Approaches for Implementing Healthy Food Interventions in Settings With Limited Resources: A Case Study of Sodium Reduction Interventions in Emergency Food Programs Addressing Food Insecurity

2021 ◽  
pp. 089011712110561
Author(s):  
Karen Strazza ◽  
Julia Jordan ◽  
Kate Ferriola-Bruckenstein ◽  
Heather Kane ◽  
John Whitehill ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Healthy Food ◽  
Limited Resources ◽  
Washington County ◽  
Sodium Reduction ◽  
Healthy Foods ◽  
Structured Interviews ◽  
Key Stakeholders ◽  
Food Programs ◽  
Access To Healthy Foods

Purpose This study describes how recipients of the Centers for Disease Control and Prevention funded Sodium Reduction in Communities Program (SRCP) worked with emergency food programs to improve access to healthy food to address chronic conditions. Design SRCP recipients partnered with emergency food programs to implement sodium reduction strategies including nutrition standards, procurement practices, environmental strategies, and behavioral economics approaches. Setting SRCP recipients and emergency food programs in Washington County and Benton County, Arkansas and King County, Washington. Subjects SRCP recipient staff, emergency food program staff, and key stakeholders. Measures We conducted semi-structured interviews with key stakeholders and systematic review of program documents. Analysis Data were analyzed using effects matrices for each recipient. Matrices were organized using select implementation science constructs and compared in a cross-case analysis. Results Despite limited resources, emergency food programs can implement sodium reduction interventions which may provide greater access to healthy foods and lead to reductions in health disparities. Emergency food programs successfully implemented sodium reduction interventions by building on the external and internal settings; selecting strategies that align with existing processes; implementing change incrementally and engaging staff, volunteers, and clients; and sustaining changes. Conclusion Findings contribute to understanding the ways in which emergency food programs and other organizations with limited resources have implemented public health nutrition interventions addressing food insecurity and improving access to healthy foods. These strategies may be transferable to other settings with limited resources.

scholarly journals Barriers and facilitators to implementing a healthier food outlet initiative: perspectives from local governments

2020 ◽  
pp. 1-13
Author(s):  
Tara Boelsen-Robinson ◽  
Anna Peeters ◽  
Anne-Marie Thow ◽  
Corinna Hawkes
Keyword(s):  
Local Governments ◽  
Food Service ◽  
Healthy Food ◽  
Barriers And Facilitators ◽  
Limited Resources ◽  
Food Outlet ◽  
Community Nutrition ◽  
Structured Interviews ◽  
Health Team ◽  
Key Informant

Abstract Objective: Local governments have integral roles in contributing to public health. One recent focus has been on how local governments can impact community nutrition by engaging food service outlets to improve their food offer. The Healthier Catering Commitment (HCC) is an initiative where London local governments support takeaways and restaurants to meet centrally defined nutrition criteria on their food options. Using the case of HCC, the current study aims to provide (1) practical learnings of how local governments could facilitate and overcome barriers associated with implementing healthy food service initiatives in general, and (2) specific recommendations for enhancements for HCC. Design: Key informant, semi-structured interviews were conducted with local government staff involved in HCC, exploring barriers and facilitators to HCC implementation in food businesses. A thematic analysis approach was used, with results presented according to a logic pathway of ideal implementation in order to provide practical, focused insights. Setting: Local governments implementing HCC. Participants: Twenty-two individuals supporting HCC implementation. Results: Facilitators to implementation included flexible approaches, shared resourcing and strategically engaging businesses with practical demonstrations. Barriers were limited resources, businesses fearing negative customer responses and low uptake in disadvantaged areas. Key suggestions to enhance implementation and impact included offering additional incentives, increasing HCC awareness and encouraging recruited businesses to make healthy changes beyond initiative requirements. Conclusions: In order to facilitate the implementation of healthy food initiatives in food outlets, local governments would benefit from involving their environmental health team, employing community-tailored approaches and focusing on supporting businesses in disadvantaged areas.

scholarly journals Improving the nutritional status of food-insecure women: first, let them eat what they like

2007 ◽  
Vol 10 (11) ◽  
pp. 1288-1298 ◽  
Author(s):  
Lynn McIntyre ◽  
Valerie Tarasuk ◽  
Tony Jinguang Li
Keyword(s):  
Nutritional Status ◽  
Dietary Intake ◽  
Food Insecurity ◽  
Food Preferences ◽  
Food Choices ◽  
Healthy Food ◽  
Dietary Intakes ◽  
Healthy Foods ◽  
Food Bank ◽  
Diverse Community

AbstractObjectiveTo determine the extent to which identified nutrient inadequacies in the dietary intakes of a sample of food-insecure women could be ameliorated by increasing their access to the ‘healthy’ foods they typically eat.DesignMerged datasets of 226 food-insecure women who provided at least three 24-hour dietary intake recalls over the course of a month. Dietary modelling, with energy adjustment for severe food insecurity, explored the effect of adding a serving of the woman's own, and the group's typically chosen, nutrient-rich foods on the estimated prevalence of nutrient inadequacy.Setting and subjectsOne study included participants residing in 22 diverse community clusters from the Atlantic Provinces of Canada, and the second study included food bank attendees in Toronto, Ontario, Canada. Of the 226 participants, 78% lived alone with their children.ResultsWhile nutritional vulnerability remained after modelling, adding a single serving of either typically chosen ‘healthy’ foods from women's own diets or healthy food choices normative to the population reduced the prevalence of inadequacy by at least half for most nutrients. Correction for energy deficits resulting from severe food insecurity contributed a mean additional 20% improvement in nutrient intakes.ConclusionsFood-insecure women would sustain substantive nutritional gains if they had greater access to their personal healthy food preferences and if the dietary compromises associated with severe food insecurity were abated. Increased resources to access such choices should be a priority.

scholarly journals Exploring the needs and perceptions regarding healthy eating among people at risk of food insecurity: a qualitative analysis

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Laura van der Velde ◽  
Linde Schuilenburg ◽  
Jyothi Thrivikraman ◽  
Mattijs Numans ◽  
Jessica Kiefte-de Jong
Keyword(s):  
At Risk ◽  
Environmental Factors ◽  
Food Insecurity ◽  
Healthy Eating ◽  
Eating Behaviors ◽  
Nutrition Knowledge ◽  
Healthy Food ◽  
Healthy Foods ◽  
Factors Influencing ◽  
Healthy Eating Behaviors

AbstractIntroductionHealthy eating behaviors are essential determinants of overall health. These behaviors are generally poor among people at risk of experiencing food insecurity, which may be caused by many factors including perceived higher costs of healthy foods, financial stress, inadequate nutrition knowledge, and inadequate skills required for healthy food preparation. Few studies have examined how these factors influence eating behaviors among people at risk of experiencing food insecurity. We therefore aimed to gain a better understanding of the needs and perceptions regarding healthy eating in this target group.MethodsWe conducted a qualitative open interview study with 10 participants at risk of experiencing food insecurity. Thematic analysis identified four core themes on factors influencing healthy eating behaviors: (1) health related topics, influences on eating behaviors by both the (2) social and (3) physical environment, and (4) financial influences on eating behaviors.ResultsOverall, participants showed adequate nutrition knowledge. However, eating behaviors were strongly influenced by both social environmental factors (e.g. child food preferences and cultural food habits), and physical environmental factors (e.g. temptations in the local food environment). Perceived barriers for healthy eating behaviors included poor mental health, financial stress, and high prices of healthy foods. Participants had a generally positive and conscious attitude towards their financial situation, among others reflected in their strategies to cope with a limited budget. Food insecurity was mostly mentioned in reference to the past or to others and not to participants’ own current experiences. Participants were familiar with several existing resources to reduce food-related financial strain and generally had a positive attitude towards these resources. An exception was the Food Bank, which was highly criticized on its food parcel content. Proposed new resources included distributing free meals, facilitating social contacts, increasing healthy food supply in the neighborhood, and lowering prices of healthy foods.ConclusionThe insights from this study increase understanding of factors influencing healthy eating behaviors of people at risk of food insecurity. Therefore, this study could inform future development of potential interventions aiming at helping people at risk of experiencing food insecurity to improve healthy eating, thereby decreasing the risk of diet-related diseases.

scholarly journals Strategizing Dinner: How American Pantry Users Think about Feeding Their Families with Limited Resources

2021 ◽  
Vol 13 (17) ◽  
pp. 9772
Author(s):  
Tracey Kathleen Burke ◽  
Amanda K. Walch ◽  
Kiana Holland ◽  
Brynn Byam ◽  
David Reamer
Keyword(s):  
United States ◽  
Financial Crisis ◽  
Food Insecurity ◽  
The United States ◽  
Limited Resources ◽  
Structured Interviews ◽  
Community Based ◽  
Food Pantry ◽  
Assistance Programs ◽  
Nutrition Assistance

The financial crisis associated with the COVID-19 pandemic has exacerbated food insecurity in the United States. The emergency provides an opportunity to re-think the American nutrition-assistance system. In this paper, we describe findings from a community-based project conducted in urban Alaska before the pandemic in collaboration with a local food pantry. We conducted semi-structured interviews with nineteen food recipients, half of them twice, about how they procure food and prepare their meals in the context of juggling other expenses and demands on their time. What participants in our study do fits mainstream American patterns. Our study adds to the knowledge base by focusing on how families think strategically about their situations in context. In addition to cost, participants take nutrition and flavor into account. Most importantly, they do not think about assistance programs in isolation but holistically.

scholarly journals A Subsidized Healthy Food Prescription Program for Adults With Type 2 Diabetes Who Are Experiencing Food Insecurity: Protocol for a Randomized Controlled Trial

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1272-1272
Author(s):  
Sharlette Dunn ◽  
Dana Olstad ◽  
Reed F Beall ◽  
Eldon Spackman ◽  
Lorraine Lipscombe ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Food Insecurity ◽  
Diet Quality ◽  
Diabetes Complications ◽  
Controlled Trial ◽  
Healthy Food ◽  
Healthy Foods ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Average Blood Glucose

Abstract Objectives It is vital for individuals with type 2 diabetes (T2DM) to adhere to a healthy dietary pattern to maintain optimal blood glucose levels and overall health. Increasing costs of healthy foods, however, are a barrier to maintaining healthful dietary patterns, particularly for individuals with T2DM who are experiencing food insecurity. Poor diet quality may result in difficulties maintaining optimal blood glucose levels, leading to higher rates of diabetes complications, and increased acute care usage and costs. Although the adverse impacts of food insecurity on maintaining optimal blood glucose levels are well documented, effective strategies to this among individuals with T2DM are lacking. One approach is providing subsidies to purchase healthy foods through subsidized healthy food prescription programs. These programs may help reduce food insecurity and improve diet quality, thereby improving blood glucose levels and reducing diabetes complications over time. Methods A parallel group randomized controlled trial will examine the effectiveness of a subsidized healthy food prescription program compared to a healthy food prescription alone in improving average blood glucose levels (primary outcome), and other secondary outcomes among 404 adults who are experiencing food insecurity and persistent hyperglycemia. The subsidized healthy food prescription program consists of two core elements: 1) A one-time healthy food prescription pamphlet that outlines an evidence-based healthy dietary pattern; 2) A healthy food subsidy of $1.50/day/household member to purchase healthy foods in participating supermarkets for 6 months. At baseline and 6-month follow-up, participants will provide responses to sociodemographic and health-related items, and a variety of patient-reported outcomes. Biochemical and physical measurements will also be obtained. Results The study's theory of change posits that reducing food insecurity and improving diet quality will be key mediators in improving blood glucose levels, which may reduce diabetes complications, and healthcare usage and costs over time. Conclusions The results of this study will demonstrate if a subsidized healthy food prescription program results in meaningful changes in average blood glucose levels and other clinically relevant outcomes. Funding Sources Alberta Innovates, Alberta Health Services.

scholarly journals Tracking Double-up Food Bucks (DUFB) Program Use Among Supplemental Nutrition Assistant Program (SNAP) Recipients and the Implications for Healthy Food Access

2020 ◽  
Author(s):  
Abiodun Atoloye ◽  
Carrie Durward
Keyword(s):  
Food Access ◽  
Single Market ◽  
Healthy Food ◽  
Healthy Foods ◽  
Total Revenue ◽  
Supplemental Nutrition ◽  
Frequent Users ◽  
Healthy Food Access ◽  
Access To Healthy Foods

Acceptance of SNAP benefits has increased in farmers’ markets (FM) over the years. However, getting SNAP recipients to take up the opportunity of extra dollars for healthy food options remains a challenge. Thus, we tracked the use of the Double-up Food Buck (DUFB) program among SNAP recipients who visit participating FMs in Utah to understand the unique characteristics of the program users. Our results identified varying types of program users (multiple and single market shoppers, more frequent and less frequent shoppers). While our findings indicate a higher DUFB transaction in token value among frequent users, larger markets are more likely to have higher DUFB transactions with a higher number of market visits compared to smaller ones. In conclusion, while all types of users may add to the total revenue generated by participating FM, additional initiatives are required to encourage frequent visits and uptake of the program for better access to healthy foods.

scholarly journals A Subsidized Healthy Food Prescription Program for Adults with type 2 Diabetes who are Experiencing Food Insecurity: Protocol for a Randomized Controlled Trial, Modelling and Implementation Studies

2021 ◽  
Author(s):  
Dana Lee Olstad ◽  
Reed F Beall ◽  
Eldon Spackman ◽  
Sharlette Dunn ◽  
Lorraine Lipscombe ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Program Effectiveness ◽  
Controlled Trial ◽  
Healthy Food ◽  
Healthy Foods ◽  
Glucose Levels ◽  
Randomized Controlled ◽  
Blood Glucose Levels ◽  
Persistent Hyperglycemia

Abstract Background: The high cost of many healthy foods poses a significant challenge to the maintenance of optimal blood glucose levels for adults with type 2 diabetes (T2DM) who are experiencing food insecurity, leading to diabetes complications and excess acute care usage and costs. Subsidized healthy food prescription programs may help to reduce food insecurity by financially supporting patients to improve their diet quality, prevent diabetes complications and avoid acute care use. This study will use a type 2 hybrid effectiveness-implementation design to examine the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of a subsidized healthy food prescription program for adults who are experiencing food insecurity and persistent hyperglycemia. A randomized controlled trial (RCT) will investigate program effectiveness via impact on blood glucose levels (primary outcome), food insecurity, diet quality and other clinical and patient-reported outcomes. A modelling study will estimate longer-term program effectiveness in reducing diabetes-related complications, resource use and costs. An implementation study will examine all RE-AIM domains, including reasons behind program successes and failures, fidelity, mechanisms of impact, contextual determinants of effective implementation and sustainability. Methods: 404 adults who are experiencing food insecurity and persistent hyperglycemia, including adults who identify as Indigenous, will be randomized to a subsidized healthy food prescription intervention (n=202) or a healthy food prescription comparison group (n=202). Both groups will receive a healthy food prescription. The intervention group will additionally receive $1.50/day/household member to purchase healthy foods in supermarkets for 6 months. The implementation process will follow the Quality Implementation Framework. Outcomes will be assessed at baseline and follow-up (6 months) in the RCT and analyzed using mixed-effects linear and multinomial logistic/ordinal regression models. Longer-term outcomes will be modelled using the validated UK Prospective Diabetes Study outcomes simulation model-2. Implementation processes and outcomes will be continuously measured via quantitative and qualitative data and analyzed using descriptive statistics and theory-informed directed content analysis, respectively. Discussion: This research will provide a comprehensive body of data with high internal and external validity to assist policymakers and practitioners to effectively and rapidly translate the evidence generated into programs and policies to support patients with T2DM who are experiencing food insecurity. Trial registration: ClinicalTrials.gov NCT04725630 (January 25, 2021; https://www.clinicaltrials.gov/ct2/show/NCT04725630?term=Subsidized+Healthy+Food+Prescription+Program&cond=Diabetes+Mellitus%2C+Type+2&draw=2&rank=1).

scholarly journals Needs and perceptions regarding healthy eating among people at risk of food insecurity: a qualitative analysis

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Laura A. van der Velde ◽  
Linde A. Schuilenburg ◽  
Jyothi K. Thrivikraman ◽  
Mattijs E. Numans ◽  
Jessica C. Kiefte-de Jong
Keyword(s):  
At Risk ◽  
Food Insecurity ◽  
Healthy Eating ◽  
Eating Behaviour ◽  
Cultural Influences ◽  
Financial Stress ◽  
Healthy Food ◽  
Financial Strain ◽  
Healthy Foods ◽  
Factors Influencing

Abstract Background Healthy eating behaviour is an essential determinant of overall health. This behaviour is generally poor among people at risk of experiencing food insecurity, which may be caused by many factors including perceived higher costs of healthy foods, financial stress, inadequate nutritional knowledge, and inadequate skills required for healthy food preparation. Few studies have examined how these factors influence eating behaviour among people at risk of experiencing food insecurity. We therefore aimed to gain a better understanding of the needs and perceptions regarding healthy eating in this target group. Methods We conducted a qualitative exploration grounded in data using inductive analyses with 10 participants at risk of experiencing food insecurity. The analysis using an inductive approach identified four core factors influencing eating behaviour: Health related topics; Social and cultural influences; Influences by the physical environment; and Financial influences. Results Overall, participants showed adequate nutrition knowledge. However, eating behaviour was strongly influenced by both social factors (e.g. child food preferences and cultural food habits), and physical environmental factors (e.g. temptations in the local food environment). Perceived barriers for healthy eating behaviour included poor mental health, financial stress, and high food prices. Participants had a generally conscious attitude towards their financial situation, reflected in their strategies to cope with a limited budget. Food insecurity was mostly mentioned in reference to the past or to others and not to participants’ own current experiences. Participants were familiar with several existing resources to reduce food-related financial strain (e.g. debt assistance) and generally had a positive attitude towards these resources. An exception was the Food Bank, of which the food parcel content was not well appreciated. Proposed interventions to reduce food-related financial strain included distributing free meals, facilitating social contacts, increasing healthy food supply in the neighbourhood, and lowering prices of healthy foods. Conclusion The insights from this study increase understanding of factors influencing eating behaviour of people at risk of food insecurity. Therefore, this study could inform future development of potential interventions aiming at helping people at risk of experiencing food insecurity to improve healthy eating, thereby decreasing the risk of diet-related diseases.

scholarly journals I Can for Kids: Experiences and Perceived Outcomes of a Summer Food Program for Low-Income Households at Risk of Food Insecurity in Calgary, Alberta, Canada

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 151-151
Author(s):  
Yun Yun Lee ◽  
Stéphanie Caron-Roy ◽  
Bobbi Turko ◽  
Jane Shearer ◽  
Donald Barker ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Low Income ◽  
Family Relationships ◽  
Data Generation ◽  
Structured Interviews ◽  
Agency Staff ◽  
Program Delivery ◽  
Food Programs ◽  
Perceived Outcomes ◽  
Low Income Households

Abstract Objectives The prevalence of household food insecurity increases in the summer when school meals are no longer accessible, which can negatively impact children's health and wellbeing. Summer food programs, such as I Can for Kids (IC4K) in Calgary, Alberta, Canada, aim to reduce food insecurity in low income households with school-aged children during the summer months. Qualitative studies have not yet examined whether or how grocery gift cards (GGC) can reduce experiences of food insecurity among low-income households. We explored recipients’ and agency staff experiences and perceived outcomes of receiving or distributing GGC from IC4K. 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 38 primary caregivers (i.e., GGC recipients) and 17 agency staff who distributed GGC. Directed content analysis was used to analyze the data from each set of interviews using a deductive-inductive approach. Codes were combined into themes that summarized GGC recipients’ and agency staff's experiences and perceived outcomes of receiving or distributing GGC, and feedback to improve program delivery. Results Three themes were generated from the data. The first theme was Financial Relief and reflected increased self-efficacy, improved diet quality, and reduced household stress from receiving GGC. The second theme was Social Connectedness and described enriched family relationships, enhanced rapport between staff and recipients, and increased recipient social capital. The last theme was Program Enhancements and described feedback to improve program delivery by extending program duration, increasing strategic direction to staff on GGC distribution, and additional promotional efforts to increase awareness of GGC availability. Conclusions GGC recipients and agency staff perceived that GGC offered financial relief and enhanced social connections for recipients, and suggested areas for program improvements. Study findings can inform improvements to summer food programs that deliver GGC to reduce food insecurity among low-income households in the summer. Funding Sources Funding provided by the O'Brien Institute for Public Health at the University of Calgary.

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