A Qualitative Study on the Motivators, Barriers and Supports to Participation in a Pediatric Produce Prescription Program in Hawai‘i

Abstract

Produce prescriptions that provide vouchers to individuals to purchase fresh FVs at a specified retail outlet have the potential to positively impact food security status, diet, and chronic disease risk. However, maximizing program participation is vital to ensuring program success. This research describes motivators, barriers, and support for participation in a child produce prescription program among a population of Native Hawaiian and Other Pacific Islanders, who are underrepresented in this field of research. This qualitative grounded theory study was nestled within a quasi-experimental pilot intervention trial and included semi-structured interviews with pediatric program participants. Twenty-five interviews were conducted, which represented one-third of program participants. The top support factors for program participation included: ease of voucher use, program convenience, health center/pediatrician endorsement and positive communications with farmers’ market vendors. Key motivators for program participation were produce enjoyment, child support, financial support, and positive impacts on family. Three themes emerged consistently as barriers to participation amongst participants, (1) difficult use of vouchers, (2) conflicting schedules, and (3) online market concerns. (4) Conclusions: This research offers insight into policy implications as the number of produce prescription programs has grown. These findings suggest that key program design characteristics can enhance and support program participation.

Caregiver perceptions of a pediatric produce prescription program during the COVID-19 pandemic

“…Program cards helped streamline the check-out process by eliminating the need to separate fruits and vegetables. Participants could conveniently use the card at self-check-out, a feature that many enjoyed and preferred, whereas incentives distributed as vouchers may extend the checkout time to sort exact voucher amounts and eligible items ( 28 , 44 ). A qualitative study among WIC recipients revealed that major barriers to shopping with WIC included finding eligible items, difficulty at check-out with WIC vouchers, and perceived stigma against WIC participants primarily by cashiers at checkout ( 45 ).…”

Clients’ experiences and satisfaction with produce prescription programs in California: a qualitative evaluation to inform person-centered and respectful program models

“…Participants in our study also felt respected when store employees made an effort to assist them in using their gift cards during checkout. Previous qualitative studies of produce prescription programs documented that participants reported having positive interactions with farmers’ market vendors when they were friendly and helped participants use their vouchers ( 25 , 26 ).…”

“…For instance, participants wanted to use vouchers for foods beyond fruits and vegetables ( 25 ). Their ability to select the fruits and vegetables they wanted was also diminished when using an online market due to the limited variety of produce available and the inability to personally hand pick the produce of highest quality ( 25 , 27 ).…”

“…Participants in this study frequently discussed ease of use of the programs, which has been an area commonly reported upon in studies evaluating produce prescription programs. Making vouchers easy to use is a widely known facilitator to program engagement, while difficulties with voucher use such as expiration dates and vouchers that require all funds be used at one time have been documented as barriers to engagement, including use of the full voucher amount ( 25 , 40 ). Moreover, previous studies found that participants want and suggest that vouchers and incentives not have an expiration date or that the expiration date be extended ( 27 , 28 ).…”

Narrative review: food as medicine across the pediatric age continuum

“…Such behavioral proxy measures include change in fruit and vegetable consumption but could also include changes in child preference and acceptance of produce and changes in culinary and nutrition skills and knowledge. These outcomes have been reported in pediatric PRx interventions [67 ▪ ,68,75] and a self-selection PRx intervention in adults [76 ▪ ]. Nearly all pediatric PRx studies published to date have been feasibility or qualitative studies, therefore critical questions remain regarding how to best implement PRx interventions, the ideal target population, dose and duration, the minimum standards for a redemption or fulfillment setting, and the long-term impact on pediatric health and health proxy outcomes, healthcare utilization, and cost.…”