Increasing Use of a Healthy Food Incentive: A Waiting Room Intervention Among Low-Income Patients

Abstract

Introduction Diet-related disease is disproportionally concentrated in low-income communities where fruit and vegetable consumption is far below guidelines. To address financial barriers, Double Up Food Bucks (DUFB)—a statewide healthy food incentive—matches Supplemental Nutrition Assistance Program (SNAP) funds spent at farmers markets. However, incentive use is limited. This study examined the impact of a brief waiting room–based intervention about DUFB on program utilization and produce consumption. Study design Longitudinal, repeated measures, quasi-experimental trial. Setting/participants SNAP—enrolled adults at a health center in a low-income, racially and ethnically diverse area of Southeast Michigan. Intervention Participants received a brief explanation of DUFB, written program materials, a map highlighting market locations and hours, and an initial $10 market voucher. DUFB use and produce consumption were measured through four surveys over 5 months (August 2014–January 2015). Main outcome measures Outcome measures included DUFB use and fruit and vegetable consumption (analyses conducted in 2015–2016). Results A total of 302 eligible adults were identified, and 177 (59%) enrolled. One hundred twenty-seven (72%) completed all surveys. At baseline, 57% of participants reported shopping at a farmers market within the last year; 18% had previously used DUFB. By the end of the DUFB season, participants were significantly more likely to report DUFB use than at baseline (AOR=19.2, 95% CI=10.3, 35.5, p<0.001), with 69% of participants reporting use of DUFB at least once, and 34% reporting use of DUFB three or more times. Adjusted fruit and vegetable consumption increased from baseline by 0.65 servings/day (95% CI=0.37, 0.93, p<0.001) at 3 months, and remained 0.62 servings/day (95% CI=0.32, 0.92, p<0.001) higher than baseline 2 months post-DUFB season. Conclusions A brief clinic-based intervention was associated with a nearly fourfold increase in uptake of a SNAP incentive, as well as clinically significant increases in produce consumption. Results suggested sustained behavior change even once the financial incentive was no longer available. Providing information about healthy food incentives is a low-cost, easily implemented intervention that may increase produce consumption among low-income patients.

Interventions Addressing Food Insecurity in Health Care Settings: A Systematic Review

“…There were 2 randomized control trials (RCT) (9%), 16,21 1 cluster RCT (4%), 22 2 quasi-experimental studies (9%), 17,18 3 matched cohort studies (13%), [23][24][25] and 8 single group, pre-/post-studies (35%). [26][27][28][29][30][31][32][33] The remainder of the studies had descriptive, mixed methods, or qualitative designs (n = 7, 30%).…”

“…Some articles focused on specific patient populations: 9 studies evaluated interventions targeting adult caregivers of pediatric patients (39%), 16,21,22,28,29,31,[34][35][36] 1 targeted adolescents (4%), 37 2 focused on pregnant women (9%), 18,24 5 focused on patients with diabetes 27,30,32,33,39 or another chronic condition 25 (22%), and 1 focused on patients with cancer (4%). 38 Seventeen studies (74%) were considered low 17,26,28,30,31,32,37 or very low quality 18,27,29,[33][34][35][36][38][39][40] and 6 (26%) studies were rated moderate quality. 16,[21][22][23][24][25] Interventions fell into 2 categories based on the food-related resources or assistance pro-vided.…”

“…15 In cases where data were not included in the original manuscript (n = 3), we contacted study authors to request information for SMD calculations. [16][17][18] Only 1 study team was able to provide additional information. 18 Where SMDs were not calculated and for studies reporting descriptive outcomes, results are presented as described in the original publication.…”

The behavioural constellation of deprivation: Causes and consequences

“…For example, mothers living in low-income neighbourhoods describe wanting to provide more fruits and vegetables for their children but not having the money to afford them or the time to prepare them (Jabs et al 2007). Qualitative interviews and preliminary outcome evaluations reveal that programmes that subsidise fruit and vegetable purchases can literally help mothers put fruit on the table (Bowling et al 2016;Cohen et al 2017;Lloyd 2014;McFadden et al 2014). These findings suggest that increasing the financial availability of healthier foods increases parents' ability to enact the choices they want to make.…”

Estágio curricular supervisionado em uma estratégia de saúde da família: um relato de experiência acadêmico

“…Um estudo realizado no sudeste de Michigan (EUA) revelou que uma breve intervenção baseada na sala de espera foi associada ao aumento do uso de um programa de incentivo alimentar saudável, denominado Double Up Food Bucks (DUFB), no qual adultos inscritos em um centro de saúde localizado em uma região de baixa renda incentiva a população a comprar em mercados de agricultores, aumentando o consumo de verduras e frutas, tornando a alimentação mais saudável (COHEN et al, 2017).…”