Qualitative Perspectives from African American Adults with CKD on Community-Based Fruit and Vegetable Promotion

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Abstract
Key Points: Social cognitive theory guided identification of facilitators & barriers to increase fruit & vegetable intake in African American persons with CKD. This study found that ongoing social determinants such as access to healthy foods and costs continue after study support is removed. Community health workers were a source of social support and encouragement that improved motivation for healthy eating and study participation. Background: CKD disproportionately affects African American persons with incidence rates 2–4 times that of White persons. Structural inequities such as limited access to healthy foods and lower socioeconomic status might be contributing factors. The Fruits and Vegetables for Kidney Health Study was a randomized controlled trial in African American persons with CKD that demonstrated reductions in urine albumin-to-creatinine ratio when participants were given free fruits and vegetables (FV) over 6 months with or without a 6-week cooking class. This qualitative study aimed to understand participant experiences in each group, using social cognitive theory to identify program components that contributed to FV intake and can inform future interventions. Methods: Focus groups were held virtually and in-person. Focus group questions were informed by Social Cognitive Theory to evaluate study participation, changes to self-efficacy, barriers, and benefits to individual and community-level FV intake. An applied thematic analysis approach was used for data analysis with trained staff using MAXQDA. Results: Six focus groups were conducted ( N =40; 100% African American persons, mean age 63 years, 83% female, 58% with annual income <$25,000). Primary themes included ( 1 ) study participation empowered participants to change food-related behaviors; ( 2 ) care and accountability from staff positively influenced participant engagement; ( 3 ) barriers affect the sustainability of recently acquired skills and health habits; and ( 4 ) enhance program reach through intergenerational social connections and social media. Conclusions: Access to both FV alone and with cooking classes had positive effects on reported FV intake, although cooking class participants reported greater benefits. Sustainability of changes, particularly after access to free produce ends, remains challenging. Participants indicated that integrating community health workers and staff skilled in diverse populations promoted participant trust and long-term engagement. Finally, expanding intervention targets to include family and social media could further enhance reach and support for kidney health promoting foods.
Funding Information
  • National Institute of Diabetes and Digestive and Kidney Diseases (R21DK113440)

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