A Q methodology study of stakeholders' views about accountability for promoting healthy food environments in England through the responsibility deal food network

In March 2011, the United Kingdom's (UK's) Government launched five Public Health Responsibility Deal Networks to address public health priorities. The Networks used voluntary partnerships to influence peoples' choice architecture to move them toward healthier behaviors. The purpose of this research was to conduct an exploratory study of diverse stakeholders' perspectives about perceived responsibility and accountability expectations to improve food environments in England through the Food Network partnerships. A purposive sample of policy elites (n=31) from government, academia, food industry and non-government organizations sorted 48 statements related to improving food environments in England. Statements were grounded in three theoretical perspectives (i.e., legitimacy, nudge and public health law). PQMethod 2.33 statistical software program used factor analysis to identify viewpoints based on intra-individual differences for how participants sorted statements. The results revealed three distinct viewpoints, which explained 64% of the variance for 31 participants, and emphasized different expectations about responsibility. The food environment protectors (n=17) underscored government responsibility to address unhealthy food environments if voluntary partnerships are ineffective; the partnership pioneers (n=12) recognized government-industry partnerships as legitimate and necessary to address unhealthy food environments; and the commercial market defenders (n=1) emphasized individual responsibility for food choices and rejected government intervention to improve food environments. Consensus issues included: protecting children's right to health; food industry practices that can and should be changed; government working with industry on product reformulation; and building consumer support for economically viable healthy products. Contentious issues were: inadequacy of accountability structures and government inaction to regulate food marketing practices targeting children. We conclude that understanding different viewpoints is a step toward building mutual trust to strengthen accountability structures that may help stakeholders navigate ideologically contentious issues to promote healthy food environments in England.