Use of a Social Marketing Campaign to Promote Healthy Eating Behaviors Among Low-Income Caregivers

Social marketing is a community and public health approach used in nutrition education that helps to complement programming. Researchers evaluated an eight-week social marketing campaign to promote healthy eating behaviors and encourage fruit and vegetable consumption among low-income caregivers. The campaign focused on the benefits of modeling healthy fruit and vegetable intake behaviors for caregivers of young children through television, radio, digital media, billboards, gas pump toppers, posters, and promotional materials. A survey was conducted to measure campaign awareness. Online data tracked digital reach, frequency, and total impressions. The main study findings were campaign awareness and correctly understanding the campaign’s tagline. We used descriptive analyses to evaluate the social marketing campaign. Data were collected by calling 7,802 phone numbers, 192 respondents agreed to participate in the baseline survey. Among those, 101 remembered seeing/hearing the campaign, and 70 agreed to complete the survey. Sixty-six out of 70 respondents correctly understood the campaign’s message. The campaign was effective in creating awareness of campaign messages. More than 50% of respondents recognized the campaign. Future studies should consider having pre-and post-test surveys, longer-term campaigns, and placing marketing ads at locations that “prompt” behavior change

Veggie Van Pilot Study: Impact of a Mobile Produce Market for Underserved Communities on Fruit and Vegetable Access and Intake

We conducted a pilot evaluation of the Veggie Van, a mobile produce market that brings weekly boxes of reduced-cost locally grown fruits and vegetables (F&V) to lower-income communities and offers cooking and nutrition education to customers. We conducted surveys just prior to starting Veggie Van at each of 3 sites and again at 2–3 months. F&V intake was measured with a 2-question item and a 10-item food frequency questionnaire (FFQ) in a subset of participants. At baseline, average servings/day of F&V was 4.9 (SD = 2.6, n = 60). At follow-up, individuals who reported shopping at Veggie Van frequently (n = 32) increased their F&V consumption by 0.41 servings/day compared with a decrease of −1.19 for those who rarely/never used Veggie Van (n = 27), a total difference of 1.6 servings/day (P =.01). There were no statistically significant differences in F&V consumption between groups based on the FFQ measure. Frequent shoppers reported additional health improvements and increases in their ability to buy enough F&V. We conclude that offering weekly boxes of affordable F&V paired with education in underserved communities may improve F&V consumption for frequent program users

A Systematic Literature Review of Nutrition Interventions Implemented to Address Food Insecurity as a Social Determinant of Health

Background: Policy initiatives have provided funding for non-acute nutrition interventions to address food insecurity as a social determinant of health, but more research is needed to understand the outcomes of these initiatives in order to determine the areas of highest impact. Therefore, the purpose of this systematic review was to evaluate the outcomes that were assessed in three nutrition interventions (produce prescription programs, medically tailored meals, and community supported agriculture) that aim to address food insecurity as a social determinant of health, and this was undertaken in order to identify future areas of study that can heighten impact. Methods: This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria. A list of search terms and keywords were compiled by the research team. A Boolean search was conducted from 1 January 2000 to 1 January 2023 in the PubMed advanced search database. Results: A total of 1015 articles were initially pulled from the PubMed database, and, after a screening process, 21 articles were included in our review. Nineteen of the articles focused on adult populations or families and two focused on children. The main outcomes assessed were changes in self-reported dietary intake, while a few of the articles addressed feasibility and cost-related outcomes. Conclusions: More research is needed to assess whether nutritional interventions to address food insecurity as a social determinant of health are feasible and more cost effective in the long term. Additionally, more work should be conducted in pediatric populations, which could have a robust return on investment in terms of both healthcare utilization and healthcare expenditure

Implementing the MOVE! Weight-Management Program in the Veterans Health Administration, 2007-2010: A Qualitative Study

IntroductionOne-third of US veterans receiving care at Veterans Health Administration (VHA) medical facilities are obese and, therefore, at higher risk for developing multiple chronic diseases. To address this problem, the VHA designed and nationally disseminated an evidence-based weight-management program (MOVE!). The objective of this study was to examine the organizational factors that aided or inhibited the implementation of MOVE! in 10 VHA medical facilities.MethodsUsing a multiple, holistic case study design, we conducted 68 interviews with medical center program coordinators, physicians formally appointed as program champions, managers directly responsible for overseeing the program, clinicians from the program's multidisciplinary team, and primary care physicians identified by program coordinators as local opinion leaders. Qualitative data analysis involved coding, memorandum writing, and construction of data displays.ResultsOrganizational readiness for change and having an innovation champion were most consistently the 2 factors associated with MOVE! implementation. Other organizational factors, such as management support and resource availability, were barriers to implementation or exerted mixed effects on implementation. Barriers did not prevent facilities from implementing MOVE! However, they were obstacles that had to be overcome, worked around, or accepted as limits on the program's scope or scale.ConclusionPolicy-directed implementation of clinical weight-management programs in health care facilities is challenging, especially when no new resources are available. Instituting powerful, mutually reinforcing organizational policies and practices may be necessary for consistent, high-quality implementation

Recruiting Community Partners for Veggie Van: Strategies and Lessons Learned From a Mobile Market Intervention in North Carolina, 2012–2015

BACKGROUND: Food access interventions are promising strategies for improving dietary intake, which is associated with better health. However, studies examining the relationship between food access and intake are limited to observational designs, indicating a need for more rigorous approaches. The Veggie Van (VV) program was a cluster-randomized intervention designed to address the gap between food access and intake. In this article, we aim to describe the approaches involved in recruiting community partners to participate in VV. COMMUNITY CONTEXT: The VV mobile market aimed to improve access to fresh fruits and vegetables by providing subsidized, high-quality, local produce in low-resource communities in North Carolina. This study describes the strategies and considerations involved in recruiting community partners and individual participants for participation in the VV program and evaluation. METHODS: To recruit partners, we used various strategies, including a site screener to identify potential partners, interest forms to gauge future VV use and prioritize enrollment of a high-need population, marketing materials to promote VV, site liaisons to coordinate community outreach, and a memorandum of understanding between all invested parties. OUTCOME: A total of 53 community organizations and 725 participants were approached for recruitment. Ultimately, 12 sites and 201 participants were enrolled. Enrollment took 38 months, but our approaches helped successfully recruit a low-income, low-access population. The process took longer than anticipated, and funding constraints prevented certain strategies from being implemented. INTERPRETATION: Recruiting community partners and members for participation in a multi-level, community-based intervention was challenging. Strategies and lessons learned can inform future studies

Examining commonly used perceived and objective measures of fruit and vegetable access in low-income populations and their association with consumption

Perception-based and objective food access measures are often examined as factors influencing individuals' shopping decisions and dietary habits, but the relative influence of these two factors on behaviors needs further examination. This study sought to (a) determine if perception-based and objective measures of fruit and vegetable (F&V) access were related and (b) examine perception-based and objective access measures as predictors of F&V consumption. Participants were recruited as part of a larger intervention study from 12 sites across three urban North Carolina counties. Perception-based food access measured included self-reported perceptions of convenience, variety, and quality of F&V within a neighborhood. Food outlet density was used as the objective measure. This was derived by summing the total number of geocoded convenience stores, grocery stores, supermarkets, and supercenters located within 1 road network mile of participants' home address. Associations between perception-based and objective measures were examined using Pearson's correlations, and associations of F&V access and intake were examined using linear regression models. Pearson correlations between perception-based and objective measures revealed that F&V variety was associated with supermarkets. Regression results show that perception-based barriers to F&V access were not significantly associated with intake, but supercenter density within 1 mile was significantly associated with decreased F&V intake. Common measures of perception-based and objective measures of food access may not be the best predictor of F&V intake. Understanding the relationships of these factors for lower-income populations can offer guidance for future policies and programs

Barriers and Facilitators of Online Grocery Services: Perceptions from Rural and Urban Grocery Store Managers

Online grocery shopping has expanded rapidly in the U.S., yet little is known about the retailer’s perceptions of online grocery services, which can aid in the expansion of services. Furthermore, many barriers to online grocery utilization persist across geographic areas, especially among Supplemental Nutrition Assistance Program (SNAP)-authorized retailers. This study captured perceived barriers and facilitators of online grocery shopping for managers of SNAP-authorized retailers. Qualitative semi-structured interviews were conducted with managers (n = 23) of grocery stores/supermarkets in urban and rural areas across four different states: TN, KY, NC, and NY. Grocery store managers offering online ordering (n = 15) and managers from brick-and-mortar stores without online services (n = 8) participated in the interviews. Three primary themes emerged among managers offering online ordering: (1) order fulfillment challenges, (2) perceived customer barriers, and (3) perceived customer benefits. Among managers at brick-and-mortar locations without online services, four major themes emerged: (1) thoughts on implementing online shopping, (2) COVID-19 pandemic impacts, (3) competition with other stores, and (4) benefits of maintaining brick-and-mortar shopping. This study provides a deeper understanding of retailers’ experience and perceptions of online grocery services among stores authorized to accept SNAP benefits. This perspective is necessary to inform policies and enhance the evolving virtual food marketplace for SNAP customers

A Cluster-Randomized Trial of a Mobile Produce Market Program in 12 Communities in North Carolina: Program Development, Methods, and Baseline Characteristics

Background: Mobile markets are an increasingly popular method for providing access to fresh fruits and vegetables (F/V) in underserved communities; however, evaluation of these programs is limited, as are descriptions of their development, study designs, and needs of the populations they serve. Objective: Our aim was to describe the development and theoretical basis for Veggie Van (VV), a mobile produce market intervention, the study design for the VV evaluation, and baseline characteristics of the study population. Design: The protocol and sample for a cluster-randomized controlled trial with 12 sites are described. Participants/setting: Community partner organizations in the Triangle region of North Carolina that primarily served lower-income families or were located in areas that had limited access to fresh produce were recruited. Eligible individuals at each site (older than 18 years of age, self-identified as the main shoppers for their household, and expressed interest in using a mobile market) were targeted for enrollment. A total of 201 participants at 12 sites participated in the VV program and evaluation, which was implemented from November 2013 to March 2016. Main outcome measures: Change in F/V intake (cups/day), derived from self-reported responses to the National Cancer Institute F/V screener, was the main outcome measure. Statistical analyses performed: We performed a descriptive analysis of baseline sample characteristics. Results: Mean reported F/V intake was 3.4 cups/day. Participants reported generally having some access to fresh F/V, and 57.7% agreed they could afford enough F/V to feed their family. The most frequently cited barriers were cost (55.7%) and time to prepare F/V (20.4%). Self-efficacy was lowest for buying more F/V than usual and trying new vegetables. Conclusions: By addressing cost and convenience and building skills for purchasing and preparing F/V, the VV has the potential to improve F/V consumption in underserved communities

Cluster randomized controlled trial of a mobile market intervention to increase fruit and vegetable intake among adults in lower-income communities in North Carolina

Abstract Background Poorer diets and subsequent higher rates of chronic disease among lower-income individuals may be partially attributed to reduced access to fresh fruits and vegetables (F&V) and other healthy foods. Mobile markets are an increasingly popular method for providing access to F&V in underserved communities, but evaluation efforts are limited. The purpose of this study was to determine the impact of Veggie Van (VV), a mobile produce market, on F&V intake in lower-income communities using a group randomized controlled trial. Methods VV is a mobile produce market that sells reduced-cost locally grown produce and offers nutrition and cooking education. We recruited 12 sites in lower-income communities in North Carolina (USA) to host VV, randomizing them to receive VV immediately (intervention) or after the 6-month study period (delayed intervention control). Participants at each site completed baseline and follow-up surveys including F&V intake, perceived access to fresh F&V and self-efficacy for purchasing, preparing and eating F&V. We used multiple linear regression to calculate adjusted differences in outcomes while controlling for baseline values, education and clustering within site. Results Among 142 participants who completed the follow-up, baseline F&V intake was 3.48 cups/day for control and 3.33 for intervention. At follow-up, adjusted change in F&V consumption was 0.95 cups/day greater for intervention participants (p = 0.005), but was attenuated to 0.51 cups per day (p = 0.11) after removing extreme values. VV customers increased their F&V consumption by 0.41 cups/day (n = 30) compared to a 0.25 cups/day decrease for 111 non-customers (p = 0.04). Intervention participants did not show significant improvements in perceived access to fresh F&V, but increased their self-efficacy for working more F&V into snacks (p = 0.02), making up a vegetable dish with what they had on hand (p = 0.03), and cooking vegetables in a way that is appealing to their family (p = 0.048). Conclusions Mobile markets may help improve F&V intake in lower-income communities. Trial registration Clinicaltrials.gov ID# NCT03026608 retrospectively registered January 2, 2017

Qualitative perspectives of the North Carolina healthy food small retailer program among customers in participating stores located in food deserts

Background: The North Carolina Healthy Food Small Retailer Program (NC HFSRP) was established through a policy passed by the state legislature to provide funding for small food retailers located in food deserts with the goal of increasing access to and sales of healthy foods and beverages among local residents. The purpose of this study was to qualitatively examine perceptions of the NC HFSRP among store customers. Methods: Qualitative interviews were conducted with 29 customers from five NC HFSRP stores in food deserts across eastern NC. Interview questions were related to shoppers’ food and beverage purchases at NC HFSRP stores, whether they had noticed any in-store efforts to promote healthier foods and beverages, their suggestions for promoting healthier foods and beverages, their familiarity with and support of the NC HFSRP, and how their shopping and consumption habits had changed since implementation of the NC HFSRP. A codebook was developed based on deductive (from the interview guide questions) and inductive (emerged from the data) codes and operational definitions. Verbatim transcripts were double-coded and a thematic analysis was conducted based on code frequency, and depth of participant responses for each code. Results: Although very few participants were aware of the NC HFSRP legislation, they recognized changes within the store. Customers noted that the provision of healthier foods and beverages in the store had encouraged them to make healthier purchase and consumption choices. When a description of the NC HFSRP was provided to them, all participants were supportive of the state-funded program. Participants discussed program benefits including improving food access in low-income and/or rural areas and making healthy choices easier for youth and for those most at risk of diet-related chronic diseases. Conclusions: Findings can inform future healthy corner store initiatives in terms of framing a rationale for funding or policies by focusing on increased food access among vulnerable populations