Mapping factors associated with a successful shift towards healthier food retail in community-based organisations: A systems approach

Background: Food retailers in community settings are gatekeepers to the crucial food systems changes needed to improve population nutrition. Evidence-based models of change are needed to enable shifts in these complex retail environments. Systems thinking offers unique insights by capturing potential unintended consequences and multiple pathways to success. This study sought to create a systems map for retailers, public health practitioners and other stakeholders seeking to implement healthy food retail policies. It aimed to identify (i) points of intervention through which community-based organisations can shift to healthier food provision, and (ii) key feedback loops that could drive potential unintended consequences of such policies in a complex system. Methods: Semi-structured interviews (n = 26) were conducted, from 2015 to 2018, across four community food retail settings where healthy food retail policies had been implemented in Victoria, Australia. Interviews were coded by identifying causal relationships and their direction between factors. Vensim software was used to merge interview results and then reduce the map to the strongest and most frequent factors and relationships. Illustrative implementation stories and points of intervention were identified. Findings: The resulting map is titled the Systems Thinking Approach for Retail Transformation (START) map. Five prominent implementation stories incorporating 17 factors highlighted that: 1) retailer resistance to change is strongest in the beginning but decreases with the demonstration of favourable initiative outcomes; 2) successive changes tend to be increasingly complex, and therefore harder for retailers to implement; 3) organisational resourcing can be influenced through multiple pathways; 4) customer acceptability of healthy changes and retailers' willingness to engage in changes influence each other; and 5) challenges in accessing healthy supply options make retailers more resistant to implementing healthy changes. Conclusions: The application of systems thinking to the challenge of unhealthy food retail creates novel and practical insights for retailers and health promotion practitioners into what actions are most likely to promote healthy changes in complex retail environments.