“This Program is a Make or Break Scenario for Me:” A Qualitative Study on Participant Perceptions of a Supermarket Fruit and Vegetable Incentive Program

Abstract

Background: Complete Eats Rx is a USDA-funded fruit and vegetable prescription program that is designed to incentivize fruit and vegetable consumption among SNAP recipients via $10 vouchers to purchase fruits and vegetables at a mid-price large scale grocery chain in Washington State. Objective: To understand participant experiences with the Complete Eats Rx program in the context of chronic food insecurity to better understand the user experience, to improve the program, and to determine the perceived impacts and consequences of the program. Design: Qualitative analysis of three photovoice-style focus group discussions, including a total of 26 participants. Participants were provided with cameras and instructed to take photos based on a participant-chosen theme. Focus group discussions were used to elicit participant experience with the Complete Eats Rx program. The SHOWeD/VENCeR process was used to relate the photo to participant experience in the context of the chosen theme. Each session was facilitated by a health organization staff member or community health worker and a note taker was present. Sessions were audio-recorded and transcribed. Setting: Participants were recruited from three health organizations participating in the Complete Eats Rx program in Spokane, Seattle, and Yakima Valley, Washington. Participants: Twenty-six participants in the Complete Eats Rx incentive program. Analysis: Transcriptions were coded using inductive methods. Coded statements were organized into major themes. Coding structures and analysis were strengthened by iterative interactions between researchers. Results: Participants reported that Complete Eats Rx is an important resources for families and improved their food security, mental health, and diet quality, affordability, and variety. Primary barriers to food security and fruit and vegetable consumption among participants include limited geographic accessibility and the high cost of fruits and vegetables exacerbated by other financial constraints such as rising housing costs. The most frequently mentioned barrier to program use was difficulty at the supermarket checkout due to embarrassment, stigmatization, and inability to redeem incentives. The most frequently mentioned barrier to program acceptability was the partner supermarket as the sole acceptor of the incentive, limiting options for redemption. Conclusion: Participants reported Complete Eats Rx as an important intervention to increase both food security and produce consumption in their households. Supermarket-based incentive programs are a unique strategy to increase produce consumption that can be modeled by other localities. As incentive programs continue to increase in frequency and size, focus on geographic accessibility and positive shopping experiences may improve incentive redemption and usability.