Corner Store Owners as Health Promotion Agents in Low-Income Communities

Abstract

Reports of small business owner motivations for participation in health promotion interventions are rarely reported in the literature, particularly in relation to healthy eating interventions. This study explicates and defines the development of healthy corner stores as community-based enterprises (CBEs) within eight low-income, suburban communities. CBEs are defined as community-oriented small businesses with a common goal to improve population health. The corner stores assessed in this study were participants in Healthy HotSpot (HH), a corner store initiative of the Cook County Department of Public Health. To determine store alignment with the CBE construct, a case study design was used for qualitative inquiry. Participant narratives from store owners (n = 21), community-based organizations (CBOs; n = 8) and consumer focus groups (n = 51) were analyzed using an iterative process to determine how store owners aligned with the CBE construct, and how this influenced continuation of health promotion activities. Several key factors influenced the strength of store owners’ alignment with the CBE construct. They included the following: (a) shared ethno-cultural identities and residential area as consumers; (b) positive, trustworthy relationships with consumers; (c) store owners valuing and prioritizing community health, often over profits; and (d) collaboration with a highly engaged CBO in the HH project. Results can assist in theory development and intervention design in working with corner store owners, and other small business owners, as health promotion agents to improve and sustain health outcomes and help ensure the economic vitality of low-income communities.

Keywords

community-based enterprise corner stores food access healthy eating interventions store owners

Introduction

Nearly 20 million residents within the United States have limited or no access to healthy foods (Rhone, Ver Ploeg, Dicken, Williams, & Breneman, 2017). Individuals with limited access to healthy foods often reside within communities of low-socioeconomic status, which are more likely to have disproportionate rates of obesity and other chronic disease, especially among racial and ethnic minorities (Centers for Disease Control and Prevention, 2017; Powell, Slater, Mirtcheva, Bao, & Chaloupka, 2007; Rhone et al., 2017), an abundance of fast food restaurants and other small format food stores, or corner stores, and a significant lack of full-service grocery stores (Cannuscio, Weiss, & Asch, 2010; Story, Kaphingst, Robinson-O’Brien, & Glanz, 2008). This phenomenon has stimulated initiatives within corner stores to sell healthier foods with the intent to improve healthy food access and prevent obesity (Bunnell et al., 2012; Gittelsohn, Rowan, & Gadhoke, 2012).

The connection between healthy eating and obesity is a significant driver of food retail interventions nationwide (Mozaffarian, Hao, Rimm, Willett, & Hu, 2011; Story et al., 2008). Corner store interventions to date have been effective in increasing access to healthy foods (Gittelsohn et al., 2012), consumer purchases of healthy foods (Surkan, Tabrizi, Lee, Palmer, & Frick, 2016) and in some cases consumption of healthy foods (Rushakoff et al., 2017); however, corner stores and the role they may play in promoting and sustaining community health, as a community-based enterprise (CBE; Peredo & Chrisman, 2006)—or a community-oriented small business with a common goal to improve population health—has not been discussed explicitly in the public health and social entrepreneurship literature (Gorman, Hanlon, & King, 1997; Lehner & Kansikas, 2013; Mair & Marti, 2006; Peredo & McLean, 2006; Volkmann, Tokarski, & Ernst, 2012). A few studies have partnered with community-based small businesses to deliver health promotion messages and health education on topics ranging from cancer screening and prevention (Meade, Menard, Luque, Martinez-Tyson, & Gwede, 2011) to reduction of sexual risk behaviors (Woods, Euren, Pollack, & Binson, 2010). Most notably, there were several projects housed within barbershops and beauty salons to promote healthy behaviors among African American communities with varying success on long-term health outcomes (Ford et al., 2009; Linnan & Ferguson, 2007; Releford, Frencher, & Yancey, 2010). Primary drivers of the successful barbershop and beauty salon interventions included a sense of social entrepreneurship, shared values for community health and other intrinsic motivators among staff and owners of the hair salons (Ford et al., 2009; Linnan & Ferguson, 2007; Meade et al., 2011). Mayer et al. (2016) also assessed perspectives among Philadelphia and Camden corner store owners and found that store owners provide a unique perspective when implementing retail interventions. A majority of the owners assessed described a desire to participate in advancing community health but often met many challenges in changing the healthy eating behaviors of their consumers (Mayer et al., 2016). Given that retail interventions are growing in popularity and usage nationwide, specifically as a driver for improving community healthy food access, it is important to understand the processes and actions needed to effectively collaborate with store owners to facilitate health promoting activities and institutionalize healthy behaviors in low-income communities (Altman, 1995; Brennan, Castro, Brownson, Claus, & Orleans, 2011; Gittelsohn, Lee-Kwan, & Batorsky, 2013). The purpose of this study was to explicate and define the development of healthy corner stores as CBEs within eight low-income, suburban communities, and to understand the CBE construct from the perspective of corner store owners.

Intervention Description

The Healthy HotSpot (HH) corner store pilot project provided a basis for the current study to explore the role of corner store owners in advancing community health, and the transformation of their store into a health-promoting resource for the community—or a CBE. The project, which took place in 2012, involved 21 (of 200) corner stores in suburban Cook County, Illinois, and eight local community-based partner organizations (CBOs) who facilitated the intervention with store owners. CBOs in low-income communities were identified as partners for the HH project based on a previous outreach process conducted by staff of the Suburban Cook County Communities Putting Prevention to Work initiative. The initiative was led by the Cook County Department of Public Health and the Public Health Institute of Metropolitan Chicago.

Store owners were required to add six new healthy products to their store, including one fresh fruit and one fresh vegetable. If they complied, they received a small stipend, new equipment, marketing materials, a plan for healthy product and equipment placement, and enhanced community outreach and engagement by the local CBOs. Training and technical assistance was provided to CBO staff to enhance their capacity in working with and recruiting corner stores into the HH project, with a goal to improve the availability of healthy foods in low-income communities. Details of this study are found in Jaskiewicz et al. (2013) and Jaskiewicz, Dombrowski, Barnett, Mason, and Welter (2016).

Method

Study Design

Using an instrumental case study design, this study analyzed narratives from participants within the HH project to explicate a locally relevant understanding of corner stores as CBEs, and how the CBE construct promoted institutionalization of health promoting activities (Creswell, 2013; Ragin & Becker, 1992). This study was approved by the University of Illinois at Chicago Institutional Review Board for secondary data analysis in February 2016.

Setting

Suburban Cook County, Illinois, surrounds the City of Chicago and is a large, geopolitically complex area in the Midwestern United States with vast pockets of health and socioeconomic disparities focused in the south and west suburbs (Cook County Department of Public Health, 2011). Nearly 2.3 million people reside within suburban Cook County, which comprises 735 square miles, 125 municipalities, 21 acute care hospitals, and 143 school districts (Cook County Department of Public Health, 2011). This study used existing data collected within the following communities: Blue Island, Calumet Park, Chicago Heights, Cicero, Ford Heights, Harvey, Mount Prospect, and Riverdale.

Sample

The sample was predetermined to 21 stores within eight communities that completed the HH project. The qualitative notion of purposeful sampling was supported in this study because it was reasonable to assume that a single case study of suburban corner stores was able to reveal and clarify useful processes, actions, and categories that began to inform an appreciation for the construct of CBEs in health promotion interventions (Creswell, 2013; Palinkas et al., 2015).

Data Sources

There are three categories of data sources that define this case study, each is summarized below (Table 1).

Table 1.

Case Study Data Sources.

Data source and type	Purpose for this study	Duration of data collection	Description	Location	Number	Date collected
Demographic survey data	These data were used to understand HH project participant identity (SES, residence) and how this influenced the development of stores as CBEs	10 Minutes	Short questionnaire administered to store owners, CBO staff and consumers prior to interviews and focus groups	All HH communities	Consumers (n = 51); store owners (n = 21); CBO staff (n = 8)	April 2012 to June 2012
U.S. Census sata	These data were used to understand SES of communities and how this influenced the development of stores as CBEs	N/A	Consumers	All HH communities	N/A	2000-2010
Semistructured interviews	These data were used to understand factors related to healthy corner stores becoming CBEs and the impact of the owners’ CBE identity on community healthy eating behaviors	1.5 Hours	Store owners (Primary data source)	Blue Island	2	April 2012 to May 2012
				Calumet Park	1
				Chicago Heights	2
				Cicero	7^a
				Ford Heights	2
				Harvey	3
				Mount Prospect	1^a
				Riverdale	3
				Total	21
		1 Hour	Community organization key contact/staff member	All HH communities	8	April 2012
Consumer focus groups	These data were used to understand store owner relationships with community members and how this is related to institutionalization of store changes and impact of owners’ CBE identity on community healthy eating behaviors	1 Hour	Groups of up to 18 consumers in six of eight HH communities	Calumet ParkChicago HeightsCiceroHarveyMount ProspectRiverdaleTotal	41814^a34^a851	April 2012 to May 2012

Note. CBE = community-based enterprises; HH = Healthy HotSpot; CBO = community-based organizations; SES = socioeconomic status.

Indicates data collection completed in Spanish.

Demographic Data

Existing data from demographic questionnaires collected among HH participants and county-level data from the U.S. Census Bureau (2011) were combined to assess and explicate community context for this case study. Community context includes the socioeconomic environment around the participating stores as well as HH participant and community resident demographics. These data provided information about the residents and potential customers for the HH stores.

Questionnaires were completed by all interview and focus group participants (Table 1) and included five short questions related to participant residence, ethno-cultural identity, income, and education. These data allowed for characterization of the participants within this study, as well as, exploration of differences that existed between consumers who shared ethno-cultural identities and residential area with store owners and those who did not.

In-Depth Interview Data

Store owners and CBO staff were interviewed either within their work place or at a community meeting location of their choice by a HH project staff member trained in qualitative data collection methods. Interviews were conducted in Spanish and English and were recorded and transcribed verbatim by the same HH staff member. The store owner interview guide included questions related to store history and owner experience, product availability and placement, usage of the HH equipment, motivation to continue the sale of healthy foods, their overall experience in the HH intervention, and their perceptions of the value of the intervention for community health. The CBO staff interview guide included questions related to organization history and experience, perceptions of the barriers and facilitators to continuing the HH project with store owners, perceptions of the barriers and facilitators in expanding the HH project to new stores, their overall experience in the HH intervention, and their perceptions of the intervention on community health.

Focus Group Data

Consumers in six of the eight participating communities were recruited to attend a 2-hour focus group session (in either Spanish or English) at a community facility within proximity to the HH store. Recruitment occurred within the corner stores through dissemination of flyers and oral promotion. Project staff trained in qualitative data collection methods facilitated the focus groups and one notetaker was also present. Focus groups were recorded and transcribed verbatim by HH project staff. The focus group guide questions were ordered to create discussion among participants in the areas of shopping behaviors, potential to purchase healthy foods, recognition of the HH project within local stores, and overall perception of local corner stores. Due to limits in funding and time constraints, 6 out of 8 community focus groups were completed with a range of 3 to 18 participants per group.

Data Analysis

Store owner narratives served as the primary data source for this study. An iterative process was used to conduct initial and focused coding, using gerunds to identify store owner actions and processes that best shaped and defined the CBE construct and institutionalization of health promotion activities. Larger categories of meaning (themes) were created from the store owner data, CBO interviews and consumer focus group narratives, utilizing a constant comparative method (Bernard & Ryan, 2010; Charmaz, 2006, 2014; Miles, Huberman, & Saldaña, 2013). The focused coding and data saturation process allowed for the initial codes to be assessed for conceptual strength and alignment in the creation of three key thematic categories (discussed in the Results section) that arose from the analysis processes (Charmaz, 2014). Memo writing was used during and after the focused-coding process for the purpose of documenting analytic decisions and to explore understanding of the CBE construct (Charmaz, 2014). ATLAS. ti v7.5.10 (Scientific Software Development GmbH, 2015) was used to code and manage the qualitative data.

Results

Description of Store Owner and Community Demographics

In five communities, consumers served by the HH stores were primarily African American, except Chicago Heights, in which the stores also may have served Latino/Hispanic populations (33.9% of total population; Table 2; U.S. Census Bureau, 2011). In three communities, consumers served by the HH stores were predominantly Hispanic/Latino populations (U.S. Census Bureau, 2011). In Mount Prospect (predominately White), a large enclave of low income, Hispanic/Latino populations were served by the HH store. Additionally, a large majority of consumers served by the stores in all eight communities had obtained at least a high school diploma, however, nearly a quarter to half of community families live in poverty (U.S. Census Bureau, 2011).

Table 2.

Community and Store Owner Demographics and Socioeconomic Status.

Municipality	Population	Percentage of White, not Hispanic/Latino	Percentage of African American	Percentage of Latino/Hispanic	Percentage in poverty^a	Percentage with High School diploma	Number of stores	Store owner race/ethnicity	Store owners living in community
Blue Island	23,706	21.0	30.8	47.0	21.8	77.7	2	Latino/Hispanic (2)	2
Calumet Park	37,042	13.3	70.6	15.0	22.0	85.6	1	Arab	0
Chicago Heights	30,276	23.3	41.5	33.9	29.0	78.3	2	White (2)	0
Cicero	83,891	9.2	3.8	86.6	22.0	61.5	7	Latino/Hispanic (5); Arab (1); White (1)	6
Ford Heights	2,782	1.4	95.4	1.5	46.2	78.6	2	Arab (1); Other (1)	0
Harvey	25,282	3.6	75.8	19.0	35.0	75.7	3	Arab (2); Asian (1)	1
Mount Prospect	54,167	69.0	2.4	15.5	4.3	88.3	1	Latino/Hispanic	0
Riverdale	13,549	3.8	93.7	1.7	25.3	88.4	3	Arab (1); Asian (2)	0

Poverty threshold for a family of four in 2010 = $22,314.

Store owner demographics were often different from community demographics noted above, especially in relation to racial/ethnic composition and residence of store owners versus the consumers they served (Table 2). A large majority of HH store owners were male (n = 16) and had some college or a college degree (n = 10). Within the African American communities, store owners typically were of a different ethno-cultural identity and resided outside the community they served. However, in Latino/Hispanic communities, most store owners identified as Latino/Hispanic and resided within the community (Table 2). Overall, a large majority of store owners in this study identified as Latino/Hispanic (n = 7) or Arab (n = 6).

Narrative Descriptions of the CBE Construct

Store owners’ CBE identity emerged from the data analysis process to understand and describe owners’ intrinsic motivations and intentionality in running a business that also promotes community health. Table 3 outlines the three key thematic categories and accompanying quotations that best illustrated the meaning of the CBE construct within the narratives. The categories include Prioritizes Community Health, Positive Community Engagement, and Health Resource for the Community.

Table 3.

Narrative Descriptors of the CBE Construct.^a

CBE construct descriptor categories	Store owners	CBOs	Consumers
Prioritizes Community Health	“I have been selling fresh fruits and vegetables since we opened, I believe it’s important to value health and I want to be part of helping people eat healthier.” “No . . . I will bring healthier options . . . doesn’t matter the cost. If the customers ask for it, I will bring it, no matter what.”	“Honestly I would say that with everyone except [Cicero Store Owner and Cicero Store Owner], I think the incentives had a lot to do with it. I think that [Cicero Store Owner], and [Cicero Store Owner] were doing it with I think better intentions of really helping the community.”	“If item sells, the owner will offer it more. Looks like owners listen and try to accommodate requests. For example, at [Cicero Store] I asked him why don’t you sell wheat bread? . . . and he responded well if you want it I will bring it here for you.”
Positive Community Engagement	“What I like to feed my kids, I like to feed the community.”	“[Chicago Heights Store] was very engaged. They added over 40 new frozen and fresh food items to their store. And they only had to add six. I would definitely say they were signed on and fully engaged. They supported everything we were doing. Well they saw a benefit for them to move on to the next phase. It was beneficial for them to continue on. We never had any issues with them.”	“The owner of [Cicero Store] is very attentive, he put vegetables and added a lot of other healthy products, tortillas are cheaper (four for $1) and I can send my children unaccompanied to the corner stores because they are close and convenient.”
Health Resource for the Community	“I would like to try and sell healthier snacks like granola bars and/or nuts, but they are too expensive for me to purchase . . . the unhealthy snacks are what sells so unfortunately I cannot get rid of them, but I do try to encourage kids when they come in and purchase the junk food to try a healthier option, like a piece of fruit. . . . I also try and display the healthier options better so they are more visible to the customer.”	“I think [Harvey Store Owner], at the corner. He’s just really pro-community. He was doing a lot of the things that we wanted him to do even before. He was working with WIC. And some of the things that we wanted him to have, WIC wanted him to also have. He’s more enlightened and committed. Probably richer too. So he was the easiest one I think.”	“They cool with the community. If you don’t have enough (money), they’ll let you go. Or they’ll say give it back next time but most of the time they won’t ask for it. They speak to you if they see you. Like if they standing outside they shop and you on your way and you not going to their store, they speak. They um, they real polite to the kids, to everybody. They pretty much try to keep a personal one on one relationship.”

Note. CBE = community-based enterprises; CBO = community-based organizations; WIC = women, infants, and children.

This table illustrates CBE construct definitions provided in the store owner, CBO, and consumer narratives.

The first thematic category, Prioritizes Community Health, was discussed similarly within each of the participant narratives and encompassed a general sense of store owners valuing the health of their community consumers. Among the store owners, this was often illustrated through descriptions of the importance of providing healthy foods and improving the health of their consumers (Table 3). Store owners also discussed prioritizing selling healthy foods over making a profit and extended their healthy food offerings even when a financial loss might be expected. As explained by this Chicago Heights store owner in response to her reasoning for selling healthy foods:

Because it’s good for the people . . . even though it doesn’t sell well I believe over time it will start selling better . . . with time and education.

In the CBO and consumer narratives, discussions of the Prioritizes Community Health category complemented store owners’ reports. CBO staff narratives often discussed store owners’ actions in caring for the community and offering healthy foods. Consumers discussed store owners’ attentiveness to their requests for healthy foods and the owners’ initiative to add or replace products with healthier items, and/or culturally relevant healthy foods within the stores (Table 3). The more a store owner prioritized consumer needs for healthy foods, the more they were perceived to embody the CBE construct and hold a CBE identity among customers.

The second thematic category, Positive Community Engagement, was also discussed similarly within participant narratives. Store owners often described consumers as neighbors, friends, or family (Table 3) and readily participated in community-based events and activities in addition to selling healthy foods in the community. CBO staff often discussed store owners as able and willing partners within the HH project and noted positive relationships with their consumers. Consumer narratives served as a significant descriptor for this category. Several consumers described the importance of the store owners’ presence and history within the community (i.e., time spent as owners), their sociocultural background, place of residence, and overall interactions with their customers as evidence of having rapport with the communities they served and encompassing the CBE construct. This can best be described by a consumer from Cicero:

Yes I do because a lot of the people who go to these stores, they come there every day. If not every day, every other day so they do make some type of rapport with their customers so they continue to come back.

Positive Community Engagement proved to be an extremely important category to explicate the CBE construct and store owners’ CBE identity. Although most owners prioritized and valued community health, these actions were unable to overcome the negative owner–consumer relationships present within some of the communities. Several contextual factors, such as owner and consumer racial and ethnic backgrounds, place of residence, history, and recent interactions also greatly influenced alignment with the CBE identity. This was especially relevant in African American serving communities where a majority of owners did not reside within the communities they served and were of different racial and ethnic backgrounds than their consumers. In these communities, contextual differences had a negative effect on owners’ abilities to serve as a healthy food resource (Table 4).

Table 4.

Negative Community Engagement.

Themes	Quotes/discussions
Importance of residing within the community	Participant 1: “Real good. Very well. By first name. [HH Store Owner] cool. [HH Store Owner worker] is cool.” Participant 2: “I like [HH Store].” Participant 3: “[HH Store]. The owner has a nasty attitude. I don’t know his name, but he got a Napoleon complex. Have they been in the neighborhood a while? Do you think they contribute to the neighborhood? No. [HH Store] ain’t going to let you go with a penny [they won’t help you out if you come up short at the register]. [HH Store]. will let you go. You can be $5 short.”
Importance of residing within the community	“Big change. The owners before lived in the neighborhood. They cared about the neighborhood. If you needed something and didn’t have the money, come on in. Yeah we know you gonna make good on it.”
Motivations for profits	“If you saw them marketing healthier items, would you go in and see what they were? Yeah, I would go and check it out but they got to lower the price. Cause you go to the grocery store, the stuff they (corner store) selling is $10 and there (grocery store) it’s like $2. What they do is basically go to the grocery store, buy their pops and put it in their freezer and selling it to us. They buy six packs of the bottled pop and the whole pack cost a dollar then they take the price tag out and sell them each for a dollar. A $1.39, not just a dollar plus the tax. We know that’s why they all retiring because that’s supposed to be for our convenience, but it really ain’t convenience. It’s more of a hindrance because they actually basically robbing us. They like vampires in the Black community.”

Note. HH = Healthy HotSpot.

Differences in ethno-cultural backgrounds, place of residence and negative interactions with customers greatly influenced owners’ alignment with the CBE construct within these communities. Consumers were more descriptive than store owners in their discussions of negative relationships among the stores and the community. Store owners may have been unaware of these perceptions among their customers, or chose not to provide that information. Although owners may have discussed one or all three CBE thematic categories within their narratives, the lack of support for these stores by their consumers would, eventually, reduce demand for health promoting changes made in the stores and depreciate owners’ efforts to provide a CBE within these communities. Fortunately, in the Latino/Hispanic serving communities more positive influences on the CBE identity were present in the consumer narratives and are presented in Table 3.

The final thematic category, Health Resource for the Community, comprised discussions in the narratives of stores serving as more than a food resource within the community. Store owners described meeting the needs of low income, senior, and youth consumers through participation in programs such as SNAP (Supplemental Nutrition Assistance Program) and WIC (Women, Infants, and Children), as well as offering on-site health education/promotion to youth consumers (Table 3). Owners also discussed offering healthy convenient foods for their consumers and culturally relevant healthy foods in Latino/Hispanic serving communities, as one store owner from Mount Prospect illustrated,

On one hand we have to sell what the customers buy and request and on the other hand we have to offer what’s healthy. Unfortunately customers don’t request a lot of the healthy items, although they are buying them. If it were up to me, if we didn’t sell chips, I would be delighted. I know how bad they are, and that’s mainly because I think of my kids, I don’t want this for my kids, so I also don’t want it for my customers.

Owners also discussed offering healthy convenient foods for their consumers and culturally relevant healthy foods in Latino/Hispanic serving communities.

CBO staff often illustrated the benefits HH stores obtained through participation in the project, and how this enabled owners to provide more than healthy foods to the community (i.e., provide activities like health education). Consumer narratives also discussed the benefits stores provided to the community, such as participating in SNAP and WIC. However, consumers also described a unique aspect among local, small stores such as the provision of store credit when they did not have enough funds to complete their purchases (Table 3). By offering additional benefits to the community, stores were viewed as resources for health and owners more closely aligned with the CBE identity and construct.

A key concept discussed within the narratives that also enhanced store owners’ alignment with the CBE construct included partnerships with a highly engaged CBO within the HH project. A highly engaged CBO included full-time staff for the HH project, attendance at all training events, and completion of one or more marketing events within the HH stores. This was an important finding because it showed the role of linkages of small stores to community-based resources, such as the CBOs, in supporting the store as a CBE and health resource for the community.

For example, in Cicero, the seven store owners noted several benefits of participating in the HH project, including increased sales, helpfulness of the materials, and satisfaction with the new equipment/incentives. The Cicero stores were the only stores to have consumers notice the changes made within their stores due to the HH project (via the focus group narratives) and were partnered with a highly engaged CBO. This can best be explicated through the description from one Cicero store owner in discussing the benefits of participation in HH:

No not really other than I am grateful to be part of this program and have had a good experience . . . the residents of this community are very happy to see fresh fruits and vegetables sold in my store . . . I would like to try and work closer with [Cicero CBO] to do some community education classes and tie in free taste tests and samples from the food I offer at my store. Since I have a full kitchen, I would also like to start cooking and offering “healthy plates” to my customers.

It appears that for the Cicero stores, their more positive associations with the CBOs facilitated stronger associations with owners’ CBE identities and more positive responses from the community.

Discussion

Five key factors influencing store owners’ CBE identities were illustrated within the findings of this study. These included (1) store owners holding similar ethno-cultural identities and place of residence as their consumers; (2) positive, trustworthy relationships among store owners and the community; (3) store owners prioritizing community health over store profits; (4) collaborations with a CBO that was highly engaged in the HH project; and (5) an unmeasured concept of community social capital and cohesion (Kawachi, 1999), which appeared to be present in communities where owners’ held strong associations with the CBE construct. The interpretation of these findings are illustrated in Figure 1. For example, it appears among store owners who displayed positive relationships with the community, resided in the same communities as their consumers and held the same ethno-cultural identities as their consumers more readily discussed Prioritizing Community Health within the narratives. When these owners were then coupled with a highly engaged CBO in the HH project their CBE identities appeared to be enhanced and strengthened. Additionally, healthy-eating promotion activities could likely continue within this store, regardless of future funding or influence from outside agencies, given the full support of the consumers. Ultimately, all HH store owners cared about their community, given their participation in the project, however, a few store owners more adequately discussed and represented their role in the community as a health promoting resource and CBE within the participant narratives.

Figure 1.

Factors influencing store owners’ CBE identities.

As stated in the findings, contextual factors such as consumer and store owner ethno-cultural identities, place of residence, and relationships (positive or negative) were found to be highly influential on owners’ CBE identities. The ethno-cultural factors are placed first in the conceptual framework (Figure 1) due to their impact on consumer–owner relationships and trustworthiness as well as owners’ intrinsic motivations and CBE identities. An emerging, but unmeasured concept of community social capital (Kawachi, 1999) was also found to be an influential factor in determining alignment with the CBE identity. For example, in Cicero, where store owner alignment with the CBE identity was high, there were several descriptions in the narratives that aligned with community cohesion and social capital, including discussions of store owners acting as health advocates being a social norm (Kawachi, 1999). The similar sociocultural identities and related experiences among the consumers and owners, increased mutual understanding, and trustworthiness was likely influenced by social capital present within these communities (Figure 1). Store owners from these communities discussed intrinsic motivations of valuing community health (over store profits) within their narratives and consumer and CBO narratives illustrated positive, trustworthy relationships among owners and consumers.

Consumer reports revealed positive and negative contextual factors, which appeared to play a large role in the strength of store owners’ CBE identities. In communities where reports were positive, consumers described the stores as health resources for their community and displayed a sense of compassion and appreciation for the store owners. In communities where reports were negative, consumers described a great sense of dislike and disapproval for the store and the owners. Some consumers discussed “never shopping there” or a hope for “new owners” that were from the community and understood their needs. These underlying tensions within the community were greatly influenced by the dissimilar ethno-cultural identities of the owners and consumers, as well as diminished social capital and cohesion (Kawachi, 1999). Together, these factors overshadowed owners’ alignment with the CBE identity and engagement in the HH project. As with other community-based projects, insider–outsider tensions and the perceptions of power and privilege within low-income communities, if not managed properly, can diminish health-promoting activities and positive health outcomes (Israel, 2005).

Implications for Research and Practice

Collaborations with small, locally owned businesses is not a new phenomenon within public health practice, as a number of studies have partnered with barbershops and beauty salons to provide health education (Linnan & Ferguson, 2007; Releford et al., 2010), other local businesses to provide space to be physically active (Suminski & Ding, 2012; Suminski, Petosa, Jones, Hall, & Poston, 2009) and others to participate in healthy cooking demonstrations (Yancey et al., 2006). Most often, however, small businesses have been incorporated within public health interventions as secondary partners that may provide some aspects of health education (Irwin et al., 2012; Meade et al., 2011) or recruitment for program participants (Releford et al., 2010), as opposed to being a central partner that promotes healthy behaviors and elicits change within communities.

Expansion of the small business role in public health programming, to become leaders in the provision of health promotion activities and provide communities with a health promotion resource, or CBE, is a relatively novel concept in public health research and practice and has limited reports within the literature. As this study provided key insights into the food retail sector as potential health partners, more research is needed with other small business partners in low-income communities (e.g., barbershops, beauty salons, restaurants) to determine the expansion of the CBE concept to other sectors. National recognition of the role of local businesses in promoting community health has been more recently proclaimed by the Robert Wood Johnson Foundation, through their Engaging Businesses in Health initiative (Paloma, 2015), which should further assist in explicating local businesses’ responsibilities in promoting and sustaining community health. Additional interventions and research that incorporate small businesses as health promoting agents should be reported on in the public health literature for further understanding of owner motivations and intentions to improve community health and wellness.

In addition, future health collaborations with small businesses should also incorporate assessments of community ethno-cultural identities and the presence or absence of community social capital (Kawachi, 1999); as this appeared to influence owner alignment with the CBE identity, but was not measured directly within this study. Community assessment prior to any change effort, can capture aspects of community social capital within local resources (Adler & Kwon, 2002), such as local business and community development organizations, and assess their actual or potential to collaborate toward improving the local food system. Asset or resource mapping, together with key informant interviewing—using approaches such as Mobilizing for Action through Planning and Partnerships (National Association of County and City Health Officials, 2019)—can be helpful in this regard and should be included in future interventions that partner with small business owners in local settings. The identification of potential partners (e.g., local community business associations, economic development) and social capital early on in intervention planning can assist practitioners in facilitating successful, locally rooted programs that result in positive and sustained health outcomes (Story et al., 2008).

Limitations and Challenges

The procedural methods and data analysis decisions were illustrated and verified through utilization of an audit trail—including a codebook and qualitative data analysis software (Morse, Barrett, Mayan, Olson, & Spiers, 2002). As with any qualitative analysis, especially studies in which existing data are utilized, it is difficult to assure reliability and validity of methods, in particular within data collection tools and sampling of the population. Data were not collected with the intentions and aims of this study in mind, and therefore, careful review of implied meanings within the participant narratives had to be considered in the analyses. Data limitations included incomplete CBO reports, a lack of consumer information from all communities and incomplete responses within the store owner and CBO interview guides. In addition, qualitative research by nature is concerned with discovering nuances and social processes and cannot be generalized. Further studies in which data collection tools are created with the CBE concept as a focal point, as well as studies with larger sample sizes, would assist in confirming the findings of this study and the role of businesses in improving community health.

Conclusion

Engaging small business owners in health promotion and other public health activities and programming is an essential, yet underappreciated, component of community-based public health (Israel, 2005; Israel, Schulz, Parker, & Becker, 1998). This study contributes to the existing literature by exploring insights into small business owner engagement in health promotion activities, as a health resource within their communities, or rather as a CBE for health (Peredo & Chrisman, 2006).

Footnotes

Acknowledgements

This research study would not have been possible without the support of the store owners, community-based organization staff and consumers who volunteered their time and perspectives for the Healthy HotSpot Pilot project evaluation. Thank you for your thoughtful insight. Thank you to the staff of the Cook County Department of Public Health (CCDPH) and the Public Health Institute of Metropolitan Chicago (PHIMC).

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The Healthy HotSpot project was supported by a cooperative agreement with the Centers for Disease Control and Prevention (CDC; No. 1U58DP002623-01), which was provided to the Public Health Institute of Metropolitan Chicago (PHIMC) and the Cook County Department of Public Health (CCDPH). The findings and conclusions in this article are those of the authors and do not necessarily represent the views, opinions, and official policies of the CDC, PHIMC, or CCDPH.

ORCID iD

Rachael D. Dombrowski

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