Offering people free fruits and vegetables sounds like a simple way to help them eat better. But what if getting to the place that provides the food is part of the problem?
A new study from the University at Buffalo suggests that home delivery could make a big difference. In a 12-week trial involving 67 older adults, participants who received fresh produce at their doors collected nearly 90% of their weekly food benefits, compared with just 28% among those who had to visit a mobile market.
The findings, published in Frontiers in Public Health, suggest that removing transportation and other everyday obstacles could help food assistance programs reach more people. The study was led by University at Buffalo researcher Lucia Leone, who also has an ownership interest in the company that delivered the food. The university reviewed the financial relationship and established safeguards.
The study involved adults ages 65 and older in Buffalo, New York, who had difficulty accessing fresh fruits and vegetables. Participants were divided into three groups. One received weekly boxes of fresh produce delivered to their homes. Another received meal kits containing produce, recipes and other ingredients. The third received vouchers to pick up free produce at local mobile markets.
All three groups were offered free food, but those receiving deliveries didn't have to arrange transportation or make a trip to collect it. They could choose what went into their boxes, but if they didn't make any changes, the food arrived automatically.
“The problem historically with food prescription programs is that people get the vouchers but don’t redeem them,” Leone said.
The difference was substantial. Participants in both delivery groups received an average of nearly 11 of their 12 weekly food packages, while those assigned to the mobile markets picked up an average of only three to four.
Once people received their food, though, they reported using roughly the same amount regardless of how it arrived. Households in all three groups used approximately 83% to 85% of the produce they received.
In other words, the biggest obstacle appeared to be getting the food home, not knowing what to do with it.
Adding meal kits didn't make much difference, either. Participants who received recipes and all the ingredients needed to prepare meals didn't use a greater proportion of their produce than those who received ordinary fruit and vegetable boxes. The meal kits were also more expensive to provide.
The findings suggest that programs providing nutritious foods through doctors' offices and health care systems may need to consider more than the cost of the food itself. Transportation, mobility and convenience can determine whether people receive the assistance available to them.
There are limitations. The study was small, and researchers relied partly on participants' reports of how much food they used. They also didn't measure whether receiving the produce improved participants' overall diets or health. And because deliveries arrived automatically, it's unclear whether the higher participation resulted from home delivery, the convenience of not having to place an order or a combination of both.
Still, the results highlight a practical challenge: Providing nutritious food is one thing. Making sure people can actually get it is another.
The study was funded by the American Heart Association, with earlier planning work supported by the University at Buffalo's Civic Engagement Research Fund.