Investigating food environments and drivers of food acquisition in low- and middle-income countries: The case of peri-urban Hyderabad, Telangana, India

This thesis presents a body of work that deepens our knowledge and understanding of food environments and drivers of food acquisition practices in transitioning low- and middleincome country (LMIC) settings. It includes critical contributions to food environment theory, a systematic review of evidence from LMICs, the development, application, and evaluation of a novel qualitative geographical information systems (Q-GIS) methodological approach, and a qualitative investigation of the food environment and drivers of food acquisition in periurban Hyderabad, India. The first article presents a new food environment definition, a globally applicable conceptual framework for food environment research, and maps methodological approaches. Critical perspectives suggest how existing knowledge and evidence may be leveraged to accelerate food environment research in LMICs, and key challenges and opportunities are identified. The second article is the first systematic review of food environment research from LMICs. The review reveals the rapidly emerging body of literature from LMICs and provides a synthesis of the evidence base testing for associations between dimensions of food environment exposure and dietary, nutrition and health outcomes. The third article presents the development, application and evaluation of a novel Q-GIS approach that features participatory photo mapping and follow-up graphic- and photoelicitation interviews (n=22) designed to investigate food environments from an emic perspective. Results include participant’s perceptions and experiences of documenting their FE as well as empirical data on the utility and feasibility of this approach. The fourth article presents findings from in-depth interviews (n=18) and the Q-GIS approach (n=22) investigating complex, multi-scalar, and multifaceted drivers of food acquisition in two transitioning peri-urban villages in Hyderabad. Key drivers of food acquisition included: 1) food prices; 2) vendor and product properties, including freshness and quality, and adulteration and contamination; and 3) a sense of community and trust related to known people.