# Understanding the Use of Community Involvement in Rural Food Environment Modifications: A Systematic Review

## TL;DR

This systematic review explores how community involvement affects rural food environment interventions, highlighting the need for consistent reporting to improve public health outcomes.

## Contribution

The study provides a synthesis of global evidence on rural food environment modifications and emphasizes the importance of standardized community involvement reporting.

## Key findings

- Thirty-three studies were included, with a focus on restaurants, supermarkets, and schools for food environment modifications.
- Community involvement was inconsistently reported, making it difficult to draw conclusions about its impact.
- Standardized reporting is recommended to ensure authentic community involvement in rural public health interventions.

## Abstract

Rural communities experience higher rates of adverse health outcomes compared to their urban counterparts, and involving community members in intervention design and implementation is increasingly recognized as a pivotal factor in fostering successful intervention outcomes. This review aims to synthesize the evidence on rural food environment modifications globally, and to understand the role and involvement of community members in these interventions. Eligible records were dated between 1st January 2011 and 6th September 2024. Two independent reviewers conducted screening, quality assessment, and data extraction. Studies were included if they addressed a food environment, described food environment modifications, indicated community involvement, were based in regional or rural areas and published in English. The Mixed Methods Appraisal Tool was used to assess the risk of bias. Results were reported as a narrative synthesis.

Thirty-three studies were eligible for inclusion following appraisal of full texts, comprised of 46 reports. Of these, 12 studies (16 reports) focused on First Nations populations and will be reported separately, due to the complex and sensitive nature of engaging with these communities. Therefore, 21 studies (30 reports) were included in this review. Study designs were heterogenous. Restaurants, supermarkets and schools were a common focus for modifications, while some programs simultaneously targeted several food environments. However, community involvement was inconsistently reported across studies, making conclusions about involvement difficult.

Standardized reporting of the involvement of community members is needed to ensure systematic and authentic approaches to community involvement are integrated into rural public health interventions and research to enhance success.

Prospero; CRD42023400455.

The online version contains supplementary material available at 10.1007/s13668-025-00674-9.