Background: Food environments have been defined more comprehensively in the last two decades. However, there are major gaps in our understanding of food environments in low- and middle-income countries (LMICs) that are transforming because of dynamic, differential, and complex local social and economic changes.
Objective: The present systematic review was conducted to develop a conceptual framework of food environment for LMICs using McLeroy’s socioecological theory and Penchansky’s access theory.
Methods: An extensive search until July 13, 2021, in PubMed, Scopus, and Google Scholar was conducted, and selected studies were organized, categorized, and summarized for the review. Of the 5207 studies screened, 28 studies addressing the food environment of LMICs were identified through systematic process.
Results: The search clearly demonstrated that there was a paucity of research done on the food environment from LMICs (n=28) compared with HICs (n=359). The conceptual framework of the food environment has three layers: public policy, community/neighborhood and institutional (e.g., school), and household/individual. The food environment factors derived from the evidence synthesis were categorized into availability, accessibility, and affordability domains across three layers. Sociocultural and contextual acceptability are built into these three domains. The present evidence synthesis resulted in additional domains: global influences (at policy level), marketing and regulation (at policy and neighborhood level), importance of wet and informal markets, and time-constrained family members and food behavior (at household level). The context of the food environment was an important variable and was made up of neighborhood type (socioeconomic), land use, population stability, retail modality, consumer heterogeneity, hygiene and sanitation, and degree of influence of matured markets. The present evidence synthesis additionally stressed the importance of the context and neighborhood characteristics in shaping the local food environment.
Conclusions: The proposed socioecological model of food environment should lay the foundation for an operational and analytical framework for the surveillance, capturing dynamicity and its determinants, keeping an eye on the changing political and policy environment and development of contextual tools and matrices to assess the food environment for future research. One of the key next steps will be to determine the model’s applicability in diverse LMICs and its resilience to adapt to local nuances.