Barriers and Facilitators to Following the Dietary Guidelines for Vegetable Intake: Follow-up of an Intervention to Increase Vegetable Intake

Authors: De Leon, Angela; Jahns, Lisa; Casperson, Shanon

Submitted to: Food Quality and Preference
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/11/2020
Publication Date: 2/12/2020
Citation: De Leon, A., Jahns, L.A., Casperson, S.L. 2020. Barriers and facilitators to following the dietary guidelines for vegetable intake: Follow-up of an intervention to increase vegetable intake. Food Quality and Preference. https://doi.org/10.1016/j.foodqual.2020.103903.
DOI: https://doi.org/10.1016/j.foodqual.2020.103903

Interpretive Summary: The Dietary Guidelines for Americans recommend eating several servings of a variety of fruits and vegetables every day for optimum health. Despite these recommendations, most Americans do not eat enough vegetables to achieve health benefits. This study was conducted as a follow-up to a study during which half the participants received fresh, minimally prepared vegetables for 8 weeks. Although the participants did eat the provided vegetables during the study, follow-up revealed that their consumption of vegetables dropped back down to pre-study amounts. We invited participants from the primary study to attend a nominal group technique session during which they were asked to generate and prioritize ideas about why people do or do not eat the recommended amounts of vegetables. Barriers included time required to prepare vegetables, freshness, and knowledge of the guidelines for vegetable consumption. Facilitators to eating the recommended amounts of vegetables included convenience, availability, and knowledge. These results indicate that Americans do not have a clear idea of the recommendations and where to access that information. More importantly, the results of this study suggest that individuals do not make short term dietary decisions based on long-term health outcomes. More research into food choice behavior is necessary to achieve population-level changes to promote human health.

Technical Abstract: The 2015 Dietary Guidelines for Americans (DGA) stress the importance of a diet high in fruits and vegetables; however, despite the recommendations, adherence is low. Recently, we found that individuals consumed the recommended daily amounts of vegetables when they were provided, but returned to habitual amounts when vegetables were no longer supplied. This follow-up study aimed to identify key barriers and facilitators to vegetable consumption and to assess if barriers and facilitators differ between adults who had been provided vegetables in recommended amounts and those who had acted as controls with no vegetables provided during a randomized, controlled trial. Six nominal group technique (NGT) sessions were conducted to identify and prioritize perceived barriers and facilitators to following the DGA for vegetables. Each NGT group generated an extensive list of 22-37 different responses. Responses from all NGT sessions were aggregated and grouped into major themes. Convenience, availability, and knowledge were core facilitators in both groups, while motivation emerged as a facilitator only in the control group and cost a facilitator only in the intervention group. Prep time, freshness, and knowledge were core barriers in both groups, while availability emerged as a barrier only in the control group and social support a barrier only in the intervention group. The barriers and facilitators identified by both the intervention group and the control group from the primary study differed in relative rankings, suggesting that the experience of consuming provided vegetables influenced the strength of the perceived barriers and facilitators. The multi-factorial nature of the identified barriers and facilitators underscores the importance of addressing both individual and environmental factors in designing successful programs to increase vegetable consumption to amounts that confer health benefits.