The use of contracts to implement and manage healthy vending: best practice recommendations for effective and sustained interventions.

Abstract

Background: Contracts can be an effective lever to implement and manage health-enabling food retail environments. However, guidance for the effective use of contracts in food retail settings is limited. The use of contracts to create healthy food vending environments is one area where policy attention has been focussed in high income countries. We applied a public health regulatory framework to publicly available guidance documents on healthy vending to develop best practice recommendations for using contracts to create healthy food vending environments.

Methods: Document analysis involved i) snowball sampling to identify eligible publicly available healthy vending guidance documents from an identified seed paper; ii) application of a public health regulatory framework to extract data across three domains of form, substance and governance of healthy vending initiatives; and iii) synthesis of data to form best practice recommendations. Eligible documents were those aimed at implementing healthier vending; published from 2000 onwards; accessible online; and included recommendations beyond nutrition standards alone, including a reference to at least one regulatory governance process (administration, implementation, monitoring, enforcement or review).

Results: Twelve of 92 documents identified were eligible and all were from the United States (US). All noted that products need to comply with nutrition standards. Other aspects of regulatory substance (i.e., pricing, promotion, placement, labelling and contract length) were less well considered as were elements of regulatory governance (regulatory rules, administration, implementation, monitoring, enforcement and review). Our adapted framework covers three regulatory domains with nine components, and a further 20 recommendations for best practice application in healthy vending.

Conclusions: To be effective, contracts used to manage healthy food vending should include more than the nutrition standards for healthy food and drinks. Clearly stating the contract objectives, operative terms and conditions, and defining responsibilities for monitoring, review and enforcement within the contract, in addition to the nutrition standards, will assist practitioners in creating effective and sustained contract-based initiatives aimed at improving the healthiness of vending, or potentially other food retail environments.