Objective:
The British Columbia Farmers’ Market Nutrition Coupon Program (FMNCP) provides low-income households with coupons valued at $21/week for 16 weeks to purchase healthy foods in farmers’ markets. Our objective was to explore FMNCP participants’ experiences of accessing nutritious foods, and perceived program outcomes.
Design:
This study used qualitative description methodology. Semi-structured interviews were conducted with FMNCP participants during the 2019 farmers’ market season. Directed content analysis was used to analyse the data whereby the five domains of Freedman et al’s framework of nutritious food access provided the basis for an initial coding scheme. Data that did not fit within the framework’s domains were coded inductively.
Setting:
One urban and two rural communities in British Columbia, Canada.
Participants:
28 adults who were participating in the FMNCP.
Results:
Three themes emerged: Autonomy and Dignity; Social Connections and Community Building; and Environmental and Programmatic Constraints. Firstly, the program promoted a sense of autonomy and dignity through financial support, increased access to high-quality produce, food-related education and skill development, and mitigating stigma and shame. Secondly, shopping in farmers’ markets increased social connections and fostered a sense of community. Finally, participants experienced limited food variety in rural farmers’ markets, lack of transportation, and challenges with redeeming coupons.
Conclusions:
Participation in the FMNCP facilitated access to nutritious foods and enhanced participants’ diet quality, well-being and health. Strategies such as increasing the amount and duration of subsidies, and expanding programs may help improve participants’ experiences and outcomes of farmers’ market food subsidy programs.
IntroductionLow-income populations have poorer diet quality and lower psychosocial well-being than their higher-income counterparts. These inequities increase the burden of chronic disease in low-income populations. Farmers’ market subsidies may improve diet quality and psychosocial well-being among low-income populations. In Canada, the British Columbia (BC) Farmers’ Market Nutrition Coupon Programme (FMNCP) aims to improve dietary patterns and health among low-income participants by providing coupons to purchase healthy foods from farmers’ markets. This study will assess the impact of the BC FMNCP on the diet quality and psychosocial well-being of low-income adults and explore mechanisms of programme impacts.Methods and analysisIn a parallel group randomised controlled trial, low-income adults will be randomised to an FMNCP intervention (n=132) or a no-intervention control group (n=132). The FMNCP group will receive 16 coupon sheets valued at CAD$21/sheet over 10–15 weeks to purchase fruits, vegetables, dairy, meat/poultry/fish, eggs, nuts and herbs at farmers’ markets and will be invited to participate in nutrition skill-building activities. Overall diet quality (primary outcome), diet quality subscores, mental well-being, sense of community, food insecurity and malnutrition risk (secondary outcomes) will be assessed at baseline, immediately post-intervention and 16 weeks post-intervention. Dietary intake will be assessed using the Automated Self-Administered 24-hour Dietary Recall. Diet quality will be calculated using the Healthy Eating Index-2015. Repeated measures mixed-effect regression will assess differences in outcomes between groups from baseline to 16 weeks post-intervention. Furthermore, 25–30 participants will partake in semi-structured interviews during and 5 weeks after programme completion to explore participants’ experiences with and perceived outcomes from the programme.Ethics and disseminationEthical approval was obtained from the University of Calgary Conjoint Health Research Ethics Board, Rutgers University Ethics and Compliance, and University of Waterloo Office of Research Ethics. Findings will be disseminated through policy briefs, conference presentations and peer-reviewed publications.Trial registration numberNCT03952338.
Objectives
Household food insecurity negatively affects children's diet quality, physical and mental health, and academic performance. I Can for Kids’ (IC4K) grocery gift card (GGC) program provides GGC to low-income households with school-aged children at risk of household food insecurity in Calgary, Canada. This study described program recipients’ and facilitators’ experiences and perceived outcomes of accessing or facilitating IC4K's GGC program.
Methods
This study used qualitative descriptive methodology. Data generation and analysis were guided by Freedman et al's theoretical framework of nutritious food access. Semi-structured interviews were conducted between August and November 2020 with 37 program recipients and 17 program facilitators who were purposively recruited. Directed content analysis was used to analyze the data using a deductive-inductive approach. Codes were combined into subthemes and themes that summarized program recipients’ and facilitators’ experiences and perceived outcomes of receiving or distributing GGC, and suggestions to improve IC4K's GGC program.
Results
Three themes were generated from the data: 1) IC4K's GGC program promoted a sense of autonomy and dignity among program recipients; 2) recipients used GGC to purchase foods that improved household dietary patterns and food skills, including foods that aligned with health-related food needs and cultural foodways and; 3) program logistical strengths and limitations, including the program's impact on facilitators’ connection with clients and their workload, experiences of differential access to GGC among recipients, and the importance of increasing program awareness to reach more food insecure households.
Conclusions
IC4K's GGC program enhanced recipients’ access to nutritious foods, had positive impacts on household finances and diet quality, as well as recipients’ social health and emotional wellbeing. However, differential access to GGC among recipients was also identified. Study findings were used to inform three recommendations to improve IC4K's GGC program: 1) increase the number of GGC that recipients can receive; 2) establish concrete guidelines governing GGC distribution and; 3) increase program awareness.
Funding Sources
O'Brien Institute for Public Health.
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