Assessment of the stage of change for increasing fruit and vegetable availability and accessibility in low-income families with preschool age children

Scope and method of study. The study utilized the Transtheoretical Model of Behavior Change to assess the psychosocial factors of decisional balance, self-efficacy and processes influencing availability and accessibility of fruit and vegetable (FV) to low-income preschool age children by their parents and caregivers (PPC). Data for the cross-sectional, quantitative study came from 238 low-income PPC of preschool age children enrolled in federal nutrition and food assistance programs. A two-stage algorithm was used for staging respondents into stages, and an eight item FV frequency survey was used to determine the availability of FV to children. Analyses of variance were used to compare differences between stages on each of the constructs and FV availability.Findings and conclusions. The findings lend evidence that low-income PPC of preschool age children were in different stages of change for increasing availability and accessibility of FV to their children. Children of PPC in preparation and action stages had significantly greater availability of whole fruit, dark green and other vegetables. Availability of 100% juice, orange and starchy vegetables was similar for all stages. PPC in preaction stages had a negative decisional balance related to cost and time to prepare FV compared to PPC in preparation and action stages. Self-efficacy, especially preparing FV acceptable to families, increased as stage and availability increased. PPC in action stages more frequently employed a variety of strategies to make FV available, particularly the behavioral process of countering by serving FV for snack instead of less nutritious foods. As such, the constructs of TTM have practical applications in nutrition education efforts aimed at increasing FV availability and accessibility in low-income households with preschool age children.