Towards an impactful intervention in a food retail setting - insights from transition management

Issue

Socioeconomic inequalities in diet and health form a persistent public health problem. Environmental, non-agentic interventions are most likely to be equitable, but have to be implemented in a wider system with interests other than health promotion.

Description of the Problem

The Supreme Nudge project (2017-2022) implements a health promotion intervention (niche experiment) in a supermarket setting (regime context). As a sufficiently impactful intervention is likely to conflict with interests of the setting, the Transition Management (TM) framework is used to guide design and implementation. Following the four steps in this cyclical model, we explore the context of the food retail system and identify key players; develop coalitions, shared visions and transition agendas; mobilize actors and implement the intervention; and evaluate, monitor and learn from the intervention. Interviews and focus groups were held to address these steps.

Results

The Dutch supermarket context consists of multiple chains that, after several price wars, are shifting competition from price to corporate social responsibility goals, including health promotion. Together with key supermarket players, a shared vision was defined: making healthy dietary choices easier while striving for neutral business outcomes. Transition paths towards this vision, including their barriers and facilitators, were explored. Additional actors were mobilized to adapt and refine intervention components, and the intervention will be implemented mid-2020. The intervention will be monitored and evaluated to facilitate upscaling.

Lessons

Applying the TM framework facilitated the development of coalitions and a shared vision, the co-creation of intervention components and identification of transition paths. This is likely to also benefit implementation and upscaling of the intervention. Applying the TM framework will also be useful for transferring successful interventions to other contexts.

Key messages

Implementing a health promotion in a food retail setting is challenging because of the conflicting interests. The Transition Management framework can facilitate successful implementation through creating a shared vision and foreseen transition paths.

Transforming maternity care: obstetric partnerships as a policy instrument for integration

Increasing continuity in Dutch maternity care is considered pivotal to improve safety and client-centeredness. Closer collaboration between the historically relatively autonomous professionals and organizations in maternity care is deemed conditional to reach this goal, both by maternity care professionals and policy makers. Governmental policy therefore strives for organizational and financial integration. One of the policy measures has been to stimulate interprofessional and interorganizational collaboration through local obstetric partnerships. This study aimed to gain insight into whether this policy measure supported professionals in reaching the policy aim of increasing integration in the maternity care system. We therefore conducted 73 semistructured interviews with maternity care professionals in the region Northwest Netherlands, from 2014 to 2016. Respondents expressed much willingness to intensify interprofessional and interorganizational collaboration and experienced obstetric partnerships as contributing to this. As such, stimulating integration through obstetric partnerships can be considered a suitable policy measure. However, collaborating within the partnerships simultaneously highlighted deep-rooted dividing structures (organizational, educational, legal, financial) in the maternity care system, especially at the systemic level. These were experienced to hinder collaboration, but difficult for the professionals to influence, as they lacked knowledge, skills, resources and mandate. A lack of clear and timely guidance and support from policy, counterbalancing these barriers, limited partnerships' potential to unify professionals and integrate their services.