Social approaches to promote F&V consumption

Fruit and Vegetable Prescription (FVRx) Program in Central Wisconsin

Inadequate consumption of fruit and vegetables is particularly concerning in children because significant growth and bone development occur during this time. Moreover, for many Americans, the dietary habits they develop as children continue throughout adulthood. Interventions during childhood, therefore, especially those related to parenting practices, which are related to children’s dietary behaviors, can be particularly effective at improving health over the course of the child’s lifetime. Fruit and Vegetable Prescription (FVRx) programs are a relatively new intervention designed to increase children’s consumption of fruit and vegetables by changing the home food environment; that is, by reducing barriers to parents buying and consuming more fruit and vegetables.

Since their introduction in 2010, FVRx programs have only targeted low-income neighborhoods, and many of these programs limit enrollment to families with diet-related chronic disease risk. However, because national data show that all socioeconomic groups would benefit from an intervention that increases fruit and vegetable consumption, community partners located within Central WI designed a FVRx pilot program that did not target a specific socioeconomic group. The goal of this pilot was to identify whether this design could positively impact fruit and vegetable purchasing and intake among families with children, regardless of their socioeconomic or health statuses.

In 2015, two Central WI communities implemented and evaluated a social media enhanced, low-subsidy fruit and vegetable prescription (FVRx) program to influence fruit and vegetable (F&V) purchasing and consumption of families regardless of socioeconomic status. Because families from all socioeconomic groups do not meet F&V recommendations, our program did not specifically target lowincome families. In partnership with community organizations and local healthcare providers, pediatricians provided families Rx’s with F&V recommendations, a $10 voucher for produce at their local farmers’ market along with access to online support materials designed using the social cognitive theory to reduce barriers to F&V consumption. The program ran 16 weeks during the farmers’ market season.

Summary of program findings:

  • Participation:
    • 36% of families (n=353) brought their FVRx from their pediatrician to the farmers’ market and received tokens to spend on produce at the market.
    • this resulted in $1,215 spend on local produce from participating farmers’ markets.
    • 10% of participating families had never attended a farmers’ market prior to this program.
    • 40% of participants reported engaging in the online educational material.
  • Evaluation:
    • For children of parents that participated in this program, reported fruit and vegetable (F&V) consumption increased by 18% and 28% respectively.
    • Parents reported increased confidence that they could handle their child’s emotional response to dietary changes.
    • Parents reported that their child’s preference for vegetables increased over the course of the 16-week program.
    • Parents who did not redeem their FVRx’s were also less likely to agree that cost was a barrier to their F&V consumption.
    • The highest reported barriers to F&V consumption for participants were:
    • “my child [does not] choose vegetables when eating out” (with 31% agreeing to this statement) and • “my child [does not] like to try different fruit and vegetables” (24% agreed to this)
    • 49% of participants disagreed with a statement that cost was a barrier to their F&V consumption.

Parental behaviors surrounding F&V purchasing did not change significantly in survey respondents, however, there was significant pre- to post-program improvement in children’s F&V consumption reported by parents. Rx redemption rates were low compared to other programs, this was likely due to logistical factors such as limited market days and distance between family’s residence and market locations. Only two markets participated in this pilot program. Most (90%) of Rx’s were redeemed by families already familiar with farmer’s markets.

The evaluation component of this program revealed some limitations of using the same standard FVRx program design for families of different socioeconomic statuses. The model for FVRx programs would benefit from further research on effective design components specific to the resources within the community offering the program. The implementation of this program, however, was significant in the development of relationships between community organizations and healthcare systems.

Follow up:

Going into year three of this program, the design has been modified to reach “low risk” and “high risk” families differently. The high risk term used by the program is associated with food insecurity and health related complications, these families now receive a higher value voucher and more one on one support. Funding for this program primarily comes from partnering hospitals but would not function without the in-kind donations from partnering community organizations.
The two original communities that piloted this program together now use different designs due to the varying needs and resources of each despite their geographic proximity. For example, one community has a higher poverty rate so they focus solely on high risk families. One community has expanded partnerships to indoor markets that sell local produce throughout the week since the main farmers market is only open once per week. These changes have increased both program participation and support from the community.

Based on: Chrisinger, A. and Wetter, A. Fruit and Vegetable Prescription Program: Design and Evaluation of a Program for Families of Varying
Socioeconomic Status. Journal of Nutrition Education and Behavior Volume 48, Number 7S, 2016

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