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. 2024 Jul 27;16(15):2450. doi: 10.3390/nu16152450
Source Location/Setting, Study Period, Intervention Study Design Sample(s) Measures of Participation Assessed
Abbott 2014, “Evaluation of the Food Bank of Delaware Community Supported Agriculture (CSA) Program” [22] Wilmington, DE; 2013

Intervention
  • ~50% cost-offset CSA ($10/week full share; $5/week half share)

  • 18 week season

  • Supplemental Nutrition Assistance Program (SNAP) benefits accepted

  • Weekly newsletter with recipes and cooking demonstrations at pick-up

Qualitative analysis:
Focus groups with cost-offset CSA participants
Participant sample (n = 208)
Eligibility criteria:
  • Receive SNAP benefits


Focus group sample (n = 10)
Eligibility criteria:
  • English-speaking

  • Picked up the most shares

Satisfaction
  • Satisfaction with cost-offset CSA


Retention
  • Interest in re-enrolling

Andreatta et al., 2008, “Lessons learned from advocating CSAs for low-income and food insecure households” [11] Piedmont region of North Carolina; 2002–2003

Intervention
  • 100% cost-offset (free) CSA

  • Choice of share size from some farms

  • 20–30 week season

  • Weekly pick-up or delivery by volunteers

  • Printed information and recipes

Observational:
Summary statistics and qualitative analysis of pre- and post-season interviews with participants
Participant sample (n = 22)
Eligibility criteria:
  • Qualify for federal food assistance

  • Live within five miles of the pick-up location

  • Access to a ‘reasonably well-equipped’ kitchen

Enrollment
  • Cooking attitudes


Satisfaction
  • Satisfaction with cost-offset CSA

  • Whether cost-offset CSA met expectations

Brehm and Eisenhauer 2008, “Motivations for Participating in Community-Supported Agriculture and Their Relationship with Community Attachment and Social Capital” [37] Central Illinois and New Hampshire, 2006

CSA Member survey
  • Three CSAs in central Illinois

  • Four CSAs in New Hampshire

Observational:
Cross-sectional analysis of participant surveys, compared across household incomes
Participant sample (n = 225)
  • Lower income, <$40,000 (26%)

  • Higher income, >$40,000 (74%)

Enrollment
  • Motivation for enrollment in CSA

Cotter et al., 2017, “Low-income adults’ perceptions of farmers’ markets and community supported agriculture programmes” [29] Three affordable housing communities in Washington, DC; 2015–2016

Hypothetical CSA
Qualitative analysis:
Focus groups
Multi-lingual focus groups (n = 28)
Eligibility criteria:
  • Resident of affordable housing community

  • Speak English, Spanish or Amharic

Enrollment
  • Familiarity with CSA

  • Perceptions of hypothetical CSA

Galt et al., 2017, “What difference does income make for Community SupportedAgriculture (CSA) members in California: Comparinglower-income and higher-income households” [30] CA statewide, 2014–2015

CSA member survey
  • 41 CSAs

  • Varied operational practices

Observational:
Summary of cross-sectional survey data for low-income households (and compared to higher-income households)
CSA member sample (n = 1049)
Eligibility criteria:
  • CSA members at the time of the survey

  • Low-income households (<$50,000/year, n = 129)

  • Higher-income households (≥$50,0000/year, n = 920)

Enrollment
  • Reasons for enrolling in CSA

  • Factors influencing the decision to enroll


Satisfaction
  • Importance of CSA attributes

Garner et al., 2021, “Making community-supported agriculture accessible to low-income families: findings from the Farm Fresh Foods for Healthy Kids (F3HK) process evaluation” [23] Rural and micropolitan communities in 4 U.S. states (NY, NC, VT, and WA); 2016–2017

Intervention
  • 50% cost-offset CSA (mean payment = $13/week)

  • Choice of share size from some farms

  • Weekly pick-up (mean = 21 weeks)

  • Choice of pick-up location from some farms

  • SNAP benefits accepted

  • FV preparation classes

  • Printed information and recipes

  • Kitchen tools

Observational:
Cross-sectional analysis of
  • Applicant eligibility screening data

  • Enrollment data

  • Post-lesson surveys

Eligibility requirements:
  • Adult caregiver of a child aged 2–12 years

  • Household income ≤ 185% United States federal poverty level (FPL)

  • No CSA in at least 3 years

  • Able to speak and read English


Applicant sample (n = 548)

Intervention sample (n = 115)
Enrollment
  • Enrollment in cost-offset CSA


Engagement
  • Pick-up rate

  • Used all or most of FVs in the share

Hanson et al., 2019, “Fruit and Vegetable Preferences and Practices may Hinder Participation in Community Supported Agriculture among Low-income Rural Families” [31] Rural and micropolitan communities in 4 states (NY, NC, VT, and WA), 2015

Hypothetical CSA
Observational:
Summary of recorded FV preferences

Qualitative analysis:
Interviews
Adult Sample (n = 41, ~10 from each state)
Eligibility criteria:
  • Primary caregiver to a child aged 2–12 years

  • Household income ≤ 185% FPL

  • No CSA in the prior 3 years

  • Able to speak English


Child Sample (n = 20, ~5 from each state)
Eligibility criteria:
  • Child of adult interviewee

  • Aged 8–12 years

Enrollment
  • FV preferences

  • Knowledge, attitudes, and beliefs about participating in a hypothetical CSA

Hanson et al., 2019, “Knowledge, Attitudes, Beliefs and Behaviors Regarding Fruits and Vegetables among Cost-offset Community Supported Agriculture Applicants, Purchasers, and a Comparison Sample” [16] VT statewide and comparison group from all New England states (MA, CT, RI, VT, NH, and ME); August 2017

Cost-offset CSA member survey
  • 50% cost-offset CSAs statewide (VT)

  • Varied operational practices

Observational:
Cross-sectional comparison of online survey data from applicants and a non-applicant comparison group
Overall eligibility requirements:
  • Caregiver of a child aged 2–12 years

  • Household income ≤ 185% FPL

  • Able to speak and read English


Applicant sample (n = 64)
Applicant eligibility requirements:
  • Resided in VT

  • Applied to a cost-offset CSA program


Comparison sample (n = 105)
Comparison eligibility requirements:
  • Female

  • Resided in a New England state

  • No CSA in at least 3 years

Enrollment
  • Applied to a cost-offset CSA

  • Enrolled/purchased a cost-offset CSA

Hanson et al., 2022, “Participation in Cost-offset Community Supported Agriculture by Low-income Households in the U.S. is Associated with Community Characteristics and Operational Practices” [24] Rural and micropolitan communities in 4 U.S. states (NY, NC, VT, and WA); 2016–2017

Intervention
  • 50% cost-offset CSA (mean payment = $13/week)

  • Choice of share size from some farms

  • Weekly pick-up (mean = 21 weeks)

  • Choice of pick-up locations from some farms

  • SNAP benefits accepted

  • FV preparation classes

  • Printed information and recipes

  • Kitchen tools

Observational:
Examined differences in shares picked up (recorded in pick-up logs) by community and participant characteristics and CSA operational practices
Participant sample (n = 137)
Eligibility requirements:
  • Adult caregiver of a child aged 2–12 years

  • Household income ≤ 185% FPL

  • No CSA in at least 3 years

  • Able to speak and read English

  • 8+ participants in community

Engagement
  • % of weeks shares were picked up

Hinrichs and Kremer 2002, “Social inclusion in a Midwest
local food system project” [38]
Midwest, 1997–1998

Intervention
  • 100% or ‘partial’ cost-offset CSA

  • FV preparation classes

Observational:
  • Summary of post-intervention telephone surveys

  • Comparison of cost-offset CSA participants with full-price members

CSA participant sample (n = 41)
  • Cost-offset CSA (n = 13)

  • Full-price CSA (n = 28)

Enrollment
  • Enrollment

  • Reasons for enrolling


Satisfaction
  • Perceptions of belonging to CSA

Hoffman et al., 2012, “Farm to Family: Increasing Access to Affordable Fruits and Vegetables Among Urban Head Start Families” [17] Four Head Start centers in Boston, MA; 2010–2011

Hypothetical CSA +
Intervention
  • 67% cost-offset CSA (mean payment = $5/week)

  • Weekly pick-up at Head Start

  • SNAP benefits accepted

  • Bilingual FV education

Observational:
  • Cross-sectional summary statistics from bilingual (English and Spanish) pre-intervention surveys

  • Cross-sectional analysis of post-intervention participant surveys

Overall eligibility criteria:
  • Caregiver of a child enrolled in Head Start

  • Able to speak and read English or Spanish


Pre-intervention Survey Sample (n = 139)

Participant Sample (n = 14)
Participant eligibility criteria:
  • Enrolled in cost-offset CSA

Enrollment
  • Interest in a hypothetical CSA

Engagement
  • Share pick-up rates

Satisfaction
  • Satisfaction with cost-offset CSA

Reasons for drop-outRetention
  • Interest in re-enrolling

Izumi et al., 2018, “Feasibility of Using a Community-Supported Agriculture Program to Increase Access to and Intake of Vegetables
among Federally Qualified Health Center Patients” [25]
Federally qualified health center (FQHC), Portland, OR; 2015

Intervention
  • 75% cost-offset CSA (mean payment = $5/week)

  • Weekly pick-up at the clinic (23 weeks)

  • SNAP benefits accepted

  • Self-selected FVs

  • FV education and recipes

  • Reminders

Observational:
Cross-sectional summary of pre- and post-intervention survey data

Qualitative analysis:
Post-intervention focus groups
Participant survey sample (n = 9)
Eligibility criteria
  • FQHC clinic patient

  • Able to speak and read English or Spanish

  • No previous participation in CSA


Participant focus group sample (n = 15)
Enrollment
  • Pre-intervention self-efficacy


Satisfaction
  • Post-intervention satisfaction

Izumi et al., 2020, “CSA Partnerships for Health: outcome evaluation results from a subsidized community-supported agriculture program to connect safety-net clinic patients with farms to improve dietary behaviors, food security, and overall health” [26] Federally qualified health center (FQHC), Portland, OR; 2017

Intervention
  • 78% cost-offset CSA (mean payment = $22/month)

  • Weekly pick-up at the clinic (23 weeks)

  • SNAP benefits accepted

  • Self-selected FVs

  • FV education and recipes

  • Reminders

Observational:
Summary of pre- and post-intervention telephone and paper surveys
Participant sample (n = 48)
Eligibility criteria
  • FQHC clinic patient

  • Able to speak and read English or Spanish

Satisfaction
  • Satisfaction with cost-offset CSA


Retention
  • Interest in re-enrolling

Martin. et al., 2019, “Low-income mothers and the alternative food movement: An intersectional approach” [32] 3 North Carolina counties (1 urban and 2 rural); 2014–2015

Hypothetical CSA
Qualitative analysis:
Semi-structured interviews about a hypothetical CSA
Low-income sample (n = 83)
Eligibility criteria:
  • Mothers/grandmothers of young children

  • Low income (not defined)

  • English speaking

  • No previous participation in CSA

Enrollment
  • Familiarity with CSA

  • Perceptions of hypothetical CSA

McGuirt et al., 2018, “A Modified Choice Experiment to Examine Willingness to Participate in a Community Supported Agriculture (CSA) Program among Low-income Parents” [34] Rural and micropolitan communities in 4 U.S. states (NY, NC, VT, and WA); 2015

Hypothetical CSA
Observational:
Summary of a modified choice experiment about a hypothetical CSA (travel distance, share size, share frequency, and price) conducted during interviews

Qualitative analysis of interview comments
Sample (n = 42, ~10 from each state)
Eligibility criteria:
  • Primary caregiver to a child aged 2–12 years

  • Household income ≤ 185% FPL

  • No CSA in prior 3 years

  • Able to speak and read English

Enrollment
  • Attitudes toward hypothetical CSA

McGuirt et al., 2019, “A mixed-methods examination of the geospatial and sociodemographic context of a direct-to-consumer food system innovation” [33] Rural and micropolitan communities in 4 U.S. states (NY, NC, VT, and WA); 2016–2017

Intervention
  • 50% cost-offset CSA (mean payment =$13/week)

  • Choice of share sizes from some farms

  • Weekly pick-up (mean = 21 weeks)

  • Choice of pick-up locations from some farms

  • SNAP benefits accepted

  • FV preparation classes

  • Printed information and recipes

  • Kitchen tools

Observational:
Geospatial analysis of participants’ homes, CSA farms, and pick-up locations

Qualitative analysis:
Focus groups with participants
Geospatial data
  • Participants’ homes (n = 92)

  • CSA farms (n = 12)

  • Pick-up locations (n = 16)


Participant sample (n = 53)
Eligibility criteria:
  • Primary caregiver to child 2–12y

  • Household income ≤ 185% FPL

  • No CSA in prior 3 years

  • Able to speak and read English

Satisfaction
  • Satisfaction with pick-up location

  • Socio-demographic context of pick-up location

Quandt et al., 2013, “Feasibility of using a Community-Supported Agriculture Program to improve fruit and vegetable inventories and consumption in an underresourced urban community” [35] Forsyth County, NC; 2012

Intervention
  • 100% cost-offset CSA (free)

  • Weekly pick-up

  • FV preparation classes and recipes

Observational:
Descriptive analysis of post-intervention telephone interviews
Participant sample (n = 25)
Eligibility criteria:
  • Clients of a community action agency

  • Female

  • Head of household with 1+ children

  • Able to speak English

Satisfaction
  • Satisfaction with cost-offset CSA


Retention
  • Interest in re-enrolling

  • Willingness-to-pay for future cost-offset CSA

White et al., 2018, “The perceived influence of cost-offset community-supported agriculture on food access among low-income families” [36] Rural and micropolitan communities in 4 U.S. states (NY, NC, VT, and WA); 2016–2017

Intervention
  • 50% cost-offset CSA (mean payment =$13/week)

  • Choice of share sizes from some farms

  • Weekly pick-up (mean = 21 weeks)

  • Choice of pick-up locations from some farms

  • SNAP benefits accepted

  • FV preparation classes

  • Printed information and recipes

  • Kitchen tools

Qualitative analysis:
Post-intervention focus groups
Participant sample (n = 53)
Eligibility criteria:
  • Primary caregiver to a child aged 2–12 years

  • Household income ≤ 185% FPL

  • No CSA in the prior 3 years

  • Able to speak and read English

Satisfaction
  • Satisfaction with cost-offset CSA