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Caregiver reported experiences, barriers and facilitators related to children′s fruit and vegetable consumption in an urban head start population: A mixed−methods evaluation

Maya Venkataramani MD MPH*, Alana Ridge MPH CPH, Nadia Hansel MD MPH, Cynthia Rand PhD, Kristin A. Riekert PhD, Michelle N Eakin PhD

Background: Few young children in the United States achieve recommended intake amounts of vegetables and fresh fruits, and intake is particularly low among children in low-income families. This mixed-methods study was conducted to characterize factors impacting fruit and vegetable intake among children from low-income families attending urban Head Start programs. Methods: The study employed a mixed-methods approach involving semi-structured interviews and an eating habits survey, both which were administered via telephone to family caregivers. Participants were recruited from Head Start programs in Baltimore, Maryland, USA. Survey items were descriptively analyzed and a thematic analysis approach involving 2 investigators was used to analyze interview content. Results: 20 caregivers (all female; 90% African American) participated. Caregivers described benefits of healthy eating on child health, weight and behavior, and identified these as motivating factors to promote fruit and vegetable intake in children. Barriers to increasing intake included overcoming child food preferences and high costs associated with buying fruits and vegetables. Caregivers described that they addressed child-related barriers through various strategies, but desired to learn additional practical skills and strategies. Conclusions: Caregivers of children attending urban Head Start programs are aware of the importance of fruit and vegetable intake to child health and are motivated to employ various parenting strategies to increase intake. Children’s fruit and vegetable intake could be further improved through enhancing parenting skills around promoting fruit and vegetable intake in children and through programs that increase families’ access to affordable produce