Table 4.
Perceptions of Formative Assessment Participants (n = 32) on Quality, Variety, and Affordability of Fruits and Vegetables by Environmental Factors and Influence (Barriers or Facilitators) on Dietary Behavior, a North Carolina Family Medicine Research Network Study, 2004
| Perception | Sample Quotationa | Applicable Environmental Factorsb | Enablers of Choicec | Effectd |
|---|---|---|---|---|
| Factors associated with aging hinder intake of fruits and vegetables. | "I guess to be very honest with you, teeth — that's the hardest part, things I used to eat when I was younger like apples and things like that, I can't eat. It's a little more difficult with false teeth." (KI1552) | Physiology (physical health), genetics, life stage | Situation or context | Barrier |
| Current chronic disease status can hinder intake of fruits. | "Well, when my tomatoes is coming in I was eating tomatoes. As far as fruits go, most of them I eat come in the can, but I've sort of backed away from sugar and they put sugar and syrup and all that in the fruits now. So I had to back off of them." (KI2305) | Physiology (physical health), genetics | Knowledge, safety, source of information, food industry | Barrier |
| Current chronic disease status can promote intake of fruits and vegetables. | "Well, because I'm diabetic, I keep a food diary of everything I eat, which helps a little bit with keeping the calorie count of what I eat .... We try to, we eat fruits and vegetables, we eat quite a few vegetables and try to stay away from the red meat." (KI I552) | Physiology | Knowledge, health care providers, health care industry | Facilitator |
| Early childhood exposure to vegetables promotes continued preference for and consumption of fruits and vegetables. | "To me, a well-balanced diet was something I grew up with, and we still have that even though it's just the 2 of us. We have a salad almost every day, we have a hot vegetable, [and] we have our starch and our protein." (FG-H) | Pleasures, self-identities, habits, values, life experience | Situation or context | Facilitator |
| Fatigue of taste buds and conditioning of palate limits consumption of fruits and vegetables. | "To keep from eating the same vegetable all the time, sometime I choose not to eat any at all. So that's what keeps me from eating vegetables all that much, I don't like a wide variety of them like I do the fruit." (KI3201) | Pleasures | Habits | Barrier |
| Work-related stress promotes unhealthy eating patterns. | "It definitely impacts my eating habits. Through stress and stress eating and through, I guess, sort of how much I work in terms of getting off late and being tired and not having time to fix a fresh, healthy dinner." (KI2882) | Hierarchy of needs, social roles, life stage, interpersonal relationships, socioeconomic status | Knowledge, situation or context | Barrier |
| Lack of forethought and inadequate planning and preparation decreases consumption of fruits and vegetables in daily diet. | "Definitely. The fruits are a real struggle for me because I'm not one to prepare fruit. Like I hate peeling oranges and things like that." (KI2882) | Hierarchy of needs, habits | Knowledge, time | Barrier |
| Laziness affects daily intake of fruits and vegetables. | "And, to me, I'll just eat more of one thing than try to fix a variety of vegetables, because I'm worth it, but don't think it's worth the time." (FG-D) | Values, beliefs | Knowledge, convenience | Barrier |
| Easy access to fast-food restaurants affects nutrition behavior. | "Why would they want to cook when you have every fast food restaurant possible within a quarter mile of each other? They have no incentive to cook." (FG-AP) | Restaurants and food outlets, life stage, values | Accessibility, convenience | Barrier |
| Fast food is a necessity when people are busy. | "A lot of people do fast food because it's fast and because people are busy, and because they're working and because you're going here [and] there." (FG-B) | Restaurants and food outlets, life stage, beliefs, values | Time, cost, social trends, accessibility, convenience | Barrier |
| Impact of food on disease symptoms influences intake. | "Yeah. Cause I think steak makes my hand hurt worse. I think it do. And pizza." (FG-BP) | Physiology | Knowledge, safety, source of information | Barrier |
| Spouses are a positive influence on intake of fruits and vegetables. | "Yeah, we try to eat as healthy as we can. My wife especially likes to eat healthy. She cooks right many vegetables." (KI4141) | Self-identities, interpersonal relationships | Situation or context | Facilitator |
| Personal value of cooking at home compared to eating out affects intake. | "I cook because I buy groceries .... I don't eat out. A lot of times people say, come on, let's eat out, but I say no, I've already bought my groceries, so I cook ... from scratch." (FG-AP) | Values, habits, interpersonal relationships, social roles | Time, cost, knowledge | Facilitator |
| Benefits and costs of maintaining a garden compared to purchasing at food stands affects intake of fruits and vegetables. | "I had 2 gardens, but I gave it up because it wasn't worth the effort for just me and my husband. These farms selling vegetables, I go down and pick 'em." (FG-AP) | Values, social roles, life stage | Accessibility, cost, time, convenience | Facilitator and barrier |
| Perceived food safety risks such as antibiotics and pesticides in foods influence consumption decisions. | "And if you get meat that don't have hormones in them or antibiotics or anything like that, they are much higher." (FG-D) | Hierarchy of needs, physiology, values, beliefs | Knowledge, source of information, safety, social trends, cost | Barrier |
| Inconsistency in media messages and contradictions in health professionals' opinions affect choices and intake. | "Year ago they tried to tell you that the margarine was better for you, now they're back ... they can't decide .... Yeah, one year eggs is terrible for you. The next year they're telling you to eat as many as you can." (FG-AP) | Health care industry, information industry, health care providers, food industry | Knowledge, source of information, safety, social trends | Barrier |
| Inflexible work schedules promote poor dietary habits. | "When you teach at school, you don't have a choice of going out to lunch. So that was not good for my health because when the kids left at 3 o'clock, I was starving and would eat whatever." (FG-D) | Workplace, local school | Time, accessibility, convenience | Barrier |
| For employed workers, food options at worksites influence intake. | "We have a kitchen where you can prepare your food and where they provide snack[s] for you .... Yeah, like cakes ... but it would be like cakes, cookies, pies, homemade stuff like." (KI2780) | Community, workplace | Accessibility, convenience | Barrier |
| Lack of finances affects purchasing of fruits and vegetables. | "Well, in my case, it would be finances." (KI3559) | Socioeconomic status | Cost | Barrier |
| Lack of transportation decreases access to fruit and vegetables. | "And of course if you don't have a car, it's very difficult or if you're not driving to get out to the fruit stands and the vegetable stands." (FG-H) | Socioeconomic status | Cost, time, accessibility, situation or context | Barrier |
| Prices at farmers' market are lower and therefore influence purchase of fruits and vegetables. | "You can get good prices at the fruit stand." (FG-AP) | Food stores, farmers' market | Accessibility, seasonality, cost, socioeconomic status | Facilitator |
| Fatigue and long work hours hinder healthy nutrition behavior. | "Because you can't eat but at certain times. Most of the time by the time you eat, you have to go to bed. And it kind of messes you up trying to eat and go to sleep. Makes you gain weight." (KI3173) | Hierarchy of needs, physiology, home | Social roles, life stage, socioeconomic status, time | Barrier |
| Variability in (shift) work schedules alters eating patterns. | "Oh yeah, well, there were occasions when you normally take a lunch break, but you couldn't ... You had to wait until a later time ... your schedule. It would just steadily change." (KI3559) | Life stage, social role, workplace, community | Time, situation or context | Barrier |
| Economic constraints resulting from chronic disease status negatively influence purchase and intake of fruits and vegetables. | "Another problem that we have since we're both disabled, we live on a limited income so you can't always get what you need." (FG-H) | Socioeconomic status, local government, (national) government | Cost, accessibility | Barrier |
| Low personal income status affects intake of fresh fruits and vegetables. | "The only thing that makes it hard is money wise." (KI3720) | Socioeconomic status | Cost, knowledge | Barrier |
| Healthy foods are expensive. | "The reason I laugh is because the healthy food is expensive. It's all junk food that is reasonably priced. But most of the healthy food is very expensive." (KI3720) | Food stores, food industry | Cost, knowledge | Barrier |
a
Excerpted quotes from focus group (FG) and key informant (KI) or individual interview transcripts.
b
Environmental factors from the framework by Booth et al (11), which are evidenced by the quotation.
c
Applicable enablers identified from the framework.
d
Impact of the reported perception on intake.