Bmjopen 2019 036241.draft Revisions

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BMJ Open
Mapping the digital food environment: a Scoping Review

Protocol
Journal: BMJ Open
Manuscript ID bmjopen-2019-036241
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Article Type: Protocol
Date Submitted by the

06-Dec-2019
Author:
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Complete List of Authors: Granheim, Sabrina Ionata; Inland Norway University of Applied Sciences,
Department of Public Health and Sport Sciences
Opheim, Elin; Inland Norway University of Applied Sciences, University
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Library
Terragni, Laura ; Oslo Metropolitan University, Department of Nursing
and Health Promotion
Torheim, Liv Elin; Oslo Metropolitan University, Department of Nursing
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Thurston, Miranda; Inland Norway University of Applied Sciences,
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NUTRITION & DIETETICS, PUBLIC HEALTH, Nutrition < TROPICAL

Keywords:
MEDICINE
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For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml

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BMJ Open Page 2 of 12
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Mapping the digital food environment: a Scoping Review Protocol
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Sabrina Ionata Granheim,1 Elin Opheim,2 Laura Terragni,3 Liv Elin Torheim,4 Miranda Thurston5
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14 Affiliations and contact information
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16 1Corresponding author. Department of Public Health and Sport Sciences, Inland Norway University of
17 Applied Sciences, Elverum, Norway. Postal address: Terningen Arena, Hamarveien 112, 2406
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Elverum, Norway. Telephone: +47 62 43 03 72. sabrina.granheim@inn.no.
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20 2UniversityLibrary, Inland Norway University of Applied Sciences, Elverum, Norway.
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elin.opheim@inn.no
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23 3Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.
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25 lterragn@oslomet.no
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26 4Department
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of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.
28 livtor@oslomet.no
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29 5Department
30 of Public Health and Sport Sciences, Inland Norway University of Applied Sciences,
31 Elverum, Norway. miranda.thurston@inn.no
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Keywords: food environment, nutrition environment, digital technology, internet
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4 MANUSCRIPT
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6 Mapping the digital food environment: a Scoping Review Protocol
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8
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10 ABSTRACT
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12 Introduction: Food environments are the interface through which people interact with the broader
13 food system. They are a key determinant of healthy and sustainable diets. The widespread use of digital
14 technology in late modernity and the shift towards a digital society has posed new challenges for
15
nutrition and health, with a concomitant surge in research on social media, digital health promotion
16
17 interventions, and more recently increasing interest in digital food marketing. While the literature is
18 abundant on studies linking food, nutrition and digital technology, the effort to conceptualize and
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19 describe the digital food environment is new. This scoping review aims to support the development of
20 a definition of the digital food environment and characterize it, along with key thematic research
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trends on this topic and potential consequences for nutrition and health.
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23 Methods and analysis: The planned scoping review will be supported by the methodological
24
25
framework proposed by Arksey and O’Malley and further developed by Levac, Colquhoun and O'Brien.
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26 Development and reporting will follow the Preferred Reporting Items for Systematic Reviews and
27 MetaAnalyses—Extension for Scoping Reviews (PRISMA-ScR) checklist and guidelines. The
28 development of the search strategy was guided by the food environment conceptual framework
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29 developed by Turner et al. Four databases will be searched: Medline, Embase, Scopus and Web of
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31 Science. Snowball sampling will be applied to identify additional studies, and reference lists of reviews
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32 will be checked. Studies in English, published from the year 2000 onwards, will be included. No
33 geographical limits will be applied. Data will be extracted and analysed using a standardized charting
34 tool.
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36 Ethics and dissemination: No ethical approval is required for this study. The results will be submitted
37 to an international peer-reviewed journal and scientific conferences. They will be disseminated
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through digital science communication platforms, including academic social media, to amplify its reach
39
40 and usefulness.
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ARTICLE SUMMARY: STRENGTHS AND LIMITATIONS OF THIS STUDY
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45  The proposed scoping review will map the existing research on food environments and digital
46
technology, contributing to the theoretical development of the concept of digital food
47
48 environment and its potential consequences for nutrition and health.
49  By focusing on the breadth of the research landscape over depth, it will allow for the
50 description of research trends and main themes investigated in the literature, and the
51 identification of research gaps for future investigation.
52  Though comprehensive, the study design for this proposed scoping review has limitations
53 regarding the number of databases, the language and search terms used, and may
54
underrepresent research from low- and middle-income countries.
55
56  By focusing on food environments, the study may not capture the whole extent of research
57 being conducted on the linkages between food, nutrition and digital technology.
58  There will be no quality assessment of studies retrieved, a common feature of scoping reviews.
59 INTRODUCTION
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1
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3 Food environments have been defined in several ways,1-4 more recently and concisely as the interface
4
through which people interact with the broader food system.5 The role of food environments in the
5
6 current multiple burden of malnutrition (undernutrition, overweight, obesity and micronutrient
7 deficiencies) and diet-related noncommunicable diseases (NCDs) is widely recognized.6 They are a key
8 determinant of healthy and sustainable diets.
9
10 The number of published research articles assessing the food environment has increased considerably
11 in the past decade.7 A number of systematic reviews on food environments and the link with nutrition
12 and health outcomes have been conducted.8-11 Some systematic reviews focus on particular aspects of
13
14
the food environment, such as food marketing,12 rather than on the whole. While research gaps and
15 challenges still exist in food environment research, e.g. challenges on standardized measurement tools
16 and methods, an important topic has recently emerged, related to the role of digital technology for
17 nutrition and health, in particular social media, digital health promotion interventions and digital food
18 marketing.
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20 Social media and digital interventions have been the topic of several health-related systematic reviews
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to date. In fact, health represents a major share of research within the broader field of social media
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23 research.13 A systematic review and meta-analysis of randomized controlled trials by Williams, et al. 14
24 explored the use of social media to promote physical activity and healthy diets for the general
25 population. Maher, et al. 15 conducted a systematic review to evaluate the effectiveness of online social
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26 networks on behaviour change interventions targeting a range of modifiable health behaviours such
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as tobacco use, alcohol consumption, dietary intake and physical activity. A systematic review by Willis,
28
et al. 16 explored the use of social networks as a primary intervention platform by evaluating the
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30 effectiveness of weight management interventions delivered through such platforms. Klassen, et al. 17
31 conducted a mixed-methods systematic review to investigate the use of social media for nutrition
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32 outcomes among youth.

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34 Whereas most research on food marketing still focuses on traditional broadcast media, there has been
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35 some momentum towards researching digital food marketing in recent years. This includes a
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37 systematic review on digital marketing and youth attitudes and behaviour related to unhealthy
38 commodities (food, alcohol and tobacco) by Buchanan, et al. 18 and reports by the World Health
39 Organization 19 20.
40
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41 In summary, these reviews and reports, along with individual studies, have identified the potential of
42 digital technology for health promotion interventions, through dietary and physical activity mobile
43 apps for self-monitoring, among others.21 At the same time, the existing literature also indicates the
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potential harm offered by the digital world to nutritional health, for example via increased
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46 consumption of unhealthy snacks due to influencer digital food marketing,22 or the increase in
47 particular social behaviour online linked to rising body image and eating disorders.23
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49 In the context of the widespread use of such technologies in late modernity and the consequent shift
50 towards a digital society, it has been suggested that the sum of digital influences on health and
51 nutrition goes beyond social media, digital health promotion interventions and digital food marketing,
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to include a broad range of digital actors and activities that are creating a new layer to food
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54 environments, the digital food environment.24 While the literature is abundant on studies linking food,
55 nutrition and digital technology, an attempt to conceptualize the digital food environment is new. This
56 proposed scoping review intends to contribute to that process, as this first stage in a larger ongoing
57 research project.25
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59 The aim of this planned scoping review is therefore to map and collate the published academic
60 literature on the digital food environment. The findings will be used to support the development of a

1
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3 definition of the digital food environment, characterize its components and identify potential
4
consequences for diets and nutritional health.
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6 Specific objectives are to:
7
8  develop a descriptive overview of existing academic literature to uncover research trends on
9 aspects related to the digital food environment.
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 provide elements to help characterize the digital food environment and develop this concept.
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12  make recommendations and identify research gaps.
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14
15 METHODS AND ANALYSIS
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Scoping reviews allow for the exploration of broad research questions. They are useful when a
18 systematic mapping of the available evidence is required that indicates the scope and coverage of
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19 current literature (including main concepts, theories and knowledge gaps), rather than providing
20 detailed answers to very specific questions.26-28 This proposed scoping review will involve a mapping
21 of previous studies to determine the status of knowledge on the digital food environment. It aims to
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provide an overview of this broad study field, and will prioritize breadth over depth,29 not searching
24 for exhaustiveness and completeness, but rather for a comprehensive overview of the available
25 evidence.30 It will identify the breadth of research on themes related to the digital food environment,
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26 focusing on the range of studies that are available and the identification of gaps, rather than focusing
27 on one specific theme in depth.
28
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29 The planning of this scoping review has been informed by the methodological framework for scoping
30
reviews proposed by Arksey and O’Malley31 and further developed by Levac, Colquhoun and O'Brien.32
31
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32 Development and reporting will follow the Preferred Reporting Items for Systematic Reviews and
33 MetaAnalyses—Extension for Scoping Reviews (PRISMA-ScR) checklist and guidelines27, which have
34 also been consulted for the development of this protocol.
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36 While focusing on breadth over depth may be a limitation of this study, this scoping review may be the
37 gateway to future systematic reviews for in-depth exploration of particular/specific topics identified
38 through this study. It will also inform the next stages in the broader research project previously
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40 mentioned.25
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Conceptual framework
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43 Currently, no definition of the digital food environment exists. This proposed scoping review aims to
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inform the development of such a definition. In order to do so, it will be guided by the food
46 environments conceptual framework developed by Turner et al.5, adding a digital dimension. While
47 other frameworks on food environments exist, this one in particular was chosen as it is one of the most
48 recent, and was developed based on a comprehensive review of the literature on food environments.
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50 According to this framework, a food environment is part of the broader food system (from farm to
51 flush), and includes two domains: an external domain, and a personal domain. There are four
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dimensions to the external domain: food availability, food prices, food vendor and product properties
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54 (which includes issues such as food quality, composition, level of processing, packaging, among
55 others), and food marketing and regulation. In the personal domain, there are also four dimensions:
56 food accessibility, food affordability, convenience (for preparing, cooking and consuming food) and
57 desirability (preferences, acceptability, tastes, desires, attitudes, culture, knowledge and skills).
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3 These eight dimensions will inform the development of the search strategy, as they will guide the
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choice of search terms to find relevant studies on the food environment. These will be combined with
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6 search terms relating to digital technology.
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Research questions
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9 The research questions that will guide the scoping review are presented in Table 1.
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11 Table 1. Scoping review questions
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Aspect Research questions
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14 Descriptive What is the volume of studies published by year?
15 What is the geographical scope of the publications?
16 Methods What type of theoretical approaches and research methods are used?
17 What types of studies are published?
18 What population groups are being studied?
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Nutrition and What themes are being studied?
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21 health What dimensionsa of food environments are being studied?
To what extent are studies measuring outcomes in nutrition and health?
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23 What are the outcomes in health and nutrition reported to date, if any?
24 Are there other outcomes being reported (e.g. societal, economic, etc)?
25 aAvailability, prices, vendor and product properties, marketing, accessibility, affordability, convenience and desirability. The
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26 dimensions are defined by the theoretical framework applied in the study.

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30 Inclusion and exclusion criteria
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32 This proposed scoping review will include publications from year 2000 onwards, to coincide with the
33 spread in use of digital technology by the general population and the emergence of social media.17 The
34 first social network, SixDegrees, was launched in 1997; the first scientific literature on blogs appeared
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35 in 2003, with research on other forms of social media emerging after that.33 Other studies have chosen
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similar cut-off dates. 17 34 No geographical or population restrictions will be applied, given the desired
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38 breadth of the review. Other criteria for inclusion or exclusion are outlined in Table 2. These will be
39 refined post hoc for relevance, through an iterative process to take place once abstracts have been
40 identified and screened, as typical of scoping reviews.31 32
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42 Table 2. Inclusion and exclusion criteria for the scoping review
43 Inclusion criteria Exclusion criteria
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45  Peer reviewed articles, including  Books and book chapters
46 original research and review articles  Book reviews
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48  Commentaries and opinion pieces  Grey literature
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published in peer reviewed journals  Website and newspaper articles
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51  Conference proceedings,  Social media content
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53 dissertations/theses and abstracts  Studies using digital research
54 published in peer reviewed journals methods but not about digital
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56  Protocols technology and nutritional health /
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 Indexed in MEDLINE, EMBASE, food environments
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59 Scopus or Web of Science
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 Published from year 2000 onwards  Studies on digital public health,
5  Language: English including interventions, but not
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7 related to the one of the eight
8 dimensions of the food environment.
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13 Search Strategy
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The search strategy was developed in consultation with a senior librarian. It will cover terms related to
16 two main concepts related to the digital food environment: digital technology and food environment.
17 As the concept of digital food environment is new and under elaboration, having no formal definition
18 or consensus on descriptive words, terminology used to describe aspects related to it is likely to be
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19 inconsistent, varied and general. The definition of search terms has endeavoured to capture that broad
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21 scope, and the conceptual framework described above has been a useful tool in this regard.
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22 Search terms were defined using an interactive scanning of the literature, as described by Booth,35
23 aiming to increase the likelihood of retrieving material relevant to the research questions. Table 3
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presents the search terms to be used in the scoping review. The search strategy will include free text
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26 and subject heading terms, which will be adapted to each of the databases.
27 The search will be conducted in the following databases: MEDLINE (OVID interface, 1948 onwards) and
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EMBASE (OVID interface, 1974 onwards), two major databases on health sciences and life sciences;
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30 and Scopus (Elsevier) and Web of Science (Clarivate Analytics), two major multidisciplinary databases,
31 to cover the non-clinical aspects of the relationship between humans, digital technology and food,
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32 including cultural aspects, for example. The snowball sampling technique will also be applied to identify
33 additional studies that may not be indexed in the databases searched. For instance, reference lists of
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existing (systematic) reviews will be checked to ensure the relevant literature appearing in such
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36 reviews are taken into account in this study.
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39 Table 3. Search strategy for Medline
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# Search syntax
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42 Digital Technology
43 1 internet/
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45 2 exp Webcasts/
46 3 exp Web Browser/
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4 exp Video Games/
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49 5 exp Virtual Reality/
50 6 exp Social Media/
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52 7 exp Smartphone/
53 8 exp Online Social Networking/
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9 exp Mobile Applications/
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56 10 exp Electronic Mail/
57 11 exp Data Visualization/
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59 12 exp "Cell Phone Use"/
60 13 exp Cell Phone/

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3 14 exp Blogging/
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5 15 exp Attitude to Computers/
6 16 (blog* or microblog*).ab,kw,ti.
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17 (cyber* or virtual or digital*).ab,kw,ti.
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9 18 ((digital or new) adj media).ab,kw,ti.
10 19 "information technolog*".ab,kw,ti.
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12 20 (smartphone* or mobile* or touchscreen* or wearable*).ab,kw,ti.
13 21 (social adj (media or network*)).ab,kw,ti.
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22 (web-based or online or on-line).ab,kw,ti.
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16 23 (website* or web site* or webpage* or web page*).ab,kw,ti.
17 (Facebook or Instagram* or Twitter or tweet* or Snapchat or YouTube or Reddit or WhatsApp
18 24
or TikTok or Tumblr or Pinterest or LinkedIn).ab,kw,ti.
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20 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19
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21 or 20 or 21 or 22 or 23 or 24
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Food Environments
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24 26 ((food or nutrition* or eating or obesogenic) adj environment*).ab,kw,ti.
25 27 (food adj (desert* or swamp*)).ab,kw,ti.
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27 (food adj1 (accept* or access* or acqui* or ad or ads or advertis* or aesthetic* or afford* or
28 attitude* or availab* or brand* or choice* or composition or consumption or convenience or
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29 cost* or cultur* or desir* or knowledge* or label* or marketing or outlet* or packag* or

30 28
perception* or practice* or preference* or prepar* or price* or pricing* or process* or
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promot* or provision* or purchas* or quality or retail or sale* or selection or service* or shop*
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33 or sponsorship* or stall* or store* or tast* or vendor*)).ab,kw,ti.
34 29 (food porn or foodporn or gastroporn).ab,kw,ti.
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30 "foodscape*".ab,kw,ti.
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37 (cafe* or canteen* or restaurant* or supermarket* or takeaway* or take-away or vending
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38 machine* or kiosk*).ab,kw,ti.
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32 (grocery adj (shop* or store*)).ab,kw,ti.
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41 33 26 or 27 or 28 or 29 or 30 or 31 or 32
42 34 25 and 33
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35 limit 34 to english language
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45 36 limit 35 to yr="2000 -Current"
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48 Study selection
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50 One researcher will carry out the search through electronic databases and keep a record of searches.
51 The software Endnote X9 (Clarivate Analytics) will be used for database organization of the results
52 retrieved. Duplicate removal and screening will be conducted using the online software Covidence
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(Veritas Health Innovation). Four researchers will be involved in the screening of titles and abstracts
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55 against the inclusion and exclusion criteria. Following a model previously applied in other reviews,36 37
56 at a first stage the researchers will independently screen a sample of the results, to determine the
57 degree of consistency in the individual assessments. Once an acceptable degree of consistency has
58 been reached, the remaining articles will be screened (title and abstract) by one of the researchers. At
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a second stage of screening (full text), two reviewers will work independently. One researcher will
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3 screen all records, while the work of the second reviewer will be divided equally among three
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researchers. A third reviewer may be involved when agreement cannot be reached by the two main
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6 reviewers.
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Data extraction and analysis
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9 Data extraction (charting) will be conducted using standardized tools to be developed for this scoping
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11 review. A preliminary charting table with indicators to be used to address the research questions is
12 provided in Table 4. The charting table will be piloted by two reviewers on a sample of included studies
13 to adjust its sensitivity. One reviewer will then perform the analysis, and the second reviewer will
14 independently check a sample of the total of articles, for accuracy. Any disagreements will be resolved
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through the involvement of a third reviewer.
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17 The data extracted in the standardized tool will be summarized through thematic content analysis,38
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grouping findings in similar categories based on commonalities. It will also be analysed to identify
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20 historical trends and the main research areas/topics that are being researched and published. Given
21 the scope and aims of this review, it will include both large and small-scale studies and a combination
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22 of different study designs and methods (including qualitative and quantitative data). This is not
23 uncommon for scoping reviews.39
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25 Table 4. Preliminary charting table
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27 Item Description (including examples of categories, which will be
28 expanded as themes emerge)
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29 Author(s)
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Title
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32 Year of publication
33 Journal
34 Country / geographical area By country
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35 By geographical area (continents)

36 By income category (high-, middle- and low-income countries)
37 …
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39
Study type Original research
40 Systematic Review
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41 Commentary
42 Protocol
43 …
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44 Aims/objectives of the study Describe the stated objective of the publication

45 Study population Women
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Men
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48 Children
49 Adolescents
50 Elderly
51 …
52 Methods RCTs
53 Case studies
54 Social network analysis
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…
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57 Themes Digital health and nutrition literacy
58 Innovation on digital food services (e.g. online food retail)
59 Digital social engagement on nutrition
60 Internet food subcultures

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3 Social media consequences on nutrition
4 …
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Food environment dimensions Food availability
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7 Food prices
8 Vendor and product properties
9 Food marketing
10 Food accessibility
11 Food affordability
12 Convenience
13 Desirability
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Health and nutrition outcomes Describe the reported outcomes (for intervention studies)
15
16 Other outcomes Describe the reported outcomes
17 Settings Social networking services
18 Websites
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19 Online communities
20 Games
21 ….
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23
24 ETHICS AND DISSEMINATION
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26 This study is based on the analysis of published scientific literature and does not involve patients,
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medical research or any type of personal information. Thus, no ethical approval is required. The results
28
of this scoping review will be submitted for publication in an international peer-reviewed journal
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30 (preferably open access) and scientific meetings and conferences on public health, nutrition and digital
31 research. Once published, results will be disseminated through digital science communication
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32 platforms, including academic social media, to amplify its reach and usefulness.
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34
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Twitter
39 Follow SIG @sabrinaionata and LET @livelint
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43 Author contributors
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45 SIG conceived the scoping review, developed the research questions and drafted the manuscript. EO
46 supported the development of the search strategy as a whole and the detailed search syntax, and
47 reviewed the manuscript. MT, LT and LET supported the conceptualization of the study, critically
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reviewed drafts and edited the manuscript.
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52 Funding statement
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54 This scoping review received no specific grant from any funding agency in the public, commercial or
55 not-for-profit sectors. It is funded by the Inland Norway University of Applied Sciences as part of the
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PhD project of SIG, supervised by MT, LET and LT.
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59
60 Competing interests

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3 None to declare.
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1
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3 REFERENCES
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5 1. Glanz K, Sallis JF, Saelens BE, et al. Healthy nutrition environments: concepts and measures. Am J
6 Health Promot 2005;19(5):330-3, ii.
7 2. Swinburn B, Sacks G, Vandevijvere S, et al. INFORMAS (International Network for Food and
8
Obesity/non-communicable diseases Research, Monitoring and Action Support): overview
9
10
and key principles. Obes Rev 2013;14 Suppl 1:1-12.
11 3. Herforth A, Ahmed S. The food environment, its effects on dietary consumption, and potential for
12 measurement within agriculture-nutrition interventions. Food Security 2015;7(3):505-20.
13 4. HLPE. Nutrition and food systems [Internet]: A report by the High Level Panel of Experts on Food
14 Security and Nutrition of the Committee on World Food Security, 2017.
15 http://www.fao.org/3/a-i7846e.pdf
16 5. Turner C, Aggarwal A, Walls H, et al. Concepts and critical perspectives for food environment
17 research: A global framework with implications for action in low- and middle-income
18
countries. Global Food Security 2018;18:93-101.
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19
20 6. Swinburn BA, Kraak VI, Allender S, et al. The Global Syndemic of Obesity, Undernutrition, and
21 Climate Change: The Lancet Commission report. Lancet 2019;393(10173):791-846.
7. Lytle LA, Sokol RL. Measures of the food environment: A systematic review of the field, 2007-2015.
rp
22
23 Health Place 2017;44:18-34.
24 8. Engler-Stringer R, Le H, Gerrard A, et al. The community and consumer food environment and
25 children’s diet: a systematic review. BMC Public Health 2014;14(1):522.
ee
26 9. Gamba RJ, Schuchter J, Rutt C, et al. Measuring the food environment and its effects on obesity in
27
the United States: a systematic review of methods and results. J Community Health
28
2015;40(3):464-75.
rr
29
30 10. Gustafson A, Hankins S, Jilcott S. Measures of the consumer food store environment: a systematic
31 review of the evidence 2000-2011. J Community Health 2012;37(4):897-911.
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32 11. Feng J, Glass TA, Curriero FC, et al. The built environment and obesity: a systematic review of the
33 epidemiologic evidence. Health Place 2010;16(2):175-90.
34 12. Galbraith-Emami S, Lobstein T. The impact of initiatives to limit the advertising of food and
iew
35 beverage products to children: a systematic review. Obes Rev 2013;14(12):960-74.

36
13. Gruzd A. Current State of Social Media Research: From Practice to Theory #SMSociety15,
37
Toronto: Social Media Lab, Ryerson University, 2015. Available from:
38
39 https://socialmedialab.ca/2015/08/05/current-state-of-social-media-research-from-practice-
40 to-theory-part-1/ accessed 07/10/2019.
on
41 14. Williams G, Hamm MP, Shulhan J, et al. Social media interventions for diet and exercise
42 behaviours: a systematic review and meta-analysis of randomised controlled trials. BMJ Open
43 2014;4(2):e003926.
ly
44 15. Maher CA, Lewis LK, Ferrar K, et al. Are Health Behavior Change Interventions That Use Online
45 Social Networks Effective? A Systematic Review. J Med Internet Res 2014;16(2):e40.
46
16. Willis EA, Szabo-Reed AN, Ptomey LT, et al. Do weight management interventions delivered by
47
48 online social networks effectively improve body weight, body composition, and chronic
49 disease risk factors? A systematic review. J Telemed Telecare 2017;23(2):263-72.
50 17. Klassen K, Douglass C, Brennan L, et al. Social media use for nutrition outcomes in young adults: a
51 mixed-methods systematic review. Int J Behav Nutr Phys Act 2018;15(1):70.
52 18. Buchanan L, Kelly B, Yeatman H, et al. The Effects of Digital Marketing of Unhealthy Commodities
53 on Young People: A Systematic Review. Nutrients 2018;10(2)
54 19. World Health Organization (WHO). Tackling food marketing to children in a digital world: trans-
55
disciplinary perspectives. Copenhagen: World Health Organization Regional Office for Europe,
56
57
2016.
58 20. WHO. Monitoring and Restricting Digital Marketing of Unhealthy Products to Children and
59 Adolescents. Moscow: WHO European Office for the Prevention and Control of
60 Noncommunicable Diseases (NCD Office), 2019.

1
2
3 21. Fakih El Khoury C, Karavetian M, Halfens RJG, et al. The Effects of Dietary Mobile Apps on
4 Nutritional Outcomes in Adults with Chronic Diseases: A Systematic Review. J Acad Nutr Diet.
5
2019; 119(4):626-651.
6
7
22. Coates AE, Hardman CA, Halford JCG, et al. Social Media Influencer Marketing and Children's
8 Food Intake: A Randomized Trial. Pediatrics 2019;143(4). pii: e20182554.
9 23. Fardouly J, Vartanian LR. Social Media and Body Image Concerns: Current Research and Future
10 Directions. Curr Opin Psychol 2016;9:1-5.
11 24. Granheim SI. The digital food environment. UNSCN Nutrition 2019;44:115-21.
12 25. Høgskolen i Innlandet. Digital food environments and their influence on the nutritional health of
13 young women in Norway, 2019. Available from:
14 https://app.cristin.no/projects/show.jsf?id=638584 accessed 07/10/2019.
15
26. Munn Z, Peters MDJ, Stern C, et al. Systematic review or scoping review? Guidance for authors
16
17 when choosing between a systematic or scoping review approach. Bmc Med Res Methodol
18 2018;18.
Fo
19 27. Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist
20 and Explanation. Ann Intern Med 2018;169(7):467-+.
21 28. Moher D, Stewart L, Shekelle P. All in the Family: systematic reviews, rapid reviews, scoping
rp
22 reviews, realist reviews, and more. Syst Rev 2015;4:183.

23 29. Shemilt I, Simon A, Hollands GJ, et al. Pinpointing needles in giant haystacks: use of text mining to
24
reduce impractical screening workload in extremely large scoping reviews. Res Synth
25
ee
26 Methods 2014;5(1):31-49.
27 30. Levay P, Craven J. Systematic searching: practical ideas for improving results. London: Facet
28 Publishing 2019.
rr
29 31. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International

30 Journal of Social Research Methodology 2005;8(1):19-32.
31 32. Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implementation
ev
32 Science 2010;5,69.
33
33. Taylor J, Pagliari C. Comprehensive scoping review of health research using social media data.
34
BMJ Open 2018;8(12):e022931.
iew
35
36 34. Snelson CL. Qualitative and Mixed Methods Social Media Research: A Review of the Literature.
37 International Journal of Qualitative Methods 2016;15(1).
38 35. Booth A. Unpacking your literature search toolbox: on search styles and tactics. Health Info Libr J
39 2008;25(4):313-7.
40 36. Winpenny EM, Penney TL, Corder K, et al. Change in diet in the period from adolescence to early
on
41 adulthood: a systematic scoping review of longitudinal studies. Int J Behav Nutr Phys Act
42 2017;14(1):60.
43
37. Raanaas RK, Bjøntegaard HØ, Shaw L. A Scoping Review of Participatory Action Research to
ly
44
45 Promote Mental Health and Resilience in Youth and Adolescents. Adolescent Res Rev 2018,
46 doi.org/10.1007/s40894-018-0097-0.
47 38. Aveyard H. Doing a Literature Review in Health and Social Care: A practical guide. 4th ed. ed.
48 London: Open University Press/ McGraw-Hill Education 2019.
49 39. Armstrong R, Hall BJ, Doyle J, et al. Cochrane Update. 'Scoping the scope' of a cochrane review. J
50 Public Health (Oxf) 2011;33(1):147-50.
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BMJ Open
Mapping the digital food environment: a Scoping Review

Protocol
Journal: BMJ Open
Manuscript ID bmjopen-2019-036241.R1
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Article Type: Protocol
Date Submitted by the

27-Feb-2020
Author:
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Complete List of Authors: Granheim, Sabrina Ionata; Inland Norway University of Applied Sciences,
Opheim, Elin; Inland Norway University of Applied Sciences, University
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Library
Terragni, Laura ; Oslo Metropolitan University, Department of Nursing
Torheim, Liv Elin; Oslo Metropolitan University, Department of Nursing
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Thurston, Miranda; Inland Norway University of Applied Sciences,
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<b>Primary Subject
Public health
Heading</b>:
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Secondary Subject Heading: Nutrition and metabolism
NUTRITION & DIETETICS, PUBLIC HEALTH, Information technology <

Keywords:
BIOTECHNOLOGY & BIOINFORMATICS
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3 Mapping the digital food environment: a Scoping Review Protocol
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4 Sabrina Ionata Granheim,1 Elin Opheim,2 Laura Terragni,3 Liv Elin Torheim,4 Miranda Thurston5
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14 6 Affiliations and contact information
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16 7 1Corresponding author. Department of Public Health and Sport Sciences, Inland Norway University of
17 8 Applied Sciences, Elverum, Norway. Postal address: Terningen Arena, Hamarveien 112, 2406
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9 Elverum, Norway. Telephone: +47 62 43 03 72. sabrina.granheim@inn.no.
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20 10 2UniversityLibrary, Inland Norway University of Applied Sciences, Elverum, Norway.
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11 elin.opheim@inn.no
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25 13 lterragn@oslomet.no
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28 15 livtor@oslomet.no
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30 16 5Department of Public Health and Sport Sciences, Inland Norway University of Applied Sciences,
31 17 Elverum, Norway. miranda.thurston@inn.no
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33 18
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19 Keywords: food environment, nutrition environment, digital technology, internet, online
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4 24 Mapping the digital food environment: a Scoping Review Protocol
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6 25
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26 ABSTRACT
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9 27 Introduction: Food environments are the interface through which people interact with the broader
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11 28 food system. They are a key determinant of healthy and sustainable diets. The widespread use of digital
12 29 technology in late modernity and the shift towards a digital society has posed new challenges for
13 30 nutrition and health, with a concomitant surge in research on social media, digital health promotion
14 31 interventions, and more recently increasing interest in digital food marketing. While the literature is
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32 abundant on studies linking food, nutrition and digital technology, the effort to conceptualize and
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17 33 describe the digital food environment is new. This scoping review aims to support the development of
18 34 a definition of the digital food environment and characterize it, along with key thematic research
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19 35 trends on this topic and potential consequences for nutrition and health.
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21 36 Methods and analysis: The planned scoping review will be supported by the methodological
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22 37 framework proposed by Arksey and O’Malley and further developed by Levac, Colquhoun and O'Brien.
23 38 Development and reporting will follow the Preferred Reporting Items for Systematic Reviews and
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39 MetaAnalyses—Extension for Scoping Reviews (PRISMA-ScR) checklist and guidelines. The
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26 40 development of the search strategy was guided by the food environment conceptual framework
27 41 developed by Turner et al. Four databases will be searched: Medline, Embase, Scopus and Web of
28 42 Science. Citation searching will be applied to identify additional studies, through checking of reference
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29 43 lists of primary studies and reviews. Studies in English, published from the year 2000 onwards, will be
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44 included. No geographical or population limits will be applied. Data will be extracted and analysed
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32 45 using a standardized charting tool.

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34 46 Ethics and dissemination: No ethical approval is required for this study. The results will be submitted
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35 47 to an international peer-reviewed journal and scientific conferences. They will be disseminated

36 48 through digital science communication platforms, including academic social media, to amplify its reach
37 49 and usefulness.
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39 50
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41 51 ARTICLE SUMMARY: STRENGTHS AND LIMITATIONS OF THIS STUDY

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43 52  The proposed scoping review will map the existing research on food environments and digital
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44 53 technology, contributing to the theoretical development of the concept of digital food

45 54 environment and its potential consequences for nutrition and health.
46 55  By focusing on the breadth of the research landscape over depth, it will allow for the
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56 description of research trends and main themes investigated in the literature, and the
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49 57 identification of research gaps for future investigation.
50 58  Though comprehensive, the study design for this proposed scoping review has limitations
51 59 regarding the number of databases, the language and search terms used, and may
52 60 underrepresent research from low- and middle-income countries.
53 61  By focusing on food environments, the study may not capture the whole extent of research
54 62 being conducted on the linkages between food, nutrition and digital technology.
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3 64 INTRODUCTION
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5 65 Food environments have been defined in several ways,1-4 more recently and concisely as the interface
6 66 through which people interact with the broader food system.5 The role of food environments in the
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67 current multiple burden of malnutrition (undernutrition, overweight, obesity and micronutrient
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9 68 deficiencies) and diet-related noncommunicable diseases (NCDs) is widely recognized.6 They are a key
10 69 determinant of healthy and sustainable diets.
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12 70 The number of published research articles assessing the food environment has increased considerably
13 71 in the past decade.7 A number of systematic reviews on food environments and the link with nutrition
14 72 and health outcomes have been conducted.8-11 Some systematic reviews focus on particular aspects of
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73 the food environment, such as food marketing,12 rather than on the food environment as a whole.
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17 74 While research gaps and challenges still exist in food environment research, e.g. challenges on
18 75 standardized measurement tools and methods, an important topic has recently emerged, related to
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19 76 the role of digital technology for nutrition and health.

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21 77 Digital technology contributes to framing the social world and thus influencing how people understand
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22 78 and experience it. At the same time, people individually and collectively create the digital world
23 79 through complex multi-directional processes. This is particularly relevant given the growth and
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80 popularization of social media in recent years, which relies on this individual – technology dynamic
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26 81 interaction, and has provided millions with the opportunity to create content on food and nutrition
27 82 and share it online.13
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29 83 Social media has been the topic of several health-related systematic reviews to date. In fact, health
30 84 represents a major share of research within the broader field of social media research.14 A systematic
31 85 review and meta-analysis of randomized controlled trials by Williams, et al. 15 explored the use of social
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86 media to promote physical activity and healthy diets for the general population. Maher, et al. 16
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34 87 conducted a systematic review to evaluate the effectiveness of online social networks on behaviour
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35 88 change interventions targeting a range of modifiable health behaviours such as tobacco use, alcohol
36 89 consumption, dietary intake and physical activity. A systematic review by Willis, et al. 17 explored the
37 90 use of social networks as a primary intervention platform by evaluating the effectiveness of weight
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91 management interventions delivered through such platforms. Klassen, et al. 18 conducted a mixed-
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40 92 methods systematic review to investigate the use of social media for nutrition outcomes among youth.
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93 Another issue where digital technology has been particularly noticeable is food marketing. Whereas
43 94 most research on food marketing still focuses on traditional broadcast media, there has been some
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44 95 momentum towards researching digital food marketing in recent years. This includes a systematic
45 96 review on digital marketing and youth attitudes and behaviour related to unhealthy commodities
46 97 (food, alcohol and tobacco) by Buchanan, et al. 19, and reports by the World Health Organization 20 21.
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48 98 In summary, these reviews and reports, along with individual studies, have identified the potential of
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99 digital technology for health promotion interventions, through dietary and physical activity mobile
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51 100 apps for self-monitoring, among others.22 At the same time, the existing literature also indicates the
52 101 potential harm offered by the digital world to nutritional health, for example via increased
53 102 consumption of unhealthy snacks due to influencer digital food marketing,23 or the increase in
54 103 particular social behaviours online linked to rising body image and eating disorders.24
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56 104 In the context of the widespread use of such technologies in late modernity and the consequent shift
57 105 towards a digital society, it has been suggested that the sum of digital influences on health and
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59 106 nutrition goes beyond social media, digital health promotion interventions and digital food marketing,
60 107 to include a broad range of digital actors and activities that are creating a new layer to food
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3 108 environments, the digital food environment.13 While the literature is abundant on studies linking food,
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109 nutrition, and digital technology, an attempt to conceptualize the digital food environment is new. This
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6 110 proposed scoping review intends to contribute to that process, as this first stage in a larger ongoing
7 111 research project.25
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9 112 The aim of this planned scoping review is therefore to map and collate the published academic
10 113 literature on the digital food environment. The findings will be used to support the development of a
11 114 definition and conceptual framework of the digital food environment, characterize its components,
12 115 and identify potential consequences for diets and nutritional health.
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14 116 Specific objectives are to:
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16 117  develop a descriptive overview of existing academic literature to uncover research trends on
17 118 aspects related to the digital food environment;
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119  provide elements to help characterize the digital food environment and develop this concept;
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20 120  contribute to the development of a conceptual framework for digital food environments; and
21 121  make recommendations and identify research gaps.
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24 123 METHODS AND ANALYSIS
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26 124 Scoping reviews allow for the exploration of broad research questions. They are useful when a
27 125 systematic mapping of the available evidence is required that indicates the scope and coverage of
28 126 current literature (including main concepts, theories and knowledge gaps), rather than providing
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29 127 detailed answers to very specific questions.26-28 This proposed scoping review will involve a mapping
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128 of previous studies to determine the status of knowledge on the digital food environment. It aims to
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32 129 provide an overview of this broad study field, and will prioritize breadth over depth,29 not searching
33 130 for exhaustiveness and completeness, but rather for a comprehensive overview of the available
34 131 evidence.30 It will identify the breadth of research on themes related to the digital food environment,
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35 132 focusing on the range of studies that are available and the identification of gaps, rather than focusing
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133 on one specific theme in depth.
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38 134 The planning of this scoping review has been informed by the methodological framework for scoping
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135 reviews proposed by Arksey and O’Malley31 and further developed by Levac, Colquhoun and O'Brien.32
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41 136 Development and reporting will follow the Preferred Reporting Items for Systematic Reviews and
42 137 MetaAnalyses—Extension for Scoping Reviews (PRISMA-ScR) checklist and guidelines27, which have
43 138 also been consulted for the development of this protocol.
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45 139 While focusing on breadth over depth may be a limitation of this study, this scoping review may be the
46 140 gateway to future systematic reviews for in-depth exploration of particular/specific topics identified
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141 through this study. It will also inform the next stages in the broader research project previously
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49 142 mentioned.25
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143 Conceptual framework
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144 Currently, no definition of the digital food environment exists. This proposed scoping review aims to
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54 145 inform the development of such a definition and conceptual framework. In order to do so, it will be
55 146 guided by the food environments conceptual framework developed by Turner et al.5, adding a digital
56 147 dimension. While other frameworks on food environments exist, this one in particular was chosen as
57 148 it is one of the most recent, and was developed based on a comprehensive review of the literature on
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149 food environments.
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3 150 According to this framework, a food environment is part of the broader food system (from farm to
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151 flush), and includes two domains: an external domain, and a personal domain. There are four
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6 152 dimensions to the external domain:
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8 153 1. food availability,
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154 2. food prices,
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11 155 3. food vendor and product properties (which includes issues such as food quality,
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13 156 composition, level of processing, packaging, among others), and
14 157 4. food marketing and regulation.
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17 159 In the personal domain, there are four additional dimensions:
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160 5. food accessibility,
21 161 6. food affordability,
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23 162 7. convenience (for preparing, cooking and consuming food), and
24 163 8. desirability (preferences, acceptability, tastes, desires, attitudes, culture, knowledge
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26 164 and skills).

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29 166 These eight dimensions will inform the development of the search strategy, as they will guide the
30 167 choice of search terms to find relevant studies on the food environment. These will be combined with
31 168 search terms relating to digital technology. For the purpose of this scoping review, digital technologies
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169 include a broad range of electronic tools, systems and devices, such as social media and other forms
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34 170 of new media, smartphone/mobile applications, digital games, artificial intelligence, blockchain, blogs,
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35 171 wearable devices, virtual reality, among others.

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37 172 Research questions
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39 173 The research questions that will guide the scoping review are presented in Table 1.
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174 Table 1. Scoping review questions

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42 Aspect Research questions
43 Descriptive What is the volume of studies published by year?
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44 What is the geographical scope of the publications?

45 Methods What type of theoretical approaches and research methods are used?
46 What types of studies are published?
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What population groups are being studied?
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49 Nutrition and What themes are being studied?
50 health What dimensionsa of food environments are being studied?
51 To what extent are studies measuring outcomes in nutrition and health?
52 What are the outcomes in health and nutrition reported to date, if any?
53 Are there other outcomes being reported (e.g. societal, economic, etc)?
54 175 a Availability, prices, vendor and product properties, marketing, accessibility, affordability, convenience and desirability. The
55 176 dimensions are defined by the conceptual framework applied in the study.
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57 177
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59 178 Inclusion and exclusion criteria
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3 179 This proposed scoping review will include publications from year 2000 onwards, to coincide with the
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180 spread in use of digital technology by the general population and the emergence of social media.18 The
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6 181 first social network, SixDegrees, was launched in 1997; the first scientific literature on blogs appeared
7 182 in 2003, with research on other forms of social media emerging after that.33 Other studies have chosen
8 183 similar cut-off dates. 18 34 No geographical or population restrictions will be applied, given the desired
9 184 breadth of the review. Other criteria for inclusion or exclusion are outlined in Table 2. These will be
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185 refined post hoc for relevance, through an iterative process to take place once abstracts have been
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12 186 identified and screened, as typical of scoping reviews.31 32
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187 Table 2. Inclusion and exclusion criteria for the scoping review
15 Inclusion criteria Exclusion criteria
16  Peer reviewed articles, including  Books and book chapters
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18 original research and review articles  Book reviews
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 Commentaries and opinion pieces  Grey literature
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21 published in peer reviewed journals  Website and newspaper articles
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23  Conference proceedings,  Social media content
24 dissertations/theses, and abstracts  Studies using digital research
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26 published in peer reviewed journals methods but not about digital

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 Protocols technology and nutritional health /
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29  Indexed in MEDLINE, EMBASE, food environments

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31 Scopus or Web of Science  Studies on digital public health,
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32  Published from year 2000 onwards including interventions, but not

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34  Language: English related to the one of the eight
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dimensions of the food environment.
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38 188
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40 189 Search Strategy
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42 190 The search strategy was developed in consultation with a senior librarian. It will cover terms related to
43 191 two main concepts related to the digital food environment: digital technology and food environment.
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44 192 As the concept of digital food environment is new and under elaboration, having no formal definition
45 193 or consensus on descriptive words, terminology used to describe aspects related to it is likely to be
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194 inconsistent, varied and general. The definition of search terms has endeavoured to capture that broad
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48 195 scope, and the conceptual framework described above has been a useful tool in this regard.
49 196 Search terms were defined using an interactive scanning of the literature, as described by Booth,35
50 197 aiming to increase the likelihood of retrieving material relevant to the research questions. Table 3
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52 198 presents the search terms to be used in the scoping review. The search strategy will include free text
53 199 and subject heading terms, which will be adapted to each of the databases.
54 200 The search will be conducted in the following databases: MEDLINE (OVID interface, 1948 onwards) and
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201 EMBASE (OVID interface, 1974 onwards), two major databases on health sciences and life sciences;
57 202 and Scopus (Elsevier) and Web of Science (Clarivate Analytics), two major multidisciplinary databases,
58 203 to cover the non-clinical aspects of the relationship between humans, digital technology and food,
59 204 including cultural aspects, for example. Citation searching, will also be applied to identify additional
60 205 key studies that may not be indexed in the databases searched.30 By using this technique, reference
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3 206 lists of existing primary studies and reviews will be checked to ensure the relevant literature appearing
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207 in such reviews is taken into account in this study.
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6 208
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209 Table 3. Search strategy for Medline
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9 # Search syntax
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Digital Technology
12 1 internet/
13 2 exp Webcasts/
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15 3 exp Web Browser/
16 4 exp Video Games/
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5 exp Virtual Reality/
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19 6 exp Social Media/

20 7 exp Smartphone/
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8 exp Online Social Networking/
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23 9 exp Mobile Applications/
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10 exp Electronic Mail/
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26 11 exp Data Visualization/

27 12 exp "Cell Phone Use"/
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13 exp Cell Phone/
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30 14 exp Blogging/
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15 exp Attitude to Computers/
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33 16 (blog* or microblog*).ab,kw,ti.
34 17 (cyber* or virtual or digital*).ab,kw,ti.
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36 18 ((digital or new) adj media).ab,kw,ti.
37 19 "information technolog*".ab,kw,ti.
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20 (smartphone* or mobile* or touchscreen* or wearable*).ab,kw,ti.
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40 21 (social adj (media or network*)).ab,kw,ti.
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41 22 (web-based or online or on-line).ab,kw,ti.

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43 23 (website* or web site* or webpage* or web page*).ab,kw,ti.
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44 (Facebook or Instagram* or Twitter or tweet* or Snapchat or YouTube or Reddit or WhatsApp

45 24
or TikTok or Tumblr or Pinterest or LinkedIn).ab,kw,ti.
46
47 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19
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48 or 20 or 21 or 22 or 23 or 24
49 Food Environments
50
51 26 ((food or nutrition* or eating or obesogenic) adj environment*).ab,kw,ti.
52 27 (food adj (desert* or swamp*)).ab,kw,ti.
53
(food adj1 (accept* or access* or acqui* or ad or ads or advertis* or aesthetic* or afford* or
54
55 attitude* or availab* or brand* or choice* or composition or consumption or convenience or
56 cost* or cultur* or desir* or knowledge* or label* or marketing or outlet* or packag* or
28
57 perception* or practice* or preference* or prepar* or price* or pricing* or process* or
58 promot* or provision* or purchas* or quality or retail or sale* or selection or service* or shop*
59
or sponsorship* or stall* or store* or tast* or vendor*)).ab,kw,ti.
60
7
1
2
3 29 (food porn or foodporn or gastroporn).ab,kw,ti.
4
5 30 "foodscape*".ab,kw,ti.
6 (cafe* or canteen* or restaurant* or supermarket* or takeaway* or take-away or vending
7 31
machine* or kiosk*).ab,kw,ti.
8
9 32 (grocery adj (shop* or store*)).ab,kw,ti.
10 33 26 or 27 or 28 or 29 or 30 or 31 or 32
11
34 25 and 33
12
13 35 limit 34 to english language
14 36 limit 35 to yr="2000 -Current"
15
16 210
17 211 Study selection
18
Fo
19 212 One researcher will carry out the search through electronic databases and keep a record of searches.
20 213 The software Endnote X9 (Clarivate Analytics) will be used for database organization of the results
21
214 retrieved. Duplicate removal and screening will be conducted using the online software Covidence
rp
22
23 215 (Veritas Health Innovation). Four researchers will be involved in the screening of titles and abstracts
24 216 against the inclusion and exclusion criteria. Following a model previously applied in other reviews,36 37
25 217 at a first stage the researchers will independently screen a sample of the results, to determine the
ee
26 218 degree of consistency in the individual assessments. Once an acceptable degree of consistency has
27
219 been reached, the remaining articles will be screened (title and abstract) by one of the researchers. At
28
220 a second stage of screening (full text), two reviewers will work independently. One researcher will
rr
29
30 221 screen all records, while the work of the second reviewer will be divided equally among three
31 222 researchers. A third reviewer may be involved when agreement cannot be reached by the two main
ev
32 223 reviewers.
33
34 224 Data extraction and analysis
iew
35
36 225 Data extraction (charting) will be conducted using standardized tools to be developed for this scoping
37 226 review. A preliminary charting table with indicators to be used to address the research questions is
38
227 provided in Table 4. The charting table will be piloted by two reviewers on a sample of included studies
39
40 228 to adjust its sensitivity. One reviewer will then perform the analysis, and the second reviewer will
on
41 229 independently check a sample of the total of articles, for accuracy. Any disagreements will be resolved
42 230 through the involvement of a third reviewer.
43
ly
44 231 The data extracted in the standardized tool will be summarized through thematic content analysis,38
45 232 grouping findings in similar categories based on commonalities. It will also be analysed to identify
46
233 historical trends and the main research areas/topics that are being researched and published. Given
47
48 234 the scope and aims of this review, it will include both large and small-scale studies and a combination
49 235 of different study designs and methods (including qualitative and quantitative data). This is not
50 236 uncommon for scoping reviews.39
51
52 237 Table 4. Preliminary charting table
53
54 Item Description (including examples of categories, which will be
55 expanded as themes emerge)
56 Author(s)
57 Title
58
Year of publication
59
60 Journal
8
1
2
3 Country / geographical area By country
4 By geographical area (continents)
5
By income category (high-, middle- and low-income countries)
6
7 …
8 Study type Original research
9 Systematic Review
10 Commentary
11 Protocol
12 …
13 Aims/objectives of the study Describe the stated objective of the publication
14
15
Study population Women
16 Men
17 Children
18 Adolescents
Fo
19 Elderly
20 …
21 Methods RCTs
rp
22
Case studies
23
24
Social network analysis
25 …
ee
26 Themes Digital health and nutrition literacy

27 Innovation on digital food services (e.g. online food retail)
28 Digital social engagement on nutrition
rr
29 Internet food subcultures

30 Social media consequences on nutrition
31
…
ev
32
33 Food environment dimensions Food availability
34 Food prices
iew
35 Vendor and product properties

36 Food marketing
37 Food accessibility
38 Food affordability
39 Convenience
40
on
Desirability
41
42 Health and nutrition outcomes Describe the reported outcomes (for intervention studies)
43 Other outcomes Describe the reported outcomes
ly
44 Settings Social networking services

45 Websites
46 Online communities
47 Games
48 ….
49
50
238
51
239 Patient and Public Involvement
52
53 240 No patient involved. As the study is a literature review, there are no study participants.
54
55 241
56
57 242 ETHICS AND DISSEMINATION
58
59 243 This study is based on the analysis of published scientific literature and does not involve patients,
60 244 medical research, or any type of personal information. Thus, no ethical approval is required. The results
9
1
2
3 245 of this scoping review will be submitted for publication in an international peer-reviewed journal
4
246 (preferably open access) and scientific meetings and conferences on public health, nutrition and digital
5
6 247 research. Once published, results will be disseminated through digital science communication
7 248 platforms, including academic social media, to amplify its reach and usefulness.
8
9 249
10
11 250
12
251 Twitter
13
14 252 Follow SIG @sabrinaionata and LET @livelint
15
16
253
17
254
18
Fo
19 255 Author contributions

20
21 256 SIG conceived the scoping review, developed the research questions and drafted the manuscript. EO
rp
22 257 supported the development of the search strategy as a whole and the detailed search syntax, and
23
24
258 reviewed the manuscript. MT, LT and LET supported the conceptualization of the study, critically
25 259 reviewed drafts and edited the manuscript.
ee
26
27 260
28
261 Funding statement
rr
29
30 262 This scoping review received no specific grant from any funding agency in the public, commercial or
31
ev
32 263 not-for-profit sectors. It is funded by the Inland Norway University of Applied Sciences as part of the
33 264 PhD project of SIG, supervised by MT, LET and LT.
34
265
iew
35
36
37
266 Competing interests
38
267 None to declare.
39
40
on
268
41
42 269
43
ly
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
10
1
2
3 270 REFERENCES
4
5 271 1. Glanz K, Sallis JF, Saelens BE, et al. Healthy nutrition environments: concepts and measures. Am J
6 272 Health Promot 2005;19(5):330-3, ii. doi: 10.4278/0890-1171-19.5.330 [published Online First:
7 273 2005/05/18]
8
274 2. Swinburn B, Sacks G, Vandevijvere S, et al. INFORMAS (International Network for Food and
9
10
275 Obesity/non-communicable diseases Research, Monitoring and Action Support): overview
11 276 and key principles. Obes Rev 2013;14 Suppl 1:1-12. doi: 10.1111/obr.12087 [published Online
12 277 First: 2013/10/23]
13 278 3. Herforth A, Ahmed S. The food environment, its effects on dietary consumption, and potential for
14 279 measurement within agriculture-nutrition interventions. Food Security 2015;7(3):505-20. doi:
15 280 10.1007/s12571-015-0455-8
16 281 4. HLPE. Nutrition and food systems. Rome: High Level Panel of Experts on Food Security and
17 282 Nutrition of the Committee on World Food Security, 2017.
18
283 5. Turner C, Aggarwal A, Walls H, et al. Concepts and critical perspectives for food environment
Fo
19
20 284 research: A global framework with implications for action in low- and middle-income
21 285 countries. Global Food Security 2018;18:93-101. doi: 10.1016/j.gfs.2018.08.003
286 6. Swinburn BA, Kraak VI, Allender S, et al. The Global Syndemic of Obesity, Undernutrition, and
rp
22
23 287 Climate Change: The Lancet Commission report. Lancet 2019;393(10173):791-846. doi:
24 288 10.1016/S0140-6736(18)32822-8 [published Online First: 2019/02/01]
25 289 7. Lytle LA, Sokol RL. Measures of the food environment: A systematic review of the field, 2007-2015.
ee
26 290 Health Place 2017;44:18-34. doi: 10.1016/j.healthplace.2016.12.007 [published Online First:

27
291 2017/01/31]
28
292 8. Engler-Stringer R, Le H, Gerrard A, et al. The community and consumer food environment and
rr
29
30 293 children’s diet: a systematic review. BMC Public Health 2014;14(1):522. doi: 10.1186/1471-
31 294 2458-14-522
ev
32 295 9. Gamba RJ, Schuchter J, Rutt C, et al. Measuring the food environment and its effects on obesity in
33 296 the United States: a systematic review of methods and results. J Community Health
34 297 2015;40(3):464-75. doi: 10.1007/s10900-014-9958-z [published Online First: 2014/10/19]
iew
35 298 10. Gustafson A, Hankins S, Jilcott S. Measures of the consumer food store environment: a systematic
36
299 review of the evidence 2000-2011. J Community Health 2012;37(4):897-911. doi:
37
300 10.1007/s10900-011-9524-x [published Online First: 2011/12/14]
38
39 301 11. Feng J, Glass TA, Curriero FC, et al. The built environment and obesity: a systematic review of the
40 302 epidemiologic evidence. Health Place 2010;16(2):175-90. doi:
on
41 303 10.1016/j.healthplace.2009.09.008 [published Online First: 2009/11/03]

42 304 12. Galbraith-Emami S, Lobstein T. The impact of initiatives to limit the advertising of food and
43 305 beverage products to children: a systematic review. Obes Rev 2013;14(12):960-74. doi:
ly
44 306 10.1111/obr.12060 [published Online First: 2013/07/13]

45 307 13. Granheim SI. The digital food environment UNSCN Nutrition 2019;44:115-21.
46
308 14. Gruzd A. Current State of Social Media Research: From Practice to Theory #SMSociety15 Toronto:
47
48 309 Social Media Lab, Ryerson University; 2015 [Available from:
49 310 https://socialmedialab.ca/2015/08/05/current-state-of-social-media-research-from-practice-
50 311 to-theory-part-1/ accessed 07/10/2019.
51 312 15. Williams G, Hamm MP, Shulhan J, et al. Social media interventions for diet and exercise
52 313 behaviours: a systematic review and meta-analysis of randomised controlled trials. BMJ Open
53 314 2014;4(2):e003926. doi: 10.1136/bmjopen-2013-003926
54 315 16. Maher CA, Lewis LK, Ferrar K, et al. Are Health Behavior Change Interventions That Use Online
55
316 Social Networks Effective? A Systematic Review. J Med Internet Res 2014;16(2):e40. doi:
56
57
317 10.2196/jmir.2952 [published Online First: 14.02.2014]
58 318 17. Willis EA, Szabo-Reed AN, Ptomey LT, et al. Do weight management interventions delivered by
59 319 online social networks effectively improve body weight, body composition, and chronic
60
11
1
2
3 320 disease risk factors? A systematic review. J Telemed Telecare 2017;23(2):263-72. doi:
4 321 10.1177/1357633X16630846 [published Online First: 2016/02/18]
5
322 18. Klassen K, Douglass C, Brennan L, et al. Social media use for nutrition outcomes in young adults: a
6
7
323 mixed-methods systematic review. Int J Behav Nutr Phys Act 2018;15(1):70. doi:
8 324 10.1186/s12966-018-0696-y [published Online First: 2018/07/26]
9 325 19. Buchanan L, Kelly B, Yeatman H, et al. The Effects of Digital Marketing of Unhealthy Commodities
10 326 on Young People: A Systematic Review. Nutrients 2018;10(2) doi: 10.3390/nu10020148
11 327 [published Online First: 2018/02/01]
12 328 20. WHO. Tackling food marketing to children in a digital world: trans-disciplinary perspectives.
13 329 Copenhagen: World Health Organization Regional Office for Europe, 2016.
14 330 21. WHO. Monitoring and Restricting Digital Marketing of Unhealthy Products to Children and
15
331 Adolescents. Moscow: WHO European Office for the Prevention and Control of
16
17 332 Noncommunicable Diseases (NCD Office), 2019.
18 333 22. Fakih El Khoury C, Karavetian M, Halfens RJG, et al. The Effects of Dietary Mobile Apps on
Fo
19 334 Nutritional Outcomes in Adults with Chronic Diseases: A Systematic Review. Journal of the
20 335 Academy of Nutrition and Dietetics 2019 doi: https://doi.org/10.1016/j.jand.2018.11.010
21 336 23. Coates AE, Hardman CA, Halford JCG, et al. Social Media Influencer Marketing and Children's
rp
22 337 Food Intake: A Randomized Trial. Pediatrics 2019 doi: 10.1542/peds.2018-2554 [published
23 338 Online First: 2019/03/06]
24
339 24. Fardouly J, Vartanian LR. Social Media and Body Image Concerns: Current Research and Future
25
ee
26 340 Directions. Curr Opin Psychol 2016;9:1-5. doi: 10.1016/j.copsyc.2015.09.005

27 341 25. Høgskolen i Innlandet. Digital food environments and their influence on the nutritional health of
28 342 young women in Norway 2019 [Available from:
rr
29 343 https://app.cristin.no/projects/show.jsf?id=638584 accessed 07/10/2019.

30 344 26. Munn Z, Peters MDJ, Stern C, et al. Systematic review or scoping review? Guidance for authors
31 345 when choosing between a systematic or scoping review approach. Bmc Med Res Methodol
ev
32 346 2018;18 doi: 10.1186/s12874-018-0611-x

33
347 27. Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist
34
348 and Explanation. Ann Intern Med 2018;169(7):467-+. doi: 10.7326/M18-0850
iew
35
36 349 28. Moher D, Stewart L, Shekelle P. All in the Family: systematic reviews, rapid reviews, scoping
37 350 reviews, realist reviews, and more. Syst Rev 2015;4:183. doi: 10.1186/s13643-015-0163-7
38 351 [published Online First: 2015/12/24]
39 352 29. Shemilt I, Simon A, Hollands GJ, et al. Pinpointing needles in giant haystacks: use of text mining to
40 353 reduce impractical screening workload in extremely large scoping reviews. Res Synth
on
41 354 Methods 2014;5(1):31-49. doi: 10.1002/jrsm.1093 [published Online First: 2014/03/01]

42 355 30. Levay P, Craven J. Systematic searching : practical ideas for improving results. London: Facet
43
356 Publishing 2019.
ly
44
45 357 31. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International
46 358 Journal of Social Research Methodology 2005;8(1):19-32. doi:
47 359 10.1080/1364557032000119616
48 360 32. Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implementation
49 361 Science 2010;5 doi: 10.1186/1748-5908-5-69
50 362 33. Taylor J, Pagliari C. Comprehensive scoping review of health research using social media data.
51 363 BMJ Open 2018;8(12):e022931. doi: 10.1136/bmjopen-2018-022931 [published Online First:
52
364 2018/12/16]
53
54
365 34. Snelson CL. Qualitative and Mixed Methods Social Media Research: A Review of the Literature.
55 366 International Journal of Qualitative Methods 2016;15(1) doi: 10.1177/1609406915624574
56 367 35. Booth A. Unpacking your literature search toolbox: on search styles and tactics. Health Info Libr J
57 368 2008;25(4):313-7. doi: 10.1111/j.1471-1842.2008.00825.x [published Online First:
58 369 2008/12/17]
59
60
12
1
2
3 370 36. Winpenny EM, Penney TL, Corder K, et al. Change in diet in the period from adolescence to early
4 371 adulthood: a systematic scoping review of longitudinal studies. International Journal of
5
372 Behavioral Nutrition and Physical Activity 2017;14(1):60. doi: 10.1186/s12966-017-0518-7
6
7
373 37. Raanaas RK, Bjøntegaard HØ, Shaw L. A Scoping Review of Participatory Action Research to
8 374 Promote Mental Health and Resilience in Youth and Adolescents. Adolescent Research
9 375 Review 2018 doi: 10.1007/s40894-018-0097-0
10 376 38. Aveyard H. Doing a Literature Review in Health and Social Care: A practical guide. 4th ed. ed.
11 377 London: Open University Press/ McGraw- Hill Education 2019.
12 378 39. Armstrong R, Hall BJ, Doyle J, et al. Cochrane Update. 'Scoping the scope' of a cochrane review. J
13 379 Public Health (Oxf) 2011;33(1):147-50. doi: 10.1093/pubmed/fdr015 [published Online First:
14 380 2011/02/25]
15
16 381
17
18
Fo
19
20
21
rp
22
23
24
25
ee
26
27
28
rr
29
30
31
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34
iew
35
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40
on
41
42
43
ly
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BMJ Open is committed to open peer review.

As part of this commitment we make the peer review

Mapping the digital food environment: a Scoping Review

Journal: BMJ Open

Date Submitted by the

and Health Promotion

NUTRITION & DIETETICS, PUBLIC HEALTH, Nutrition < TROPICAL

For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml

For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml

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32 outcomes among youth.

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26 dimensions are defined by the theoretical framework applied in the study.

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29 cost* or cultur* or desir* or knowledge* or label* or marketing or outlet* or packag* or

For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml

35 By geographical area (continents)

44 Aims/objectives of the study Describe the stated objective of the publication

For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml

For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml

For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml

35 beverage products to children: a systematic review. Obes Rev 2013;14(12):960-74.

For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml

22 reviews, realist reviews, and more. Syst Rev 2015;4:183.

29 31. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International

For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml

Mapping the digital food environment: a Scoping Review

Journal: BMJ Open

Date Submitted by the

and Health Promotion

Secondary Subject Heading: Nutrition and metabolism

NUTRITION & DIETETICS, PUBLIC HEALTH, Information technology <

For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml

For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml

32 45 using a standardized charting tool.

35 47 to an international peer-reviewed journal and scientific conferences. They will be disseminated

41 51 ARTICLE SUMMARY: STRENGTHS AND LIMITATIONS OF THIS STUDY

44 53 technology, contributing to the theoretical development of the concept of digital food

19 76 the role of digital technology for nutrition and health.

26 164 and skills).

35 171 wearable devices, virtual reality, among others.

174 Table 1. Scoping review questions

44 What is the geographical scope of the publications?

26 published in peer reviewed journals methods but not about digital

29  Indexed in MEDLINE, EMBASE, food environments

32  Published from year 2000 onwards including interventions, but not

19 6 exp Social Media/

26 11 exp Data Visualization/

41 22 (web-based or online or on-line).ab,kw,ti.

44 (Facebook or Instagram* or Twitter or tweet* or Snapchat or YouTube or Reddit or WhatsApp

26 Themes Digital health and nutrition literacy

29 Internet food subcultures

35 Vendor and product properties

44 Settings Social networking services

19 255 Author contributions

26 290 Health Place 2017;44:18-34. doi: 10.1016/j.healthplace.2016.12.007 [published Online First:

41 303 10.1016/j.healthplace.2009.09.008 [published Online First: 2009/11/03]

44 306 10.1111/obr.12060 [published Online First: 2013/07/13]

26 340 Directions. Curr Opin Psychol 2016;9:1-5. doi: 10.1016/j.copsyc.2015.09.005

29 343 https://app.cristin.no/projects/show.jsf?id=638584 accessed 07/10/2019.