Built environment elements supportive of healthy eating in rural, remote and northern communities by Kim Bergeron, Health Promotion Consultant-Nutrition Resource Centre

1. Built environment elements supportive of
healthy eating in rural, remote and northern
communities: A scoping review
November 21, 2015
V1.1

2. Presenters:
Kim Bergeron
Health Promotion Consultant
kim.bergeron@oahpp.ca
2
Introductions
Suggested citation:
Bergeron, K. Built environment elements supportive of healthy eating in rural, remote and northern
communities: A scoping review. Ontario Agency for Health Protection and Promotion, Bring Food Home,
Sustain Ontario Conference 2015 [workshop]; Sudbury: ON. [2015] November 21.

3. We provide training and support services to Ontario’s public health
and health care intermediaries to assist them to plan, conduct and
evaluate interventions which improve health and prevent chronic
disease and injury at a community and population level.
3
About Health Promotion
Capacity Building

4. Learning Objectives
• Understand the evidence
• Identify key findings for healthy eating
• Reflect on how the information can be
applied to your own area of work
4

5. Background
• Built environments can
encourage or hinder healthy
behaviours. 1
• More than 6.3 million
Canadians live in areas with
fewer than 1,000 inhabitants
and a density below 400
people per square kilometre. 2
• Rural environments pose
unique land use,
transportation and community
planning challenges. 3
5

6. Background
• Those living on low incomes in rural parts of Canada have been
identified as vulnerable. 4
• The influence of built environments in rural settings has not been
studied in great depth 5 and urban‐based approaches are not
necessarily transferable to rural settings. 3
6

7. To present evidence on the connections between elements of
the built environment and healthy eating, physical activity and
health equity in rural, remote and northern communities.
7
Purpose of scoping review

8. Followed the five stages for conducting a scoping review 6
1) Identify the research questions:
• What built environment elements are associated with
healthy eating, physical activity and health equity in rural,
remote and northern communities?
• In what ways do these elements enhance or hinder healthy
eating and physical activity in these settings, particularly for
those who experience health inequities?
• What are the research gaps?
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9. 2) Identify relevant studies
3) Select studies
• Inclusion and exclusion criteria defined
9
 Search for scholarly articles using PsychoINFO,
MEDLINE, and Proquest
 Search for grey literature using Google
 Outreach in the field
 Review reference lists of included articles

10. 10
Search results:
Healthy eating and physical activity
Published Literature
Titles & abstracts assessed
for eligibility (N=144)
48 Full‐texted article
reviewed (N= 48)
37 critically reviewed &
included
Grey Literature
Titles assessed for eligibility
(N=46)
Full‐text publications
reviewed ( N=18)
15 included
EligibilityReviewedIncluded

11. 4) Chart the data
 Critically appraised articles7
Annotated bibliographies for academic and grey literature
were created
5) Collate, summarize and report results
Synthesized key findings
Wrote a report, an academic article and developed today’s
presentation
Knowledge dissemination tools being developed
11

12. Results
Of the 37 published articles:
• 20 were quantitative 8‐27
• 15 were qualitative 28‐42
• 1 was a literature review 43
• 1 was a systematic review 44
Of the 15 grey literature publications:
• 11 were published by Canadian sources 45‐50,52, 54, 57‐59
• 4 were published by American organizations,51,53,55,56 one of
which featured a Canadian example.55
12
Description of Studies

13. Results:
Healthy eating
13
Key Findings
• More evidence is needed
• Existing evidence = limited access to healthy foods
• Food quality was linked to healthy eating and
geographic food access, availability and affordability
• Types of stores available and the concept of proximity
are closely related, but more is involved than just
distance (availability; affordability; quality) when it
comes to selecting a food store

14. Results:
Healthy eating & health equity
14
Key Findings
• Vulnerable populations (e.g., low‐income, Aboriginal
Peoples, seniors) face even greater disparity of food
accessibility, availability, and affordability = less options
and strategies
• Improvements are needed, particularly in remote
Aboriginal communities

15. Results:
Healthy eating research gaps
15
• Methodological challenge of using administrative
boundaries
• Limited studies that examined the concept of
food deserts
• Exclusion of local food production/alternative
food sources (e.g., community gardens, roadside
produce stands, farmers’ markets, foraging,
hunting, fishing) and the cultural relevance of
traditional foods in the North
• Limited consideration of consumer behaviours
such as using freezers and/or visiting more then
one store

16. Discussion
16
Healthy eating:
1. Limited access to healthy food retail outlets and some
populations experience greater disparities of food accessibility,
availability and affordability
2. Proximity to stores that offer a variety and low‐cost foods doesn’t
seem to be directly related to making choices for healthy eating.
Rural residents who choose to purchase healthy foods develop
strategies to do so; however, distance is a barrier for those living
in poverty and those living in the extreme North
3. The use of alternative food sources warrants further investigation

17. Limitations
17
• Cross‐sectional study design used by the majority of quantitative
studies; limits the ability to establish a causal relationship
• Lack of studies that examined Canadian communities; most studies
were conducted in the USA, potentially limiting applicability to the
Canadian context
• Lack of consistent definition of “rural” limits comparisons across
studies
• Our approach to locate studies has some limitations (e.g.,
combination of search terms; the use of search engines); some
relevant studies may have been missed

18. Strengths
18
• Our training and familiarity with health and the built environment
(e.g., both graduates of the Built Environment Assessment Training
Institute; conducted other research on this topic area)
• The use of comprehensive search strategies to identify literature
and assessing the included articles for quality

19. Research implications
19
• Generate Canadian studies in this topic area
• Define both rurality in general and the degree of rurality of the
region being studied, so that comparisons can be made across
studies (check out reference 60)
• Need to move beyond cross‐sectional study designs to include
longitudinal research
• Need to investigate the experiences of vulnerable populations
living in rural, remote and northern communities to better
understand how built environment elements facilitate or hinder
healthy eating and physical activity

20. Practice implications
20
• Understand the available
alternative food sources and
identify ways to connect people to
these food sources
• Understand where people shop for
food to influence municipal
decisions for development
• Consider ways to help secure
freezers

21. Questions?

22. Acknowledgements
 Co-author of the scooping review Sue Cragg,
Knowledge Broker
 Britt Erickson and Mitulika Chawla, Policy
Analysts at the Public Health Agency of Canada
 Kara DeCorby and Gloria Mensah, HPCB
 Marianne McClinton
 We would also like to thank the many researchers
and practitioners who responded to our call for
relevant studies for this project.

23. 23
Kim Bergeron
kim.bergeron@oahpp.ca

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29. Disclaimer
This document may be freely used without permission for non‐
commercial purposes only and provided that appropriate credit
is given to Public Health Ontario. No changes and/or
modifications may be made to the content without explicit
written permission from Public Health Ontario.
29