Objective:To utilise a community-based participatory approach in the design and implementation of an intervention targeting diet-related health problems on Navajo Nation.Design:A dual strategy approach of community needs/assets assessment and engagement of cross-sectorial partners in programme design with systematic cyclical feedback for programme modifications.Setting:Navajo Nation, USA.Participants:Navajo families with individuals meeting criteria for programme enrolment. Participant enrolment increased with iterative cycles.Results:The Navajo Fruit and Vegetable Prescription (FVRx) Programme.Conclusions:A broad, community-driven and culturally relevant programme design has resulted in a programme able to maintain core programmatic principles, while also allowing for flexible adaptation to changing needs.
Purpose: Healthy food incentive program implementation targeting people receiving Supplemental Nutrition Assistance Program (SNAP) benefits is supported by the federal Food Insecurity Nutrition Incentive (FINI) grant program. This study examined factors contributing to increased SNAP use at farmers’ markets with an FINI-funded incentive program. Design: Implementation evaluation. Setting: Sixteen states and District of Columbia. Participants: Two hundred eighty-two FINI-funded farmers’ markets open in 2016. Measures: Weekly SNAP sales and transactions per 1000 SNAP households in the Zip Code Tabulation Areas around markets. Analysis: Two-level hierarchical regression modeling. Results: Most farmers’ markets (53%) had less than 100 SNAP transactions in 2016. Weekly SNAP sales and transactions per 1000 SNAP households were 69.9% and 47.7% higher, respectively, if more than 1 incentive was available versus 1. Not having paid market staff resulted in declines in these sales (−34.3%) and transactions (−38.1%) compared to markets with paid staff. There was a 6.2% and 5.1% increase in SNAP sales and transactions for each additional produce vendor. Weekly SNAP sales and transactions were about 2 to 3 times higher in rural areas compared to metropolitan. Clustering of markets within states explained 10% of the variation in weekly SNAP sales and transactions. Conclusion: Four implementation factors were identified that may facilitate the reach of SNAP-based monetary incentive programs at farmers’ markets to maximize reach and impact among SNAP shoppers.
Disparities in healthy food access and consumption are a major public health concern. This study reports the findings from a two-year randomized control trial conducted at 77 farmers’ markets (FMs) in 13 states and the District of Columbia that sought to understand the impact of fruit and vegetable (FV) incentive vouchers, randomly issued at varied incentive levels to Supplemental Nutrition Assistance Program (SNAP) recipients, for use at FMs. Measures included FV and overall household food purchasing; FV consumption; food insecurity; health status; market expenditure; and demographics. A repeated-measures mixed-effects analysis and the Complier Average Causal Effect (CACE) were used to examine outcomes. Despite 82% reporting food insecurity in the prior year, the findings showed that financial incentives at FMs had statistically significant, positive effects on FV consumption; market expenditures increased with added incentives. SNAP recipients receiving an incentive of USD 0.40 for every USD 1.00 in SNAP spent an average of USD 19.03 per transaction, while those receiving USD 2 for every USD 1 (2:1) spent an average of USD 36.28 per transaction. The data showed that the incentive program at the highest level (2:1) maximally increased SNAP FM expenditure and FV consumption, increasing the latter by 0.31 daily cups among those who used their incentive (CACE model).
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