Veggie Van Pilot Study: Impact of a Mobile Produce Market for Underserved Communities on Fruit and Vegetable Access and Intake

A Novel Process to Recruit and Select Community Partners for a Hybrid Implementation-Effectiveness Study

BACKGROUND

Creating strong partnerships with community organizations is essential to test implementation of evidence-based interventions. However, partners are often chosen based on convenience rather than capacity or diversity. Streamlined processes are needed to identify qualified, diverse, and invested partners to conduct community-based research.

OBJECTIVES

There is a gap in the literature on effective and efficient processes for recruiting partners. This paper aims to fill that gap by describing a novel approach for identifying a diverse group of community organizations to participate in research.

METHODS

We used a Request for Partners (RFP) approach to recruit partners to participate in a hybrid implementation-effectiveness study of the Veggie Van mobile market model. The process included formative work to inform RFP development, creation of an external advisory committee, an intent-to-apply round, a full application round, and an inperson training and selection process. Data was collected to characterize applicant size, location, and experience; pre-post surveys were conducted to understand the training's utility.

RESULTS

We received 59 intent-to-apply submissions and invited 28 organizations to apply: 17 submitted applications and 12 organizations were chosen as finalists. The process took approximately 8 months to recruit 9 organizations and 32 community sites across 5 states and increased understanding of the intervention and partner responsibilities.

CONCLUSIONS

An RFP process is familiar to many community organizations that compete for grant funding but may not have prior research experience. This process streamlined recruitment timelines, increased diversity, and cultivated community among organizations. It may also improve research transparency, study completion, and intervention fidelity.

LGBTQ+ food insufficiency in New England

As a group, LGBTQ+ people experience food insecurity at a disproportionately high rate, yet food security scholars and practitioners are only beginning to uncover patterns in how food insecurity varies by subgroups of this diverse community. In this paper, we use data from the U.S. Census Bureau's Household Pulse Survey-which added measures of gender identity and sexuality for the first time in 2021-to analyze New Englanders' food insufficiency rates by gender, sexuality, race, and ethnicity. We find that (1) in the past seven days, 13.0 percent of LGB + (lesbian, gay, bisexual, and other non-heterosexual) New Englanders experience food insufficiency-which is nearly twice the rate of heterosexual people-and 19.8 percent of transgender+ (transgender, genderqueer, gender non-binary, and other non-cisgender people) New Englanders experience food insufficiency-which is two to three times the rate of cisgender men and women. (2) Whereas cisgender New Englanders experience food insufficiency at a lower rate than their counterparts in the rest of the nation (about two percentage points lower for both cisgender men and women), transgender+ New Englanders experience no such New England advantage compared to transgender+ people in the country as a whole. (3) LGBTQ+ New Englanders of color experience devastatingly high rates of food insufficiency, with, for example, one in three Black transgender+ New Englanders not having enough food to eat in the past seven days. These findings suggest that addressing food insecurity in New England demands approaching the problem with an intersectional queer lens, with attention to the ways in which racism, cissexism, and heterosexism are creating a systemic, ongoing food crisis for LGBTQ+ New Englanders, especially those who are transgender+ and/or people of color.

An explorative study with convenience vegetables in urban Nigeria—The Veg-on-Wheels intervention

Nigerian consumers have been found to view vegetables as healthy and health is a principal motivation for consumption; however, consumers also experience barriers related to preparation time and availability of vegetables. We therefore conducted a Veg-on-Wheels intervention, in which ready-to-cook, washed and pre-cut green leafy vegetables (GLV) were kept cool and sold for five weeks at convenient locations near workplaces and on the open market in Akure, Nigeria. Surveys were conducted prior to the intervention with 680 consumers and during the final week of the intervention with 596 consumers near workplaces and 204 consumers at the open market. Both buyers and non-buyers of the intervention were included; 49% buyers in the workplace sample and 47% in the open market sample. The Veg-on-Wheels intervention was successful, with high awareness, positive attitudes and high customer satisfaction. GLV intake was higher for Veg-on-Wheels buyers compared with non-buyers after the intervention, i.e., 10.8 vs. 8.0 portions per week, respectively. Also the intake of other vegetables was higher in the intervention group. The motives and barriers for buyers and non-buyers differed across the selling locations: main barriers were trust in the vendor and GLV source. These trust issues and vendor preferences were viewed as more important to respondents at the market than those near workplaces. This study is the first intervention study on the selling of ready-to-cook convenience vegetables in urban Nigeria. It shows that a market exists for convenience vegetables and that they have the potential to increase vegetable intake. Insights on both the food environment and consumers’ motives and behaviour was crucial for designing and evaluating the intervention.

Impacts of the COVID-19 Pandemic on Mobile Produce Market Operations: Adaptations, Barriers, and Future Directions for Increasing Food Access

BACKGROUND

Mobile produce markets were increasingly recognized as an effective and accepted approach to improving access to fruits and vegetables in lower-income and at-risk communities during the first year of the COVID-19 pandemic in the United States. This study provides insights into how mobile market operations were impacted by, and evolved in response to, challenges posed by the pandemic.

METHODS

A survey evaluating impacts of the pandemic on mobile markets was distributed to a database of mobile market operators in the United States. Respondents were asked to describe impacts to their mobile market's operations, and what adaptations were needed to continue to effectively serve their communities during 2020.

RESULTS

Surveys representing 48 unique mobile markets were collected from March to July 2021. Of the respondents, 63% reported an increase in demand for mobile market services from community members. Furthermore, 65% increased the amount of produce they distributed in 2020 as compared to 2019, often through adopting low or no-cost models or participating in pandemic government programs.

DISCUSSION

Emergency adaptations employed by mobile markets can inform long-term operational modifications for not only mobile markets, but also other food access programs, beyond the COVID-19 pandemic.

A Randomized Controlled Trial of a Research-Tested Mobile Produce Market Model Designed to Improve Diet in Under-Resourced Communities: Rationale and Design for the Veggie Van Study

Mobile produce markets are increasingly popular retail vendors used for providing access to fresh fruits and vegetables (F&V) in under-resourced communities; however, evaluation is limited due to design and implementation challenges. This protocol presents the original design of a randomized control trial aimed at assessing the effectiveness of the evidence-based Veggie Van (VV) mobile market model. Nine US community partner organizations were asked to partner with four community sites serving lower-income areas. Sites are randomized to either intervention or control. Intervention sites will host a mobile market for one year while the control sites will host planning events, with the goal to open a market afterward. Eligible participants are aged ≥ 18, the primary household shopper, live nearby/regularly frequent the site, and have expressed interest in learning about a mobile market. The primary outcome, F&V consumption, will be assessed via dietary recall at baseline and 12 months and compared between the intervention and control sites. This research advances work on the VV model and methods for mobile market evaluation with the addition of more robust measures and the study design. Determining the effectiveness of the VV model is imperative to justify taking it to scale to enhance the impact of mobile markets.

Farmers' Market Incentives for Low-Income Families: Who Uses, How Much, and Why

INTRODUCTION

Focusing on participation and utilization, this research helps to assess the potential impact and contributions of farmers' market incentive programs, often seen as means for improving nutrition and preventing disease among low-income families.

METHODS

Evaluating the largest farmers' market incentive program in the U.S. (California Market Match), this study used (1) 3 administrative databases (n=1,469, 6,799, and 30,506), (2) a participant survey (n=2,723), and (3) longitudinal interviews (n=163) with active and former participants. Quantitative data were analyzed with contingency tables and multiple regression. Qualitative data were coded into analytically significant themes. Data were collected in 2015-2018 and analyzed in 2018-2021.

RESULTS

Participation was typically low and varied across localities (3.7%-19.8% of eligible families in a sample of ZIP codes). According to administrative records, market visits by participants in 2 California regions averaged 2.18 and 3.12 per season. However, 77.1% of participants in the shopper survey indicated that they were repeat customers, and 51.0% indicated that they were regular utilizers. Deterrents to utilization included perceptions of inconvenience and high prices but not availability of produce in the community or travel time to markets. Utilization was most frequent among Asian shoppers and residents of Southern California outside Los Angeles County.

CONCLUSIONS

Farmers' market incentive programs such as Market Match appear likely to benefit population health through a core of committed shoppers. Improvement in participation and utilization may be attained through a better understanding of the communities that the markets are intended to serve.

Implementing a Rural Natural Experiment: A Protocol for Evaluating the Impacts of Food Coops on Food Consumption, Resident's Health and Community Vitality

BACKGROUND

Local food environments are recognized by experts as a determinant of healthy eating. Food cooperatives (coop) can promote the accessibility to healthier foods and thus improve the health of the population, particularly in remote rural communities.

OBJECTIVE

To measure the effects of implementing a food coop in a disadvantaged community with poor access to food. We have two main research questions: (1). Does the establishment of a food coop in rural areas described as food deserts have an impact on accessibility, frequency of use, food consumption, food quality, and ultimately the health of individuals? (2). Does the establishment of a food coop in rural areas described as food deserts have an impact on food security and community vitality?

DESIGN

A natural experiment with a mixed pre/post method will be used. The sample is composed of households that came from geographically isolated communities (population: 215 to 885 inhabitants) which qualified as food deserts and located in rural areas of Quebec (Canada). All communities plan to open a food coop (in the years 2022-2023), and as their opening will be staggered over time, participants from communities with a new food coop (intervention) will be compared to communities awaiting the opening of their food coop (control). Data collection was carried out at three time points: (1) before; (2) 1 to 5 months after; and (3) 13 to 17 months after the opening of the coop. Questionnaires were used to measure sociodemographic variables, dietary intake, residents' health, and community vitality. Semi-structured interviews were conducted with community stakeholders.

RESULTS

Few natural experiments have been conducted regarding the impact of implementing food coops. Gathering concrete data on the effectiveness and processes surrounding these interventions through natural experiments will help to quantify their impact and guide knowledge users and policymakers to make more informed decisions.

More Frequent Food Shopping May Promote Fruit and Vegetable Intake: A Systematic Review

BACKGROUND

Food shopping frequency may be an important modifiable factor related to increasing fruit and vegetable (FV) intake. Because of mixed findings of individual studies of shopping frequency, a systematic review is needed to examine findings across studies and store types.

OBJECTIVE

To conduct a systematic review of articles examining the relationship between frequency of food shopping and FV intake including examination of participation in federal nutrition assistance programs on FV intake, if reported.

METHODS

A search, guided by the Preferred Reported Items for Systematic Reviews and Metanalyses, using terms related to FV consumption and food shopping across 4 online databases, was conducted. Studies conducted in the US and published through October, 2020, included adults, and had a cross-sectional, longitudinal, cohort, or randomized study design were eligible for inclusion.

RESULTS

Twenty-four articles were included. The majority of studies found at least 1 positive finding between the frequency of food shopping and FV intake, indicating that as the frequency of food shopping increased, FV intake increased. In studies with 100% participation in government/federal nutrition assistance programs, participation was associated with FV intake. Studies that included participation as a subset found participation not associated with FV intake.

IMPLICATIONS FOR FUTURE RESEARCH AND PRACTICE

The frequency of shopping may be modifiable to increase FV intake. Experimental research is needed to test the directionality and causality of the relationship. Federal nutrition assistance programs may be a logical place to test the relationship through the adjustment of fund disbursements.

Behavioural change box? Applying the COM-B model to understand behavioural triggers that support consumption of fruits and vegetable among subscribers of a fruit and vegetable box scheme

OBJECTIVE

To understand the key mechanisms that support healthy dietary habits promoted by fruit and vegetable (F&V) box schemes, testing relevant behaviour change triggers identified under the COM-B model in an evaluation research study of a Portuguese F&V box scheme (PROVE).

DESIGN

Correlation study with a post-test-only non-equivalent group design based on survey data. The mechanisms underpinning the differences between subscribers and non-subscribers are operationalised as mediation effects. Data availability, theoretical relevance and empirical validation supported the selection and testing of four potential mediators for the effects of subscribing to the box scheme on F&V consumption. These estimations derive from the coefficients of a structural equation model combined with the product coefficient approach and Sobel test.

SETTING

The study is part of a wider evaluation study on the impact of the PROVE box scheme on sustainability, health and equity.

PARTICIPANTS

A sample of PROVE box subscribers (n 294) was compared with a matched subsample of non-subscribers (n 571) in a nationally representative survey.

RESULTS

Subscribing to the PROVE box correlates with an increased probability of eating at least five portions of F&V, irrespective of differences in age, education and perceived economic difficulties. Diet quality perceptions, and more robustly, the strength of meal habits and household availability were identified as relevant mediators.

CONCLUSIONS

The subscription to an F&V box scheme is connected with proximal context that enables the consumption of F&V by ensuring more readily available F&V and better situational conditions associated with healthier meal habits.

Participant Perceptions of a Free Fresh Produce Market at a Health Center

OBJECTIVE

To examine participant perceptions of a free, monthly produce market at a health center in Massachusetts.

DESIGN

Participants were recruited at a produce market between June 2019 and January 2020 and engaged in a 30-65-minute focus group (n = 3 English language; n = 2 Spanish; n = 2 Arabic) conducted by trained facilitators using a semistructured guide.

PARTICIPANTS

Adults (n = 49) who had attended the market at least twice in the previous 6 months.

MAIN OUTCOME MEASURES

Participant-reported facilitators, barriers, perceived benefits, and opportunities for improvement.

ANALYSIS

Conventional content analysis.

RESULTS

Reported facilitators included accessibility (eg, convenient location and timing), program experience (eg, positive volunteer interactions), and characteristics of goods and services (eg, acceptable variety of produce). Barriers fell under similar themes and included transportation challenges, poor weather, and insufficient quantity of produce for larger households. Participants perceived the market as improving diet and finances and offered suggestions for improvement: distributing nonproduce foods (eg, meat) or nonfood items (eg, toiletries) and augmenting existing initiatives aimed to help attendees make use of the produce (eg, handing out recipe cards).

CONCLUSIONS AND IMPLICATIONS

The produce market was widely accepted, and targeted areas for improvement were identified. Findings may improve existing and future charitable produce markets among diverse populations.

Retail Nutrition Programs and Outcomes: An Evidence Analysis Center Scoping Review

As nutrition-related diseases contribute to rising health care costs, food retail settings are providing a unique opportunity for registered dietitian nutritionists (RDNs) to address the nutritional needs of consumers. Food as Medicine interventions play a role in preventing and/or managing many chronic conditions that drive health care costs. The objective of this scoping review was to identify and characterize literature examining Food as Medicine interventions within food retail settings and across consumer demographics. An electronic literature search of 8 databases identified 11,404 relevant articles. Results from the searches were screened against inclusion criteria, and intervention effectiveness was assessed for the following outcomes: improvement in health outcomes and cost-effectiveness. One-hundred and eighty-six papers and 25 systematic reviews met inclusion criteria. Five categories surfaced as single interventions: prescription programs, incentive programs, medically tailored nutrition, path-to-purchase marketing, and personalized nutrition education. Multiple combinations of intervention categories, reporting of health outcomes (nutritional quality of shopping purchases, eating habits, biometric measures), and cost-effectiveness (store sales, health care dollar savings) also emerged. The intervention categories that produced both improved health outcomes and cost-effectiveness included a combination of incentive programs, personalized nutrition education, and path-to-purchase marketing. Food as Medicine interventions in the food retail setting can aid consumers in navigating health through diet and nutrition by encompassing the following strategic focus areas: promotion of health and well-being, managing chronic disease, and improving food security. Food retailers should consider the target population and desired focus areas and should engage registered dietitian nutritionists when developing Food as Medicine interventions.

The introduction of new food retail opportunities in lower-income communities and the impact on fruit and vegetable intake: a systematic review

A lack of access to fresh fruits and vegetables (F&Vs) is associated with consumption of fewer F&Vs and higher risk of obesity, especially for lower-income individuals. It is widely believed that the addition of new food retail opportunities could improve F&V consumption and subsequently reduce the chronic disease burden. Observational studies provide some support for these hypotheses, but contradictions exist. In this study we sought to examine if the introduction of a food retailer affects F&V consumption in lower-income communities. We used a systematic PRISMA approach to conduct this study. We searched PubMed, EMBASE, and ProQuest Dissertations & Theses for academic journal references and gray literature published before August 2018. Included studies were those looking at the effect of the introduction of a new food retailer on F&V consumption. Studies were also categorized based on which dimensions of food access were targeted by the food retailer. We identified 15 studies meeting inclusion criteria: 11 studies reported a positive increase in F&V consumption attributable to the introduction of a new food retailer, of which 6 were statistically significant. The remaining 4 studies, all of which examined the impact of introducing a new retail supermarket, showed no change or a decrease in F&V intake. Results from studies which change the food environment generally support the idea that increased access to healthy food improves diet, but more studies are needed in order to assess the differences between the various types of retailers, and to identify strategies for improving impact. Understanding which types of new food retail programs are most likely to impact diet has implications for policies which incentivize new food retail.

Strategies for Sustainable Business Development: Utilizing Consulting and Innovation Activities

This study explores strategies for sustainable business development via the process and performance of business consulting by using 200 samples of different industry sectors in South Korea. The main purposes of this paper are to build the consulting model framework and to analyze the relationships between consulting factors and consulting performance for establishing strategies for sustainable business development. First, the findings show that the support of CEOs for consulting projects and the innovation activities via exploration and exploitation (and ambidexterity) have higher impacts on the contribution to business performance than other consulting factors. Similarly, according to the results of IPMA, these variables are placed in a group of high importance and performance, so the findings indicate that the support of CEO and innovation activities play a central role in the consulting model. Second, the competency of CEOs for recognizing the awareness of newly changing market conditions and the importance of utilizing business consulting can serve as an engine to reach their sustainable business development. Moreover, the firms’ innovation activities via business consulting can increase their ability to utilize and absorb the external resources and knowledge for establishing strategies for sustainable business development. These abilities are used not only to induce their business innovation internally but also to pioneer new market opportunities amid a rapidly changing market environment.

A Cluster-Randomized Trial of a Mobile Produce Market Program in 12 Communities in North Carolina: Program Development, Methods, and Baseline Characteristics

BACKGROUND

Mobile markets are an increasingly popular method for providing access to fresh fruits and vegetables (F/V) in underserved communities; however, evaluation of these programs is limited, as are descriptions of their development, study designs, and needs of the populations they serve.

OBJECTIVE

Our aim was to describe the development and theoretical basis for Veggie Van (VV), a mobile produce market intervention, the study design for the VV evaluation, and baseline characteristics of the study population.

DESIGN

The protocol and sample for a cluster-randomized controlled trial with 12 sites are described.

PARTICIPANTS/SETTING

Community partner organizations in the Triangle region of North Carolina that primarily served lower-income families or were located in areas that had limited access to fresh produce were recruited. Eligible individuals at each site (older than 18 years of age, self-identified as the main shoppers for their household, and expressed interest in using a mobile market) were targeted for enrollment. A total of 201 participants at 12 sites participated in the VV program and evaluation, which was implemented from November 2013 to March 2016.

MAIN OUTCOME MEASURES

Change in F/V intake (cups/day), derived from self-reported responses to the National Cancer Institute F/V screener, was the main outcome measure.

STATISTICAL ANALYSES PERFORMED

We performed a descriptive analysis of baseline sample characteristics.

RESULTS

Mean reported F/V intake was 3.4 cups/day. Participants reported generally having some access to fresh F/V, and 57.7% agreed they could afford enough F/V to feed their family. The most frequently cited barriers were cost (55.7%) and time to prepare F/V (20.4%). Self-efficacy was lowest for buying more F/V than usual and trying new vegetables.

CONCLUSIONS

By addressing cost and convenience and building skills for purchasing and preparing F/V, the VV has the potential to improve F/V consumption in underserved communities.

Cluster randomized controlled trial of a mobile market intervention to increase fruit and vegetable intake among adults in lower-income communities in North Carolina

Background

Poorer diets and subsequent higher rates of chronic disease among lower-income individuals may be partially attributed to reduced access to fresh fruits and vegetables (F&V) and other healthy foods. Mobile markets are an increasingly popular method for providing access to F&V in underserved communities, but evaluation efforts are limited. The purpose of this study was to determine the impact of Veggie Van (VV), a mobile produce market, on F&V intake in lower-income communities using a group randomized controlled trial.

Methods

VV is a mobile produce market that sells reduced-cost locally grown produce and offers nutrition and cooking education. We recruited 12 sites in lower-income communities in North Carolina (USA) to host VV, randomizing them to receive VV immediately (intervention) or after the 6-month study period (delayed intervention control). Participants at each site completed baseline and follow-up surveys including F&V intake, perceived access to fresh F&V and self-efficacy for purchasing, preparing and eating F&V. We used multiple linear regression to calculate adjusted differences in outcomes while controlling for baseline values, education and clustering within site.

Results

Among 142 participants who completed the follow-up, baseline F&V intake was 3.48 cups/day for control and 3.33 for intervention. At follow-up, adjusted change in F&V consumption was 0.95 cups/day greater for intervention participants (p = 0.005), but was attenuated to 0.51 cups per day (p = 0.11) after removing extreme values. VV customers increased their F&V consumption by 0.41 cups/day (n = 30) compared to a 0.25 cups/day decrease for 111 non-customers (p = 0.04). Intervention participants did not show significant improvements in perceived access to fresh F&V, but increased their self-efficacy for working more F&V into snacks (p = 0.02), making up a vegetable dish with what they had on hand (p = 0.03), and cooking vegetables in a way that is appealing to their family (p = 0.048).

Conclusions

Mobile markets may help improve F&V intake in lower-income communities.

Trial registration

Clinicaltrials.gov ID# NCT03026608 retrospectively registered January 2, 2017.

Electronic supplementary material

The online version of this article (10.1186/s12966-017-0637-1) contains supplementary material, which is available to authorized users.

Best practices for using natural experiments to evaluate retail food and beverage policies and interventions

Policy and programmatic change in the food retail setting, including excise taxes on beverages with added-caloric sweeteners, new supermarkets in food deserts, and voluntary corporate pledges, often require the use of natural experimental evaluation for impact evaluation when randomized controlled trials are not possible. Although natural experimental studies in the food retail setting provide important opportunities to test how nonrandomized interventions affect behavioral and health outcomes, researchers face several key challenges to maintaining strong internal and external validity when conducting these studies. Broadly, these challenges include 1) study design and analysis; 2) selection of participants, selection of measures, and obtainment of data; and 3) real-world considerations. This article addresses these challenges and different approaches to meeting them. Case studies are used to illustrate these approaches and to highlight advantages and disadvantages of each approach. If the trade-offs required to address these challenges are carefully considered, thoughtful natural experimental evaluations can minimize bias and provide critical information about the impacts of food retail interventions to a variety of stakeholders, including the affected population, policymakers, and food retailers.

Examining the relationship between the food environment and adult diabetes prevalence by county economic and racial composition: an ecological study

BACKGROUND

Inequitable access to healthy food may contribute to health disparities. This study examines the relationship between the prevalence of adult diabetes and food access in the U.S. by county economic/racial composition.

METHODS

An ecological study from 2012 was used to estimate the relationship between diabetes and retail food outlet access. County diabetes prevalence was measured based on individual responses to the Behavioral Risk Factor Surveillance Survey question, "Have you ever been told by a doctor that you have diabetes?" If the answer was "yes" individuals were classified as having diabetes. Retail food outlets included grocery stores, supercenters, farmer's markets, full-service restaurants, fast food restaurants and convenience stores. Counties were categorized as "high-poverty" or "low-poverty". Counties were categorized as low (< 4.6%), medium (4.6%-31.0%), and high (> 31.0%) percent minority residents. Multiple linear regression models estimated the association between retail food outlets and diabetes, controlling for confounders, and testing for interactions between retail food outlets and county racial composition. Regression models were conditioned on county economic composition. Data were analyzed in 2016.

RESULTS

Density of retail foods outlets varied greatly by county economic and racial composition; counties with medium-minority populations had the least access to grocery stores and the highest access to fast food restaurants and convenience stores. Low poverty/low-minority population counties had the greatest access to farmer's markets and grocery stores. For low poverty/low-minority counties, grocery stores were associated with decreased of diabetes prevalence. Supercenters were associated with an increase in diabetes prevalence for high-poverty/low-minority counties. Only low poverty/medium-minority counties had a statistically significant relationship between farmer's markets and diabetes prevalence. Fast food restaurants were found to be positively associated with diabetes prevalence in all counties except high poverty/medium-minority. However, only low poverty/low-minority counties had a statistically significant relationship. Across all models, access to full service restaurants were significantly associated with lower prevalence of diabetes. Generally, access to convenience stores were associated with increased diabetes prevalence, except for high poverty/low-minority counties.

CONCLUSIONS

The food environment is more strongly associated with diabetes prevalence for wealthier counties with a lower proportion of minority residents. This is important given efforts to increase food access in vulnerable communities. Availability of healthier food may not be enough to change health outcomes.

Recruiting Community Partners for Veggie Van: Strategies and Lessons Learned From a Mobile Market Intervention in North Carolina, 2012-2015

BACKGROUND

Food access interventions are promising strategies for improving dietary intake, which is associated with better health. However, studies examining the relationship between food access and intake are limited to observational designs, indicating a need for more rigorous approaches. The Veggie Van (VV) program was a cluster-randomized intervention designed to address the gap between food access and intake. In this article, we aim to describe the approaches involved in recruiting community partners to participate in VV.

COMMUNITY CONTEXT

The VV mobile market aimed to improve access to fresh fruits and vegetables by providing subsidized, high-quality, local produce in low-resource communities in North Carolina. This study describes the strategies and considerations involved in recruiting community partners and individual participants for participation in the VV program and evaluation.

METHODS

To recruit partners, we used various strategies, including a site screener to identify potential partners, interest forms to gauge future VV use and prioritize enrollment of a high-need population, marketing materials to promote VV, site liaisons to coordinate community outreach, and a memorandum of understanding between all invested parties.

OUTCOME

A total of 53 community organizations and 725 participants were approached for recruitment. Ultimately, 12 sites and 201 participants were enrolled. Enrollment took 38 months, but our approaches helped successfully recruit a low-income, low-access population. The process took longer than anticipated, and funding constraints prevented certain strategies from being implemented.

INTERPRETATION

Recruiting community partners and members for participation in a multi-level, community-based intervention was challenging. Strategies and lessons learned can inform future studies.