Strengths and limitations
This study uses real-world data to advance knowledge on factors that influenced the implementation of the Healthy Stores 2020 strategy from the perspective of Store Managers responsible for the strategy’s day-to-day implementation. Our use of a well-recognised implementation framework, the CFIR, and consideration of all its constructs in data analysis and reporting, provides a comprehensive basis of implementation barriers and enablers within each of the five CFIR domains that others studies can build on to form a common understanding of factors important to implementation of healthy food retail interventions and from this design effective implementation strategies for their adoption. Interview questions were not guided by the CFIR constructs, meaning that multiple aspects of the CFIR were not asked about. No data for example were coded to the constructs of evidence strength and quality (intervention characteristics), structural characteristics, and culture (inner setting), individual stage of change, and individual identification with organisation (characteristics of individual) and planning, and external change agents (process). Using the CFIR to form interview questions may have helped examine these constructs in more detail. Our interview guide however was purposely designed to be of minimum time burden to very busy Store Managers, and to not pre-empt factors perceived to be of influence to implementation effectiveness. Descriptive data on years in the role and years having worked in Aboriginal and/or Torres Strait Islander communities may have been useful to further examine differences in Store Managers’ experiences of implementation.Store Managers may have felt pressure to report positively on the strategy due to their employment by ALPA. However, interviews were conducted by the research team and we found there to be diversity in Store Managers’ views of the strategy, with some showing scepticism of the intervention at its start, and two who remained unconvinced of its value for their store. A strength of our study to not be underestimated was the insider knowledge and context-specific experience of the research team. Without this, important contextual factors may have been overlooked in the analysis. Whilst this may lead to bias, this was minimised by cross-checking of codes and themes against interview transcripts and summaries by the research team.In addition to fortnightly adherence data, we captured Store Manager perceptions, at three different time points of strategy implementation to identify factors influencing implementation at different stages. Interviews of ALPA management, Store Boards, store staff, and customers may also have provided valuable data particularly to examine the role of Store Boards on impacting staff attitudes and customer response. The Store Manager experience however provides rich insight in to how these different players influenced the practice and attitudes of the Store Managers who were directly responsible for day-to-day strategy implementation. This research was conducted with a store organisation where Store Managers were supported by their umbrella organisation. Smaller sized single-store operations may experience different barriers to implementation to those identified herein. It is likely however that regardless of business size or business type (i.e., multiple-store vs single-store), structures and processes similar to those identified in this study, need to be considered in the design of implementation strategies for effective adoption of health-enabling food retail by the food retail sector.We applied strict criteria to our adherence assessment where even one incident of non-compliance for a strategy component identified at one time point during the 12-week intervention and rectified, was marked as non-adherence. Therefore, while it appears that there was modest implementation of strategy components, such as for the ‘no promotional activity on unhealthy products’ and ‘no visible availability of unhealthy products at high traffic areas’ components, most incidences of non-adherence were rectified when identified. Some evidence of non-adherence at set-up was identified. Future studies would benefit from including an adherence check at set-up to rectify non-adherence at this stage.