Short Talk About Fruits, Veggies Seems to Boost Interest

January 18, 2017

Source: MedPage Today
Author: Kristen Monaco

Healthy food shopping habits among low-income families improved after short waiting room chats about available food incentive programs, researchers reported.

In Southeast Michigan, use of the Double Up Food Bucks (DUFB) food incentive program for the purchase of healthy foods at farmers’ markets saw an uptick after a 5-minute explanation about the program in a health clinic waiting room (aOR 19.2, 95% CI, 10.3-35.5, P<0.001), according to Alicia J. Cohen, MD, of the University of Michigan in Ann Arbor, and colleagues.

The quasi-experimental study reported a significant increase in consumption of fruits and vegetables among participants while utilizing the program. Consumption of fruits and vegetables increased after first use of the program and continued to rise by 0.66 servings/day (0.38-0.93, P<0.001) over the first 3 months of the study, they reported in the American Journal of Preventive Medicine,

Consumption of fruits and vegetables stabilized, but continued to remain high through the remainder of the study (0.63 servings/day higher than baseline, 0.34-0.92, P≤0.001).

Among participants who used the DUFB program three or more times, consumption of fruits and vegetables was even greater after baseline (P=0.002 for frequency of DUFB use). The authors noted than even after farmers’ market season had ended in October, consumption remained increased for 2 months following.

Because fruit and vegetable consumption is typically “far below guidelines” among low-income communities, the authors aimed to address the financial barriers to a healthy diet. As a result, they hoped diet-related diseases, such as type 2 diabetes, obesity, and metabolic syndrome, would benefit through the intervention.

“Patients are often pressed to make difficult financial decisions, and fruits and vegetables aren’t always easy to afford,” said Cohen in a press release. “Clinicians can be reluctant to screen for social issues they feel unable to address. But there are so many public and private efforts that can help address needs outside the four walls of the clinic.”

“Our work suggests providing information about healthy food incentives at the doctor’s office is a low cost, easily implemented intervention that may lead to healthier diets among communities at the highest risk of diet-related disease,” she added.

Launched in 2009, DUFB is a food incentive program designed to supplement the federal Supplemental Nutrition Assistance Program (SNAP). With DUFB the customer can purchase locally grown produce through a $20 per visit incentive match, using his or her SNAP benefits, from June to October.

SNAP is currently available in over 40 states, while the DUFB program is available at over 200 grocery stores and farmers’ markets across Michigan, and continues to expand. But the authors noted that most SNAP participants are unaware of the DUFB program, and therefore do not take advantage of the benefits.

“Based on previous research, we had found that lack of program awareness among eligible participants was a major barrier to the use of Double Up Food Bucks,” Cohen told MedPage Today. “We also found that many health clinic providers and staff did not know about Double Up, and were not sharing this resource with their patients. Our hope with this study was to see if taking less than 5 minutes in the waiting room to simply screen and provide information about an existing community resource could help increase fruit and vegetable consumption among low-income patients.”

Eligible participants were recruited from a waiting room of an academic outpatient family medicine and pediatric practice in Ypsilanti, Mich. The 127 participants, identified through a survey at the waiting room, were currently enrolled in SNAP at the time of recruitment.

The researchers had brief chats in the outpatient waiting room with the participants, explaining how to use the DUFB program and presented them with a one-time, $10 voucher for use at the farmers’ market. Participants were followed up with via telephone survey three times after recruitment.

“At baseline, 57% of participants reported having been to a farmers’ market in the last year, but only 18% had used Double Up,” Cohen told MedPage Today. “This underscored how many patients were missing out on the opportunity to have their money doubled for fruits and vegetables. We were excited to find that a brief, low-cost waiting room intervention could lead to a nearly four-fold increase in Double Up use — and even more importantly, clinically significant increases in fruit and vegetable consumption.”

The authors explained how the “low-cost, easily implemented intervention” was successful through taking advantage of individual’s available time in a healthcare setting, which they hypothesize “may have conveyed the implicit endorsement of the incentive program by the health center and providers.”

“There are more and more efforts underway across the nation to help address patients’ unmet social needs,” Cohen added. “We want to get that word out that clinics and health systems don’t have to reinvent the wheel — simple interventions that tap into existing community resources can have big impacts.”

In terms of follow-up studies, Cohen said her group has qualitative work underway that will examine patient experiences using DUFB. “We hope this qualitative work helps us better understand remaining barriers to program use, and how these might be addressed,” she said.

First posted at MedPage Today on January 18, 2017.