The dynamics in food selection stemming from price awareness and perceived income adequacy: a cross-sectional study using 1-year loyalty card data.

BACKGROUND: Higher cost of healthy foods may explain unhealthy dietary patterns in lower-income households. Unfortunately, combining food selection and nutrient intake data to price and expenditure is challenging. Food retailer's customer loyalty card data, linked to nutrient composition database, is a novel method for simultaneous exploration of food purchases, price, and nutrition. OBJECTIVES: We studied the associations between perceived income adequacy (PIA) as a grouping variable with price (per kilogram or megajoule) and the volume of purchases (percentage of expenditure or energy) simultaneously as outcome variables for 17 most purchased food groups. METHODS: We used 1-year (2018) loyalty card data from the largest grocery chain in Finland. Participants were 28,783 loyalty cardholders who made ≥41% of food purchases from the retailer and answered an online questionnaire at the midpoint of data collection. The 5-level PIA described the perceived financial situation in the household. Energy and nutrient content of foods purchased were from the Finnish Food Composition Database Fineli. We calculated the Nutrient Rich Food Index per 100 g food using 11 nutrients. Trends in prices and expenditures between PIA levels were analyzed using 2-sided Jonckheere-Terpstra tests, with false discovery rate control (Benjamini-Hochberg method) and confounder adjustments (inverse probability weighting). RESULTS: Lower PIA participants selected cheaper foods per kilogram and megajoule within most food groups. They also favored unhealthy food groups cheap in energy [<1 € (USD 1.18)/MJ]. Despite lower purchase price, the expenditure (%) among lower PIA was higher on alcohol, snacks, sugar-sweetened beverages, and sweets and chocolates. CONCLUSIONS: Participants with lower PIA showed stronger price awareness. It is crucial to consider the pricing of competing alternative food groups, when steering toward environmentally sustainable and healthier food purchases. Package labeling might also direct the selection of healthier choices among the less expensive items within a food group.

Exploring Pathways of Socioeconomic Inequity in Vegetable Expenditure Among Consumers Participating in a Grocery Loyalty Program in Quebec, Canada, 2015-2017.

Vegetable consumption remains consistently low despite supportive policy and investments across the world. Vegetables are available in great variety, ranging in their processing level, availability, cost, and arguably, nutritional value. A retrospective longitudinal study was conducted in Quebec, Canada to explore pathways of socioeconomic inequity in vegetable expenditure. Data was obtained for consumers who participated in a grocery loyalty program from 2015 to 2017 and linked to the 2016 Canadian census. Vegetable expenditure share (%) was examined as a fraction of the overall food basket and segmented by processing level. Panel random effects and tobit models were used overall and to estimate the stratified analysis by median income split. Consumers allocated 8.35% of their total food expenditure to vegetables, which was mostly allocated to non-processed fresh (6.88%). Vegetable expenditure share was the highest in early winter and lowest in late summer. In the stratified analysis, the low-income group exhibited less seasonal variation, allocated less to fresh vegetables, and spent more on canned and frozen compared to the high-income group. Measures of socioeconomic status were all significant drivers of overall vegetable consumption. Consumers with high post-secondary education in the low-income group spent 2% more on vegetables than those with low education. The complexity of observed expenditure patterns points to a need for more specific vegetable consumption guidelines that include provisions by processing level. Implications for education, marketing, intersectional policies, and the role of government are discussed. Governments can scale present efforts and catalyze health-promoting investments across local, state, national, and global food systems.

Tracing the Single and Combined Contributions of Home-Grown Supply and Health Literacy on Fruit and Vegetable Consumption: An Empirical Exploration in Rural India.

Low fruit and vegetable consumption (FVC) remains a global health challenge. Fostering subsistence agriculture through the production and home-grown consumption (HGC) of fruits and vegetables are seen as potential strategies for improving overall FVC, in particular, for developing countries like India. In addition, educational strategies targeting FVC health literacy are also used. Little evidence has documented a connection between these two strategies. We examine the single and combined influence of HGC and health literacy with regard to benefits from fruits and vegetable consumption. Data were collected from 427 rural households in the state of Odisha, India. Three outcomes were examined: FVC, as well as fruit and vegetables separately. Linear and Poisson regression were used to examine the association among home-grown consumption (HGC), FVC health literacy, and the FVC outcomes. Findings show that HGC, but not FVC health literacy, was directly associated with FVC (ß = 0.65, SE = 0.10, p = 0.008) and vegetable consumption (ß = 0.57, SE = 0.11, p = 0.02). However, both HGC (ß = 0.58, SE = 0.05, p < 0.01) and FVC health literacy (ß = -0.07, SE = 0.02, p = 0.001) were associated with fruit consumption. In addition, HGC effect is concentrated among participants who reported low FVC health literacy, especially on overall FVC and vegetables alone. Results are discussed in relation to the beneficial role played by HGC in those particularly vulnerable households who perceived little FVC health literacy. Our results provide insights on novel improved FVC consumption across all population segments. Future research should explore the complex interplay between agricultural policies and educational programs in the design of interventions promoting fruit and vegetable production and consumption.

Review of cognitive behavioural therapy mobile apps using a reference architecture embedded in the patient-provider relationship.

BACKGROUND: Mobile health apps (mHealth apps) are increasing in popularity and utility for the management of many chronic diseases. Although the current reimbursement structure for mHealth apps is lagging behind the rapidly improving functionality, more clinicians will begin to recommend these apps as they prove their clinical worth. Payors such as the government or private insurance companies will start to reimburse for the use of these technologies, especially if they add value to patients by providing timely support, a more streamlined patient experience, and greater patient convenience. Payors are likely to see benefits for providers, as these apps could help increase productivity between in-office encounters without having to resort to expensive in-person visits when patients are having trouble managing their disease. KEY FINDINGS: To guide and perhaps speed up adoption of mHealth apps by patients and providers, analysis and evaluation of existing apps needs to be carried out and more feedback must be provided to app developers. In this paper, an evaluation of 35 mHealth apps claiming to provide cognitive behavioural therapy was conducted to assess the quality of the patient-provider relationship and evidence-based practices embedded in these apps. The mean score across the apps was 4.9 out of 20 functional criteria all of which were identified as important to the patient-provider relationship. The median score was 5 out of these 20 functional criteria. CONCLUSION: Overall, the apps reviewed were mostly stand-alone apps that do not enhance the patient-provider relationship, improve patient accountability or help providers support patients more effectively between visits. Large improvements in patient experience and provider productivity can be made through enhanced integration of mHealth apps into the healthcare system.