Published: March 2023

ID #: CAS067

Organization: Johns Hopkins University

Project Lead: Joel Gittelsohn

See more related research


Study Overview and Key Findings

Improving healthy food access in low-income communities continues to be a public health challenge. One promising approach has been opening supermarkets in low-income neighborhoods or converting existing food retail operations to emphasize healthy options. The overall goal of this study was to use a case study approach to understand the experiences of healthy food stores in low-income communities.

This is the first study to explore in-depth the experiences of different initiatives and models for opening and sustaining healthy food stores in low-income, urban settings. The research team used a case study approach to describe strengths and weaknesses, lessons learned, and key strategies for success in such stores. Store case studies were conducted among seven healthy food stores in Baltimore, Boston, Buffalo, Chicago, Detroit, Minneapolis and Washington DC. More details on methods of the study are included in the protocol paper.

Recommendations based on the initial findings (please see the commentary paper for complete recommendations and explanations:

  • Store-level recommendations:
    • Commit to, and invest in community engagement
    • Hire local staff
    • Engage with multiple, diverse vendors
    • Utilize alternative ownership/financial models such as a non-profit or co-op
    • Implement needs-based or loyalty programs for customers
    • Identify and work with store champions
  • Future research directions:
    • Explore how stores operationalize the strategies described above (i.e., community engagement, multiple vendor relationships, and alternative business models).
    • Simulate or test the feasibility of the potential policies and strategies related to the activities described above using tools such as casual loop diagrams and system dynamics modeling to assess their potential impacts.
    • Understand which of these practices and policies are feasible and acceptable to store owners, and what they are willing to engage in. Similarly, understand which of these practices policymakers are most willing to support.
  • Policy implications:
    • Consider incentivizing stores who engage in the activities/strategies described above (investing in the community, hiring locally, implementing loyalty or needs-based programs, etc.).
    • Support initiatives that aim to localize the food system.
    • Increase funding for technical assistance and capacity building for smaller stores attempting to utilize an alternative business model and to help navigate paperwork and stocking challenges related to accepting federal nutrition program benefits.
    • Expand federal nutrition program guidelines to make participating as a WIC and/or SNAP vendor more accessible to smaller, locally owned, mission-driven stores with fewer resources.
    • Prioritize smaller stores with fewer staff and resources in emergency relief acts in future national or global crises.

These results can be used to help existing stores increase store usage and increase stocking of healthy items, and help new stores set up a model for success using community engagement and collaborating with community stakeholders to increase healthy food access in their neighborhoods.

Study Results and Resources

Case Studies

Published Papers

The full data set from this study, including transcripts, is not publicly available. If you are interested in accessing this data set for future research, contact Dr. Joel Gittelsohn at

Related Research

October 2022

Refining the Nutrition Environment Measures Survey (NEMS) for Healthy Community Stores: Adaptations to Capture Alternative Food Retailers and Align with Dietary Guidelines

Inadequate consumption of healthy food is an ongoing public health issue in the United States. Food availability measures of supply versus consumption of healthy foods are disconnected in many studies. There is a need for an objective assessment of the food environment in order to assess how the food supply aligns with the Healthy Eating More

July 2022

A Commentary on the Healthy Community Stores Case Study Project: Implications for Retailers, Policy, and Future Research

In the United States, low-income, underserved rural and urban settings experience poor access to healthy, affordable food. Introducing new food outlets in these locations has shown mixed results for improving healthy food consumption. The Healthy Community Stores Case Study Project (HCSCSP) explored an alternative strategy: supporting mission-driven, locally owned, healthy community food stores to improve More

July 2022

Balancing Mission and Margins: What Makes Healthy Community Food Stores Successful

Mission-driven, independently-owned community food stores have been identified as a potential solution to improve access to healthy foods, yet to date there is limited information on what factors contribute to these stores’ success and failure. Using a multiple case study approach, this study examined what makes a healthy community food store successful and identified strategies More

June 2022

Forms of Community Engagement in Neighborhood Food Retail: Healthy Community Stores Case Study Project

Community engagement is well established as a key to improving public health. Prior food environment research has largely studied community engagement as an intervention component, leaving much unknown about how food retailers may already engage in this work. The purpose of this study was to explore the community engagement activities employed by neighborhood food retailers More

February 2022

The Impact of a Pricing Manipulation Intervention on Food Sales in a Small Community Grocery Store in Baltimore City

This study tested a pricing manipulation strategy in a small grocery store to assess the impact on food sales. The prices of 35 healthy foods were decreased over time while simultaneously increasing the prices of 45 unhealthy foods. Trends in sales were examined across each manipulation period. Total sales of healthy foods remained relatively stable More

January 2022

Increasing Healthy Food Access for Low-Income Communities: Protocol of the Healthy Community Stores Case Study Project

Improving healthy food access in low-income communities continues to be a public health challenge. One strategy for improving healthy food access has been to introduce community food stores, with the mission of increasing healthy food access; however, no study has explored the experiences of different initiatives and models in opening and sustaining healthy food stores. More

October 2020

Understanding Successful Healthy Stores in Low Income Communities: A Case Study Approach

The study goals and objectives are: 1) To conduct mixed methods research to construct case studies in 7 diverse healthy food-focused retail food stores located in low-income communities throughout the United States; 2) To understand experiences of these stores in the aftermath of the COVID-19 pandemic, including strengths and vulnerabilities; and 3) To conduct a More