title: Evaluation of a pilot healthy eating intervention in restaurants and food stores of a rural community: a randomized community trial.
abstract: BACKGROUND
  Research suggests that the food environment influences individual eating practices. To date, little is known about effective interventions to improve the food environment of restaurants and food stores and promote healthy eating in rural communities. We tested "Waupaca Eating Smart " (WES), a pilot intervention to improve the food environment and promote healthy eating in restaurants and supermarkets of a rural community. WES focused on labeling, promoting, and increasing the availability of healthy foods.
  
  
  METHODS
  We conducted a randomized community trial, with two Midwestern U.S. communities randomly assigned to serve as intervention or control site. We collected process and outcome data using baseline and posttest owner and customer surveys and direct observation methods. The RE-AIM framework was used to guide the evaluation and organize the results.
  
  
  RESULTS
  Seven of nine restaurants and two of three food stores invited to participate in WES adopted the intervention. On a 0-4 scale, the average level of satisfaction with WES was 3.14 (SD=0.69) for restaurant managers and 3 (SD=0.0) for store managers. On average, 6.3 (SD=1.1) out of 10 possible intervention activities were implemented in restaurants and 9.0 (SD=0.0) out of 12 possible activities were implemented in food stores. One month after the end of the pilot implementation period, 5.4 (SD=1.6) and 7.5 (SD=0.7) activities were still in place at restaurants and food stores, respectively. The intervention reached 60% of customers in participating food outlets. Restaurant food environment scores improved from 13.4 to 24.1 (p < 0.01) in the intervention community and did not change significantly in the control community. Food environment scores decreased slightly in both communities. No or minimal changes in customer behaviors were observed after a 10-month implementation period.
  
  
  CONCLUSIONS
  The intervention achieved high levels of reach, adoption, implementation, and maintenance, suggesting the feasibility and acceptability of restaurant-and food store-based interventions in rural communities. Pilot outcome data indicated very modest levels of effectiveness, but additional research adequately powered to test the impact of this intervention on food environment scores and customer behaviors needs to be conducted in order to identify its potential to promote healthy eating in rural community settings.
authors.affiliation: Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA. martinezdona@wisc.edu.
authors.forename: Ana P
authors.initials: AP
authors.lastname: Martínez-Donate
authors.affiliation: Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA. ajgolemb@gmail.com.
authors.forename: Ann Josie
authors.initials: AJ
authors.lastname: Riggall
authors.affiliation: Obesity Prevention Network, University of Wisconsin, Madison, WI, USA. ameinen@wisc.edu.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Meinen
authors.affiliation: Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA. kmalecki@wisc.edu.
authors.forename: Kristen
authors.initials: K
authors.lastname: Malecki
authors.affiliation: University of California, Los Angeles, USA. aescaron@gmail.com.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Escaron
authors.affiliation: Waupaca County NuAct Coalition, Waupaca, WI, USA. Bev.Hall@co.waupaca.wi.us.
authors.forename: Bev
authors.initials: B
authors.lastname: Hall
authors.affiliation: Waupaca County NuAct Coalition, Waupaca, WI, USA. Anne.Menzies@thedacare.org.
authors.forename: Anne
authors.initials: A
authors.lastname: Menzies
authors.affiliation: Portage County Activity and Nutrition Coalition, Stevens Point, WI, USA. garskeg@co.portage.wi.us.
authors.forename: Gary
authors.initials: G
authors.lastname: Garske
authors.affiliation: Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA. fjnieto@wisc.edu.
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Nieto
authors.affiliation: Department of Nutritional Sciences, University of Wisconsin, Madison, WI, USA. nitzke@nutrisci.wisc.edu.
authors.forename: Susan
authors.initials: S
authors.lastname: Nitzke
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005247:Feeding Behavior; D005260:Female; D019649:Food Industry; D005515:Food Labeling; D005523:Food Supply; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States; D010865:Pilot Projects; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012147:Restaurants; D012424:Rural Population; D011795:Surveys and Questionnaires