Development and Validation of a Food Retail Environment Analysis Protocol in Iran

Objective: This study aimed to adapt and validate a Food Retail Environment Analysis Protocol in Shiraz, Iran. Design: The protocol was developed by integrating the Nutrition Environment Measurement Survey in Stores (NEMS-S) with the food retail module from the International Network for Food and Obesity/Non-communicable Diseases (NCDs) Research, Monitoring, and Action Support (INFORMAS). After translating, synthesizing, and back-translating the protocol, a panel of experts reviewed and refined it to ensure cultural and contextual appropriateness. Its validity was assessed through expert evaluation, and the pre-final version was field-tested to assess reliability across different food retail environments. Setting: Shiraz City, a metropolis in Iran Participants: Nine food retail stores, including kiosks, small- and medium-sized food retailers (comparable to convenience stores), and large food retailers (comparable to grocery stores). Results: Content and face validity were assessed using the content validity ratio (CVR: 0.64–1), content validity index (CVI: 0.78–1), and item impact score (IIS: 2.84–4.83). Reliability testing by two researchers showed a 93.77% agreement and an intraclass correlation coefficient (ICC) of 0.89–1. The protocol includes 14 food groups, most of which are categorized as either healthy or unhealthy. It evaluates product availability, prominence, quality, pricing, and both in-store and external food promotions. Conclusion: The validated protocol effectively assesses diverse retail food environments, offering essential data for evaluating policies and guiding interventions to improve healthy food access. It is adaptable for broader regional or international application in public health and food policy contexts.