Fruit and vegetable intake: Influence of perceived food environment and self-efficacy.

OBJECTIVE
Identify the effects of food environment and self-efficacy perceptions on fruit and vegetable (FV) consumption.

METHODS
A cross-sectional study with a representative sample population from a public health service in a Brazilian city. Participants (3414) aged ≥20 years were recruited from 18 Health Academy Program centres via stratified cluster sampling. Perceptions of the food environment were measured by survey; participants indicated how confident they were about FV availability in their food environment. Statements about self-efficacy assessed three domains regarding perceived affordability, time, and cooking skills. In order to assess the combined effects of both perceptions of food environment and self-efficacy on FV consumption, a combined variable was created.

RESULTS
Both perceptions of food environment and self-efficacy in addition to FV consumption were higher in older participants and those with higher incomes and educational levels. Analyses of the combined variables showed that the highest FV intake was found among individuals with better food environment perceptions and greater self-efficacy. After adjustments, the association of food environment perceptions with FV consumption was marginally significant (p = 0.062), while self-efficacy was more strongly associated (p < 0.001); a one standard deviation higher confidence score was associated with a 35.10 g higher FV intake.

CONCLUSIONS
Among participants of low socioeconomic position, individuals' self-efficacy for promoting FV intake were more important to greater consumption than perceptions of food environments. In addition to public policies for tackling socioeconomic inequalities in restricted environments, it is possible that building capabilities among vulnerable individuals are fruitful pathways for enabling them to partially overcome the challenges of poor food environments.