The Food Environment Perceptions Survey: development and piloting of a survey instrument in India and Cambodia to assess consumers’ interactions with diverse food environments

OBJECTIVE: The objective of this study was to develop, implement and refine a food environment survey to capture people's perceptions of their food environments in low-and middle-income countries: the Food Environment Perceptions Survey (FEPS). DESIGN: Identifying aspects of food environment to include drawing from existing survey instruments, a Delphi survey with food environment experts working globally, workshops with local experts in India and Cambodia, cognitive testing of the survey items and piloting the tools in diverse field settings in India and Cambodia. SETTING: Rural, peri-urban and urban communities in India and Cambodia. PARTICIPANTS: Global food environment experts for the Delphi survey, food environment experts in India and Cambodia for workshops and a convenience sample of participants in India (n 44) and Cambodia (n 60) for FEPS piloting. RESULTS: The FEPS underwent many iterations prior to piloting. The initial versions of the survey were long, leading us to remove questions and reconfigure the survey to streamline it. The workshop participants rated the revised survey versions relatively favourably. The final survey consists of 109 questions covering six sections: accessibility and availability (forty-eight questions); affordability (five questions), convenience (seventeen questions); quality and safety (three questions); information, promotion and labelling (sixteen questions); and an optional sustainability section (twenty questions). Based on pilot data, we found significant differences in how participants interacted with different food environment types across rural, peri-urban and urban transects. CONCLUSIONS: The finalised FEPS is a newly developed survey instrument that can be incorporated by other researchers to characterise diverse perceptions of food environments in low-and middle-income countries.