JMIR Publications

ABSTRACT

Background:

Many factors including the impact of colonization and subsequent intergenerational trauma contribute to inequalities in health outcomes for Australian Indigenous peoples. The unacceptable health gap is particularly high for Indigenous Australians living in very remote communities. Food insecurity, defined as a lack of regular access to safe, nutritious and affordable food, is influenced by both housing and retail environments. Ensuring houses have functional and adequately maintained kitchens and access to affordable healthy food are significant policy challenges for the Australian Government, yet little remains known about these environmental health drivers in remote areas.

Objective:

This study aims to benchmark environmental health food security risk factors impacting in 19 very remote Indigenous communities in Western Australia by auditing the appropriateness and suitability of kitchens in houses (internal environment); assessing food affordability and retail practices (external environment) and residents’ concerns and perceptions of appropriate kitchens.

Methods:

The mixed methods ehealth protocol includes three methodological approaches to audit and benchmark environmental health risk factors and perceptions in houses and community stores. The internal environment is assessed via an in-house audit of facilities used to prepare, store and cook food to maintain Healthy Living Principle 4 using a customized digital App and a 5-minute face-to-face yarn (interview) with (n=130) tenants. This provides a lived experience perspective to inform recommendations for housing and store pricing policy. The external environment assessment of retail practices and prices of (n=97) food items and (n=25) sanitation products at remote community stores will be undertaken using the mobile phone Healthy Diet ASAP App and comparing the mean price of each product and the whole diet with grocery stores in the nearest town and the major capital city. Descriptive statistics and frequencies will be reported for the audits and thematic analysis of the interviews will be undertaken.

Results:

The tenant interviews and data collection for the in-house and retail audits across the 19 communities will be undertaken by November 2025 and analysis is expected to be completed by March 2026. Findings will be collated and triangulated to provide benchmark data for environmental health determinants of food security in very remote Western Australian communities. Preliminary findings will be shared with each community in formats to support and inform policy and practices regarding timely maintenance of remote homes, kitchen design suitability, and community store retail practices.

Conclusions:

his is the first study in Australia to explore the environmental health drivers of food insecurity in very remote Indigenous communities using digital technology from the perspectives of the tenant, in-house facilities and in-store retail practices. This food security environmental health benchmarking will provide evidence for advocacy to promote culturally appropriate and practical solutions to improve living conditions and health of families in very remote areas.