Mi Jin Jang; Sangah Shin; Seong-Ah Kim; Sangwon Chung; Hee Young Paik; Jeong-sook Choe; Eun Joo Hong; Hyojee Joung

doi:10.4163/jnh.2014.47.5.351

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Jang, Shin, Kim, Chung, Paik, Choe, Hong, and Joung: Developing and testing the reliability of a measurement tool for an urban area food environment in Korea – Focusing on food stores -∗

Research Article

J Nutr Health 2014;47(5):351-363.

Published online: 20 January 2014

DOI: https://doi.org/10.4163/jnh.2014.47.5.351

Developing and testing the reliability of a measurement tool for an urban area food environment in Korea – Focusing on food stores -∗

Mi Jin Jang¹, Sangah Shin², Seong-Ah Kim², Sangwon Chung¹, Hee Young Paik³, Jeong-sook Choe⁴, Eun Joo Hong⁵, Hyojee Joung^1,²

¹Department of Public Health Nutrition, Graduate School of Public Health, Seoul National University, Seoul 151–742, Korea

²Institute of Health and Environment, Seoul National University, Seoul 151–742, Korea

³Department of Foods and Nutrition, Seoul National University, Seoul 151–742, Korea

⁴National Academy of Agricultural science, Rural Development Administration, Suwon 441–707, Korea

⁵Department of Economics & Finance, Hanyang Cyber University, Seoul 133–791, Korea

Received 23 June 2014 Revised 1 August 2014 Accepted 29 September 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to develop a reliable measurement tool to assess the urban food environment, particularly focusing on food stores in Korea. Methods: The items for the measurement tool were selected through systematic literature reviews and adjusted to the Korean food environment. A total of 25 food stores in an urban area were recruited for the pilot test to evaluate the time required for completion of the survey, ease of response, willingness to participate, difficulties in conducting the survey, and appropriateness, and 34 food stores were recruited for assessment of the reliability of the tool using percent agreement and kappa value. Results: The measurement tool is composed of questions regarding food store characteristics, accessibility, and food availability. On average, 26 minutes was required to survey a single food store, and the subjects and interviewers answered that the process was not difficult for the survey. The percent agreement for the inter-rater and test-retest reliability ranged from 93.9∼98.8% and 91.9∼97.9, respectively. The kappa values ranged from 0.78 to 0.97, which was very high. Percent agreement and kappa value of food with healthy option were lower than those of the general food in the inter-rater reliability (p = 0.0027, p = 0.0095 respectively) as well as in the test-retest reliability (p = 0.0081, p = 0.0290, respectively), although they were still high enough (86.4∼98.0% for percent agreement, 0.64∼0.96 for kappa value). Conclusion: The newly developed measurement tool for assessment of food store environment appears to be feasible and reliable; therefore, it can be applied to research on the association between food environment and dietary behaviors as well as health outcomes.

Keywords: food environment, food stores, measurement tool, feasibility, reliability

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Fig. 1.

Study flow for developing a food environment measurement tool.

Table 1.

Composition of the measurement tool for food store

Features	Define	Question item
		(1) Basic information: food store type, operation hour, holiday, store size, the number of staff member and cash register, payment option
Characteristics	A typical feature of food stores to distinguish from other type of food stores	(2) Detailed information: alcoholic beverage and tobacco sales and ads, selling products around check-out lanes, primary product for sale
		(3) Customer information: average number of customer(weekday, weekend), age group of main customer, gender of main customer
Accessibility	Degree to which food stores are available in neighborhood.	(1) Geographic availability of different types of food stores: food store address
		(2) Easiness of food stores access to customers: transportation access, parking space, delivery, teleshopping or online shopping
Availability	Actual foods which are available in neighborhood food stores.	(1) Eco-friendly products sales
		(2) Sales status for 15 food categories
		(3) Sales for healthy food option of 12 food categories

Table 2.

The measurement items for food availability

Index		Measurement items
Food availability	Eco-friendly food	1) Availability for any single eco-friendly food products 2) Availability for promotional activity 3) Change in sales volume after promotional activity
Food availability	Food groups	1) Grains and cereal, 2) Breads, 3) Noodles, 4) Vegetables, 5) Fruits, 6) Meats 7) Fishes and shellfishes, 8) Legume and bean processed products, 9) Eggs, 10) Milk and dairy products, 11) Beverages, 12) Nuts, 13) Snacks, 14) Condiments and spices, 15) Fat and oils
Diversity of fruits & vegetables	Fruits	Diversity points = 1) +2) +3) +4) 1) Kinds of fresh fruits: total number 2) Dried fruits: if available, score 1 point 3) Canned or jarred fruits: if available, score 1 point 4) Frozen fruits: if available, score 1 point
Diversity of fruits & vegetables	Vegetables	Diversity points = 1) + 2) +…… + 11) ∗ If available, score 1 point per each specific food item 1. Leaf, root vegetable: 1) Room temperature or cold storage, 2) Dried, 3) Boiled, 4) Pre-processed 2. Mushroom: 5) Room temperature or cold storage, 6) Dried, 7) Preprocessed 3. Seaweed: 8) Room temperature or cold storage, 9) Dried, 10) Preprocessed, 11) Processed

Table 3.

The food specified for healthy option items

Index	Measurement items
Grains and cereal	brown rice, whole grain, instant cooked rice with whole grain, whole grain cereal
	low sugar cereal, cereal for weight management¹⁾
Breads	whole grain breads
Noodles	low calorie noodle
Meats	low fat, low sodium, no sodium nitrate for processed meats
Legume and bean processed products	low fat, calcium enriched, low GI for soymilk
Eggs	non antibiotics
Milk	low fat/ calorie, no fat, calcium enriched
Milk and Flavored milk	low fat/ calorie
dairy products Yogurt	low fat/ calorie
Cheese	low fat/ calorie, low sodium, calcium enriched
Juice	cold-chain juice
Beverages Soft drink	zero calorie soft drink
Coffee(powder type)	low fat/ calorie, decaffeinated
Nuts	low or unsalted nuts
Snacks	snack for weight management
Korean traditional sauce	low sodium
Salt	low sodium
Condiments and spices Sugar Mayonnaise, ketchup	xylose sugar, brown sugar, sugar replacement, oligosaccharide low fat/ calorie, low sodium, low sugar
Dressing	low fat/no fat
Fat and oils Butter	unsalted

1) Brown rice, whole grain were included for analysis even though they are not processed food.

Table 4.

Characteristics of food stores participated in the pilot and reliability test

	Hypermarket	Supermarket, chain	Supermarket, non-chain	Convenience store	Direct dealing market	Conventional market	Specialty store, butcher S st v	Specialty ore, fruit & egetable
Pilot test (n = 25)	0	5	8	8	0	0	3	1
Size
Mean area (m²)	–	916 ± 354¹⁾	103 ± 110	59 ± 26	–	–	59 ± 37	36²⁾
Number of staff memb	er -	20 ± 9	3 ± 1	3 ± 1	–	–	2 ± 1	2
Working condition
Business day/week	–	7 ± 0	7 ± 0	7 ± 0	–	–	7 ± 0	7
Business hour (h)/day³⁾	–	14 ± 1	17 ± 1	24 ± 1	–	–	13 ± 1	12
Number of customer
weekday	–	1,420 ± 1,069	228 ± 158	271 ± 154	–	–	67 ± 72	100
weekend	–	1,700 ± 1,017	260 ± 197	278 ± 158	–	–	67 ± 72	100
Reliability test (n = 33)	2	8	10	2	1	5	5	0
Size
Mean area (m²)	29,759 ± 22,786	634 ± 328	368 ± 461	43 ± .⁴⁾	132²⁾	15,597 ± 23,156	83 ± 39	–
Number of staff memb	ber 346 ± 190	21 ± 14	6 ± 9	2 ± 0	12	248 ± 285	5 ± 3	–
Working condition
Business day/week	7 ± 0	7 ± 0	7 ± 0	7 ± 0	7	7 ± 0	7 ± 0	–
Business hour (h)/week	kday 14 ± 0	14 ± 1	16 ± 2	24 ± 0	14	13 ± 1	13 ± 1	–
Business hour (h)/week	kend 14 ± 0	14 ± 1	15 ± 2	24 ± 0	13	13 ± 1	12 ± 1	–
Number of customer
weekday	7,000 ± 4,243	950 ± 627	337 ± 417	200 ± .4	1,200	4,540 ± 3,436	115 ± 93	–
weekend	8,000 ± 2,828	1,179 ± 973	388 ± 520	150 ± .4	1,500	5,740 ± 5,386	187 ± 159	–

1) Mean ± SD 2) No SD because of single food store 3) Business hour on weekday and weekend were same 4) One of them is missing.

Table 5.

The easiness to respond for measurement tool among the subjects who answered the question (N = 13)

Question item General characteristics	Easiness to respond
Question item General characteristics	Easy	Moderate	Difficult
Basic information
business hour	13 (100)¹⁾	0 (0)	0 (0)
holiday	13 (100)	0 (0)	0 (0)
size of store	12 (92)	0 (0)	1 (8)
number of staff member	13 (100)	0 (0)	0 (0)
payment option	13 (100)	0 (0)	0 (0)
Detailed information
primary products for sale	10 (77)	3 (23)	0 (0)
Customer information
average number of customer	6 (46)	3 (23)	4 (31)
customer characteristic ²⁾	10 (77)	3 (23)	0 (0)
Accessibility
transportation access	13 (100)	0 (0)	0 (0)
parking space	12 (92)	0 (0)	1 (8)
delivery	13 (100)	0 (0)	0 (0)
teleshopping	13 (100)	0 (0)	0 (0)
online shopping	13 (100)	0 (0)	0 (0)

1) N (%), n = number of food store 2) General age group and gender of main customer

Table 6.

Reliability of measurement tool for food availability in the food store

Food subgroups (n = number of food)	Inter-rater reliability (n = 33)¹⁾		Test-retest reliability (n = 66)²⁾
Food subgroups (n = number of food)	% agreement	Kappa value	% agreement	Kappa value
Grains and cereal (n = 9)	98.7 ± 2.2³⁾	0.97 ± 0.04	97.8 ± 3.4	0.95 ± 0.07
Breads (n = 2)	95.5 ± 2.1	0.84 ± 0.00	94.7 ± 4.5	0.78 ± 0.20
Noodles (n = 3)	93.9 ± 3.0	0.84 ± 0.08	93.9 ± 4.7	0.86 ± 0.09
Vegetables (n = 14)	95.7 ± 4.9	0.90 ± 0.12	95.2 ± 6.3	0.87 ± 0.19
Fruits (n = 4)	96.2 ± 2.9	0.91 ± 0.07	95.8 ± 2.8	0.89 ± 0.08
Meats (n = 6)	95.0 ± 6.0	0.87 ± 0.15	95.2 ± 4.2	0.86 ± 0.11
Fish and shellfish (n = 5)	98.8 ± 1.7	0.97 ± 0.05	97.9 ± 3.2	0.95 ± 0.07
Legume and bean processed products (n = 7)	96.1 ± 3.4	0.85 ± 0.18	96.1 ± 2.5	0.87 ± 0.10
Eggs (n = 2)	95.5 ± 6.4	0.91 ± 0.13	93.9 ± 4.3	0.81 ± 0.10
Milk and dairy products (n = 12)	96.2 ± 4.1	0.92 ± 0.09	93.9 ± 7.3	0.87 ± 0.15
Beverages (n = 10)	97.0 ± 3.8	0.92 ± 0.09	97.3 ± 3.2	0.91 ± 0.15
Nuts (n = 2)	93.9 ± 8.6	0.82 ± 0.26	94.7 ± 6.2	0.85 ± 0.17
Snacks (n = 2)	95.5 ± 2.1	0.88 ± 0.02	91.7 ± 6.2	0.79 ± 0.11
Condiments and spices (n = 16)	96.4 ± 4.3	0.92 ± 0.09	96.0 ± 3.9	0.89 ± 0.10
Fat and oils (n = 3)	95.0 ± 1.7	0.86 ± 0.09	95.5 ± 2.5	0.86 ± 0.12

1) Agreement of inter-observer, n = number of food store 2) Agreement of intra-observer, n = number of food store 3) Mean ± SD

Table 7.

Reliability of inter-rater and test-retest for general food and food with healthy option

Food category¹⁾	Inter-rater (n = 33)²⁾				Test-retest (n = 66)³⁾
	% agreement		Kappa value		% agreement		Kappa value
	General food	Food with healthy option ⁴⁾	General food	Food with healthy option	General food	Food with healthy option	General food	Food with healthy option
Grains and cereal	100.0 ± 0.0⁵⁾	98.0 ± 2.5	1.00 ± 0.00	0.96 ± 0.05	100.0 ± 0.0	96.7 ± 3.8	1.00 ± 0.00	0.93 ± 0.08
Breads	93.9⁶⁾	97.0⁶⁾	0.84⁶⁾	0.84⁶⁾	95.5 ± 6.4	93.9 ± 4.3	0.87 ± 0.18	0.68 ± 0.23
Noodles	93.9 ± 4.3	93.9⁶⁾	0.82 ± 0.10	0.88⁶⁾	96.2 ± 3.8	89.4 ± 2.1	0.89 ± 0.10	0.79 ± 0.04
Meats	100.0 ± 0.0	89.9 ± 3.5	1.00 ± 0.00	0.75 ± 0.11	98.0 ± 1.6	92.4 ± 4.2	0.92 ± 0.07	0.80 ± 0.12
Legume and bean processed products	97.0 ± 4.3	95.0 ± 1.7	0.93 ± 0.09	0.73 ± 0.22	95.8 ± 2.8	96.5 ± 2.3	0.91 ± 0.06	0.81 ± 0.12
Eggs	100.0⁶⁾	90.9⁶⁾	1.00⁶⁾	0.82⁶⁾	95.5 ± 2.1	92.4 ± 6.4	0.78 ± 0.09	0.85 ± 0.13
Milk and dairy products	100.0 ± 0.0	94.3 ± 3.8	1.00 ± 0.00	0.88 ± 0.08	98.5 ± 1.6	91.7 ± 8.0	0.96 ± 0.04	0.83 ± 0.17
Beverages	97.0 ± 4.7	97.0 ± 2.5	0.92 ± 0.11	0.93 ± 0.06	98.0 ± 3.5	96.2 ± 2.7	0.94 ± 0.09	0.86 ± 0.22
Nuts	100.0⁶⁾	87.9⁶⁾	1.00⁶⁾	0.64⁶⁾	100.0 ± 0.0	89.4 ± 2.1	1.00 ± 0.00	0.71 ± 0.05
Snacks	97.0⁶⁾	93.9⁶⁾	0.89⁶⁾	0.86⁶⁾	97.0 ± 0.0	86.4 ± 2.1	0.88 ± 0.01	0.71 ± 0.06
Condiments and spices	98.0 ± 3.1	95.5 ± 4.8	0.95 ± 0.08	0.90 ± 0.10	96.0 ± 3.9	96.1 ± 3.9	0.86 ± 0.11	0.91 ± 0.09
Fat and oils	95.5 ± 2.1	93.9⁶⁾	0.85 ± 0.12	0.88⁶⁾	94.7 ± 2.9	97.0 ± 0.0	0.82 ± 0.14	0.94 ± 0.00
P value	0.0027⁷⁾		0.0095⁷⁾		0.0081⁸⁾		0.0290⁸⁾

¹⁾ Only for 12 food subgroups(except vegetables, fruits, fish and shellfish) which have both general food and food with healthy option.

²⁾ Agreement of inter-observer, n = number of food store

³⁾ Agreement of intra-observer, n = number of food store

⁴⁾ Food with healthy option: whole grains and processed foods with healthy option such as low sodium, low sugar, low fat, low calorie, no fat, calcium enriched, food for weight management, decaffeinated coffee, cold-chain juice, see ‘Table 3' for specific item

⁵⁾ Mean ± SD

⁶⁾ No SD because of single question

⁷⁾ p value by t-test

⁸⁾ p value by paired t-test

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