Implications for research and practice
We previously demonstrated the effectiveness of the Healthy Stores 2020 intervention and its resultant impact on reducing sales of free sugars [There are over 200 food retail stores in very remote Australia and there are factors common to these store contexts, such as community need, that suggest a potential strong fit of the Healthy Stores 2020 intervention. Whilst store structures and internal organisation processes can differ across stores, our research shows that co-design can allow for research evidence to be combined with retailer expertise and organisation structures and processes, to develop a best-fit-to-context intervention and implementation processes to optimise implementation, and one where the cost of implementation is perceived to outweigh the benefit.Our use of the CFIR provides the food retail research community a unified way to consider and organise the factors that influence implementation of health-enabling food retail initiatives. Further research is warranted to map these factors derived from the CFIR [The fortnightly adherence checks were designed primarily to collect data for an assessment of adherence of strategy components. However, they also served to assist with timely rectifying of non-adherence and were an adherence motivator for some Store Managers. This needs to be considered in the design of implementation strategies for effective and wide adoption of health-enabling food retail initiatives. Whilst such a level of monitoring is resource-intensive, frequent monitoring may be required at the start of the implementation of a healthy food retail initiative and then less frequent monitoring and compliance checking continue once a Store Manager is confident with the initiative.In the future, we will explore the use of video-conferencing for qualitative interviews with Store Managers rather than relying on phone interviews alone. This may be important for research with store businesses where the relationship is early in its establishment.It is important that there be a workforce specifically trained to support co-design in the food retail context to ensure maximum public health gain from health-enabling initiatives. To address this, we and others are involved in a number of initiatives including: a Centre for Research Excellence in Food Retail Environments for Health (RE-FRESH) [The Healthy Stores 2020 intervention that is designed to restrict the promotion of unhealthy food and drinks could benefit communities beyond the food retail context of remote Australia. Large retail companies for example could easily adopt the Healthy Stores 2020 intervention strategy and optimise their existing structures and processes for its effective implementation. The Healthy Stores 2020 strategy however may be more amenable to food retail contexts where there is a strong sense of social purpose, such as that of ALPA, and a close retailer-community relationship, than those where commercial interests primarily drive retail practice.