Exploring Perceptions of a Fresh Food Prescription Program during COVID-19
Abstract
:1. Introduction
2. Theoretical Justification
3. Materials and Methods
3.1. Design
3.2. Study Setting and Population
3.3. Program Description
3.4. Data Collection
3.4.1. Interviews
3.4.2. Surveys
3.5. Analysis
4. Results
4.1. Participant Characteristics
4.2. Key Themes Identified
4.2.1. Participants Were Motivated to Eat or Prepare Healthy Foods
4.2.2. FFRx Positively Impacted Aspects of Participants’ Well-Being
4.2.3. FFRx Promoted Healthy Dietary Habits
4.2.4. FFRx Improved Mental Health and Feelings of Isolation
4.2.5. FFRx Enhanced Financial Well-Being
4.2.6. FFRx Alleviated Logistical Barriers to Accessing Food and Cooking
4.2.7. Participants Provided Feedback and Suggestions for FFRx Program Improvements
5. Discussion
5.1. Strengths and Limitations
5.2. Implications for Health Policy
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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COM-B Domains | TDF Constructs | Goals/Barriers/Strategy | |
---|---|---|---|
Capability | Psychological Capability | Knowledge Memory, attention, and decision processes | Goal: Improve knowledge about how to choose and prepare healthy foods. Barriers: Knowledge deficits/education Strategies: Education: Provide biweekly coaching with nutritionist through phone outreach; weekly tips through newsletters based on produce provided |
Physical Capability | Skills | Goal: Improve skills and capability to prepare produce provided in the program. Barriers: Functional or cognitive limitations. Lack of basic cooking skills. Strategies: Education: Individual counselling by dietician; Nutritionist guided recipes in newsletter Enabling interventions: Easy to prepare recipes. Screening for and provision of items needed to cook meals (microwaves, air fryers, utensils). Provision of durable medical equipment to support mobility for functionally frail. Training: Newsletter topics on label reading, cooking tricks | |
Opportunity | Physical Opportunity | Environmental context and resources | Goal: Improve access to healthy foods, increase daily consumption of produce. Barriers: Pandemic and financial strain effects on food access. Lack of in person opportunities for healthy habits education and support due to pandemic. Strategies: Environmental change: Provide access to locally grown U.S. produce through weekly produce delivery. Nutritionist guided prepackaged meals in partnership with Second Harvest Food Bank and Providence Kitchen provide heart healthy meals. Education: Phone consults with YMCA Health coach and nutritionist if requested by participant for nutritional guidance. |
Social Opportunity | Social influences | Goal: Establish a routine of integrating healthy foods into family and peer settings. Barriers: Social isolation. Differing cultural identities that impact types of preferred foods. Strategies: Persuasion: Use data from interviews of participants to tailor program to tastes by incorporating produce that people suggested that they prefer, including apples, berries, peaches, and potatoes. Eggs provided with each box per recommendation of participants. Peer support through health coaching. | |
Motivation | Reflective Motivation | Role and Identity Beliefs about Capabilities and Intentions | Goal: Increase motivation and self-efficacy when selecting, preparing, and consumption of healthy foods. Barriers: Negative self-talk, decreased perceived capabilities. Perceived lack of control over food access and over financial situation Strategies: Enablement: Provide deliveries of food boxes at same time each week with same driver for consistency. Education: Provision of education on healthy behaviors, benefits. Incentivization: Weekly contact with drivers and occasional treats in boxes based on participant input. |
Automatic Motivation | Optimism Reinforcement | Goal: Develop self-driven goals related to improving one’s own physical and mental health. Barriers: Lack of well-defined goals for health or motivation for eating healthier. Depression or mood disorders related to social isolation that can prevent motivation to care for oneself. Strategies: Modelling: Care coordinator called and remind participants of deliveries as well as provision of tips for using boxes each week. Enablement: Provide easy recipes to go along with produce. |
Capabilities-Opportunities-Motivation (COM-B) Framework Domains | TDF Construct | Interview Questions |
---|---|---|
Psychological Capability | Knowledge, Memory, Attention, and Decision Processes | How (if at all) did the fresh food program change your shopping habits in relation to fresh foods? |
Before receiving the food prescription box, how many times per month would you buy fresh fruits and vegetables? Why? | ||
How (if at all) did receiving the fresh food box influence how often you eat fresh fruits and vegetables? | ||
Physical Capability | Skills | How many times have you cooked the recipe in the newsletter? |
What other ways could this program help you cook the produce from the fresh food box? | ||
Physical Opportunity | Environmental Context and Resources | Did you have everything you needed to cook the recipe provided? Prompt: ingredients, cooking equipment |
How easy or difficult is it for you to get fresh fruits and vegetables? What makes it hard for you to buy fresh fruits and vegetables? What would make it easier for you to buy fresh fruits and vegetables? | ||
Where do you usually go to get fresh fruits and vegetables? | ||
Social Opportunity | Social Influences | Tell me about you or your family’s experience with the fresh food box you received each week. |
How (if at all) did your family benefit from the fresh food program? | ||
Reflective Motivation | Role and Identity Beliefs about Capabilities and Intentions | What are the main reasons you like to shop where you do for fresh fruits and vegetables? |
What motivates you to eat healthy? | ||
Program Quality and Feedback (not COM-B) | What did you like about the nutrition letter included in the box? What didn’t you like, or what content would you like to see in the nutrition letter ongoing? | |
What were your opinions about the delivery of the fresh foods to your home? What went well with the delivery? What didn’t go well? |
Survey Questions |
---|
Were you able to eat over ½ of the produce provided in the box this week? |
What was your favorite produce item? |
What was your least favorite produce item? |
Which pre-packaged meal did you like the most? |
What additional meals/produce items would you like to see included? |
Did you have any difficulties preparing the produce or warming up the meals? |
What is most impactful about receiving the Fresh Food Rx delivery each week? |
Participant Characteristics | Interview participants N = 18 (%) | Survey Participants N = 97 (%) | Survey Participant Responses N = 137 (%) |
---|---|---|---|
Race/Ethnicity | |||
Non-Hispanic, Black | 13 (72.2%) | 76 (78.4%) | 107 (78.1%) |
Hispanic White | 3 (16.7%) | ||
Non-Hispanic White | 2 (11.1%) | 17 (17.5%) | 22 (16.1%) |
Other | 0 (0%) | 4 (4.1%) | 8 (5.9%) |
Sex | |||
Female | 15 (83.3%) | 77 (79.4%) | 107 (78.1%) |
Male | 3 (16.7%) | 20 (20.6%) | 30 (21.9%) |
Age | |||
<60 (28–57) | 7 (38.9%) | 1 (1%) | 2 (1.5%) |
≥60 (60–88) | 11 (61.1%) | 96 (99%) | 135 (98.5%) |
Household Composition | |||
Children in Home | 8 (44.4%) | 2 (2%) | 5 (3.6%) |
No Children in Home | 10 (55.6%) | 9 (9.3%) | 113 (82.5%) |
Unknown | 15 (15.5%) | 19 (13.9%) |
Theme | Subtheme | Selected Illustrative Quotes |
---|---|---|
Participants Were Motivated to Eat or Prepare Healthy Foods | “… before we are eating fruit and vegetables three times a week, something like that, because it’s not enough. Now we got this package with the vegetable—fresh fruit and vegetables, we are eating every day.” | |
“You know how we humans are. We got our own little routine and our own little way of doin’ things, but when you’re all sent me those boxes it made me to remember. It was on my mind. It was before my face. I went ahead and ate it.” | ||
“[My children] get the experience of seein’ different fruits, different greens that they may not have tried, normally. Like zucchini. It’s not that often that I go out and buy a zucchini… ” | ||
FFRx Positively Impacted Aspects of Wellbeing | FFRx Promoted Healthy Dietary Habits | “I feel healthier with all this produce… My sugar levels have lowered. It used to be 300, now it’s under 200. I used to be stressed about can I eat a meal.” |
“The doctor is proud of my A1C and keeping my weight down.” | ||
“My doctor is pleased with my health because it’s stabilized.” | ||
FFRx Positively Impacted Social Isolation | “It gave me something to look forward to, meeting your delivery guys… it gave me a chance to talk to some people, to get out my room. They would tell us not to go out into the halls and circulate so much because of that COVID.” | |
FFRx Improved Financial Wellbeing | “It helps me. You know I don’t get much in food stamps, so it helps me get through the rest of the month… It evens out.” | |
“[I’m] able to purchase cleaning supplies and medications without giving up food. I used to skip meals because I could not afford it. That’s not good for being diabetic.” | ||
“It saves me money. It ensures that I will have at least 1 meal a day.” | ||
FFRx Alleviated Logistic Barriers to Food Access | “I know you have made my life better. Especially during the pandemic, with my autoimmune disorder, I couldn’t go out… ” | |
“For someone to be able to deliver something, helps me a lot… Someone older cannot get out and about like they want to… ” | ||
“Because I don’t do much cooking now… Sometimes I can get around, sometimes I can’t. By me having arthritis, it bothers me to get around to the store and the stove… ” | ||
Feedback and Suggestions for Improvement | “ “I like the little pamphlets that’s in there… I like the information that it provides. The knowledge on different things, different ways you can cook somethin’.” | |
“I like my own way of doin’ things. I like to cook my own style is what I’m sayin’. The ingredients and everything that were there, that were fine, but I like to cook the way I like to cook ’cause it’s the way I was raised… ” |
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Zimmer, R.; Strahley, A.; Weiss, J.; McNeill, S.; McBride, A.S.; Best, S.; Harrison, D.; Montez, K. Exploring Perceptions of a Fresh Food Prescription Program during COVID-19. Int. J. Environ. Res. Public Health 2022, 19, 10725. https://doi.org/10.3390/ijerph191710725
Zimmer R, Strahley A, Weiss J, McNeill S, McBride AS, Best S, Harrison D, Montez K. Exploring Perceptions of a Fresh Food Prescription Program during COVID-19. International Journal of Environmental Research and Public Health. 2022; 19(17):10725. https://doi.org/10.3390/ijerph191710725
Chicago/Turabian StyleZimmer, Rachel, Ashley Strahley, Jane Weiss, Sheena McNeill, Allison S. McBride, Scott Best, David Harrison, and Kimberly Montez. 2022. "Exploring Perceptions of a Fresh Food Prescription Program during COVID-19" International Journal of Environmental Research and Public Health 19, no. 17: 10725. https://doi.org/10.3390/ijerph191710725