• Alicia J Cohen, Kelsie E Oatmen, Michele Heisler, Oran B Hesterman, Ellen C Murphy, Suzanna M Zick, and Caroline R Richardson.
• Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan. Electronic address: calicia@umich.edu.
• Am J Prev Med. 2019 Apr 1; 56 (4): 571-579.

IntroductionHealthy food incentives matching Supplemental Nutrition Assistance Program (SNAP) benefits spent on fruits and vegetables subsidize increased produce consumption among low-income individuals at risk for food insecurity and diet-related disease. Yet many eligible participants do not use these incentives, in part because of limited awareness. This study examined the acceptability and impact of a primary care-based informational intervention on facilitators and barriers to use of the statewide SNAP incentive program Double Up Food Bucks.MethodsFocus groups (n=5) were conducted April-June 2015 among a purposive sample (n=26) of SNAP-enrolled adults from a Michigan health clinic serving low-income patients. All had participated in a waiting room-based informational intervention about Double Up Food Bucks; none had used Double Up Food Bucks before the intervention. Groups were stratified by Double Up Food Bucks use/non-use during the 6-month intervention period. Results were analyzed in 2016-2017 through an iterative content analysis process.ResultsParticipants reported the waiting room intervention was acceptable and a key facilitator of first-time Double Up Food Bucks use. Motivators for Double Up Food Bucks use included (1) eating more healthfully, (2) stretching SNAP benefits, (3) higher-quality produce at markets, and (4) unique market environments. Remaining barriers included (1) lack of transportation, (2) limited market locations/hours, and (3) persistent confusion among a small number of participants regarding incentive use.ConclusionsLow-income patients who received an informational intervention about Double Up Food Bucks reported numerous benefits from participation. Yet barriers remained for a subset of patients. Improving geographic accessibility and ease of SNAP incentive redemption may further improve dietary quality and food security among vulnerable populations.Published by Elsevier Inc.

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