Discussion
This research provides an in-depth analysis of the factors that operated within and external to the Store Managers to influence the implementation of a novel healthy food retail intervention during a 12-week trial of its efficacy. Factors in each of the five CFIR domains were identified to be important, as was their alignment with each other. This demonstrates the complexity of implementation of such healthy food retail interventions. Elucidation of these factors and their multiple levels of influence, and hence their complexity, can help with the much-needed design and development of implementation strategies to support the adoption and sustainment of evidence-informed health-enabling food retail interventions in to practice by the retail sector.We found there to be alignment between the Outer and Inner CFIR constructs most frequently referred to by the Store Managers as positive to strategy implementation, and the positive individual and intervention characteristics identified. Networks and communication between the Store Managers and other parts of ALPA, the implementation climate of the ALPA organisation (tension for change, compatibility, relative priority, goals and feedback, learning climate) and its readiness for implementation (organisational commitment shown through leadership engagement, available resources and access to knowledge and information) were CFIR Outer and Inner constructs most frequently referred to by the Store Managers as important to implementation. ALPA prioritised the Healthy Stores 2020 strategy, and from this we identified an organisational readiness for its implementation and a positive implementation climate, that then enabled the flow of necessary communication and resources to Store Managers, who then championed the strategy with their staff.Implementation climate and ALPA’s readiness for implementation most likely stem from the unique strong sense of social purpose that ALPA has shown with their long history of prioritising community nutrition and health goals. The ALPA Board comprises Aboriginal community representatives who bring to the organisation their commitment to advance the social, cultural, economic and health goals of their community. Health improvement is considered a priority by the ALPA board and the community store a setting to achieve this. This priority for health improvement was also echoed by Store Managers.Middel et al. (2019) [In our study, in contrast to that found by Middel et al. (2019) [Unique to the Healthy Stores 2020 study is the food retail context of ALPA. ALPA is a large Indigenous multi-store organisation with experience and maturity in health-enabling food retail that is reflected in their organisation policy. We showed that ALPA was able to establish the processes needed within their organisational structures to support the success of the Store Managers in strategy implementation. These processes were evident across the different management levels and sectors of ALPA and included the mobilisation of staff for strategy set-up, the ongoing checking of adherence and support to rectify adherence, the provision of a reference guide to Store Managers on healthy/unhealthy foods, and consistent communication from ALPA leadership to Store Management and staff on the importance of the strategy.We have evidence that ALPA as a result of the success of the Healthy Stores 2020 strategy and agreement by the relevant Store Boards, adopted the Healthy Stores 2020 strategy post-trial in to their organisation’s Health and Nutrition strategy. The organisational size and structure of ALPA, in addition to its maturity and leadership in its prioritisation of health, were likely key factors that influenced ALPA’s decision to adopt and institutionalise the strategy post-trial. It may be more difficult for single-store settings with less experience in prioritising health to adopt such initiatives. However, Middel et al. (2019) [Store Managers were a ‘make-or-break’ touchstone of implementation success. Our research shows how individual characteristics of Store Managers, including belief in the benefit of the intervention for the community, self-efficacy to adapt existing workflows to fit the strategy, and personal attributes of optimism, adaptability and retail competency, were key to the intervention’s success. This includes the positive influence they had on their store staff. This observation of retailers as facilitators, rather than as impediments to implementation due to their lack of knowledge and/or concern of profit loss, has been a less discussed theme in the literature [This research provides some insights in to this role. Of note is that although Store Managers championed the strategy, they were not the ones who chose whether or not their store would participate in the strategy, and may not necessarily have been on board at the start. Participation was decided by the Store Boards who represent the community or by the ALPA and Island and Cape Boards for the ALPA-owned stores. The inner setting culture of organisational leadership and commitment to the strategy was clear however, and Store Managers were primed for the strategy through the ALPA Nutritionist and/or Area Manager who communicated what would be involved, and through the teams that spent time with the Store Managers to set-up the strategy in their stores. These supportive elements of effective communication and intervention set-up helped to galvanise Store Manager support, engage the staff, and build Store Manager confidence in the strategy. Boelsen-Robinson et al. (2019) [Of further importance in galvanising the Store Manager support in the Healthy Stores 2020 study were the co-designed intervention characteristics of low complexity and cost–benefit alignment. Early and visible signs of intervention impact on sales data reinforced the Store Managers’ trust in the strategy as they could see a cost–benefit. Further aiding Store Manager motivation was the lack of backlash from the community that was expected by some Store Managers as the strategy was unknown ground for them. Enthusiasm for the strategy however was not shared by all Store Managers. While not entirely clear, the data suggest two possible reasons for this. First, a misalignment of the strategy with perceived community need, as viewed by one Store Manager; and second, a cost–benefit imbalance as a result of a perceived low strategy impact, as viewed by this same Store Manager and another. These two Store Managers were in stores that implemented the modified 6-point strategy and may therefore not have experienced the same convincing visible impact on sales mix that some Store Managers described with the complete strategy, although the impact on free sugar was the same for the modified strategy and complete strategy (data not presented). Stead et al. (2020) [Accountability to the strategy was important to the Store Managers. Store Managers understood that ALPA expected full adherence, they wanted to be checked and needed feedback that they were doing the right thing. However, moments of non-adherence did occur, despite the high level of commitment from Store Managers and the best efforts from ALPA to clearly communicate the strategy. Provision of resources by ALPA to Store Managers to help implement and monitor the strategy helped to minimise non-adherence as did the fortnightly phone-call adherence checks. Similarly, Stead et al. (2020) [