Contextual Factors That Lead to Increased Accessibility and Availability of Fruit and Vegetables in Areas without a Full Grocer: Cross-Site Themes from Six Communities Putting Prevention to Work (CPPW) Healthy Corner Store Interventions (HCSI)

Introduction: Lack of access to healthy food contributes to inadequate consumption of fresh fruits and vegetables (FFV) and increased odds for obesity. The literature documents the disparity in access to healthy food, particularly in rural, low-income, and minority neighborhoods. Healthy corner store intervention (HCSI) is a strategy for increasing access to, and availability of, FFV in communities that lack access to a full grocery store (i.e., food deserts). This case study describes approaches and lessons learned from six CDC-funded programs --Communities Putting Prevention to Work (CPPW)--that addressed access to healthy foods by working with corner stores.  

Methods: Analysts reviewed secondary program sources (i.e., performance monitoring data, evaluation plans, final progress reports, and manuscripts) to describe community context, characteristics of target population, population reach, food retail capacity, intervention design, and evaluation strategies. Each program verified the accuracy of abstracted data. We then conducted semistructured telephone interviews (n=8) with the primary lead and/or evaluator of each program to fill gaps in abstracted data and assess factors that influenced planning and implementation of the intervention. The analysis of independently coded verbatim interview transcripts using NVivo 10 identified crosscutting themes and lessons learned that were organized by social marketing concepts—product, price, promotion, place, and positioning.

Results: Overall, the demographic and socioeconomic characteristics of the six case study sites were similar to the average for the 26 CPPW programs that implemented HCSIs. The sites intervened in food deserts (5 of 6, 83%) in low-income (4 of 6, 67%) and rural (2 of 6, 33%) areas. The number of corner stores ranged from 7 to 47 per site. Interviews with store owners, in-store observations using Nutrition Environment Measures Survey (NEMS) and other tools, in-store promotions, and technical assistance (TA) to store owners (i.e., produce procurement) were common cross-site components. A gap was the small proportion of WIC and SNAP certified stores, a requirement by only one site. Several facilitators, barriers, and lessons learned related to planning and implementing HCSIs emerged from the cross-site analysis.

Conclusions: Public health program staff should consider a multifaceted approach when planning and implementing a healthy corner store intervention. Although corner stores are convenient and seem to be a viable strategy in creating access to healthy foods, characteristics of the community, the store owner, and the food retail environment can influence the potential success of this strategy. Promising practices about where, how, and with whom to intervene are described.