The Determinants of Long-Term Sustainment of Healthy Food Retail Environment Changes: A Systematic Review.

Healthy food retail (HFR) interventions utilize marketing strategies (e.g., product availability, placement, pricing, and promotion) to create food outlet (e.g., grocery store, food service) environments that support consumers in making healthier food purchases. To ensure ongoing population health benefits, these strategies must be sustained over time. This systematic review aimed to explore the determinants of sustained HFR environment changes (e.g., sociopolitical context, retailer-related factors). Six databases were searched up to September 12, 2024. Eligible articles followed up on HFR environment changes for at least 2 years and identified factors influencing sustained HFR changes. Articles were thematically synthesized using the Integrated Sustainability Framework, and the findings for each construct were presented as frequency counts. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Fifteen articles met the inclusion criteria, with studies undertaken in grocery stores or small stores (n = 8), school canteens (n = 3), healthcare settings (n = 2), and other settings (n = 2). The most common domains identified were "processes" (e.g., "fidelity, monitoring, and enforcement") and "interorganizational factors" (e.g., "external partners, support, and resources"). Sustainment-related findings were often reported as secondary outcomes in study results, limiting the comprehensiveness of the review and highlighting the need for more long-term evaluation of HFR interventions.