Fresh Start: Experiences with Produce Access Among Wic-eligible Families

Background: Nearly 22% of children in Philadelphia live in food-insecure (FI) households, often leading to reliance on inexpensive, nutrient-poor foods, and associated poor health outcomes. Eating patterns developed in childhood carry into adulthood, indicating the importance of early development of healthy eating behaviors. Conducted in partnership with our local WIC office, this study explores: 1) experiences with produce access among low-income families with young children in West Philadelphia, and 2) caregiver preferences for food assistance in order to inform future programming.

Methods: We abstracted basic demographic and contact information from the electronic health record for families of children under the age of 5 from an urban, pediatric primary care center who are WIC-eligible. We recruited 30 caregivers to participate in semi-structured phone interviews to understand experiences with produce access and explore preferences for programs aimed at increasing produce consumption. All interviews were digitally recorded and transcribed. We used content analysis with constant comparison to code interviews inductively and identified emerging themes through an iterative process.

Results: 30 caregivers with an average of 3 children per household and a 61% rate of FI participated in our qualitative study. A major theme that emerged from the data is a preference among caregivers for their children to eat more produce, although there were many barriers to produce access, including: limited availability, convenience, cost, difficulty shopping with young children, and time constraints. Barriers exacerbated by the COVID-19 pandemic included lack of childcare, decreased access to WIC benefits due to office closures, and fear of visiting stores. Owning a vehicle, and receiving both SNAP and WIC benefits improved ability to purchase produce.

Features of an ideal food program included: delivery-based, wide variety of fruits and vegetables offered, ability to self-select produce, and inclusion of recipes and produce-oriented children’s activities. Additionally, participants suggested that a program would be most helpful if free or covered by food benefits, but that a small fee may be appropriate for those able to afford it.

Conclusion: Our study demonstrates desire for better access to fresh produce among WIC-eligible families, and highlights multiple barriers, which have been worsened by COVID-19. Caregivers described a preference for delivery-based, low-or-no cost food programs to increase produce access and intake among children.