrument should be well researched and applicable to each unique setting.
References
1. University of Pennsylvania. Welcome to NEMS. In Nutrition Environment Measures Survey; [date unknown]. Available from: http://www.med.upenn.edu/nems/index.shtml
2. Glanz K, Sallis JF, Saelens BE, Frank LD. Healthy Nutrition Environments: Concepts and Measures. Am J Health Behav. 2005; 19(5), 330-333.
3. Martins PA, Cremm, EC, Leite F, Maron LR, Scagliusi FB, Oliveira MA. Validation of an Adapted Version of the Nutrition Environment Measurement Tool for Stores (NEMS-S) in an Urban Area of Brazil. J Nutri Educ Behav. 2013; 45(6), 785-792.
4. Kanter R, Alvey J, Fuentes D. A novel mobile phone application to assess nutrition environment measures in low- and middle-income countries. Food Nutr Bull. 2014; 35(3), 296-300.
