A summary of participant self-reported demographic characteristics is presented in Table 2. Among the 29 participants, the majority were female (59%) and the majority were between 18 and 64 years of age. Approximately 55% were Black/African American, 41% White, and 3% American Indian/Alaska Native. Nearly 45% had a high school degree or less. Half of the participants (52%) were employed full-time.
Table 2 Participant Demographics among Customers of Stores in the North Carolina Healthy Food Small Retailer Program (N = 29)
Through coding, six main themes emerged from the interviews based on frequency of the code and depth of discussion. These themes included the following, in order of frequency of codes: 1) Change in food purchasing behavior; 2) Stocking suggestions for additional healthy food items; 3) Awareness of current healthy food promotion and advertising efforts; 4) Suggestions for how to promote healthy foods and beverages in the future; 5) Opinions on the NC HFSRP; and, 6) Opinions concerning NC HFSRP funding. Table 3 describes each theme and its operational description, as well as the number of interviews in which each theme is referenced, and the total number of references for each theme.
Table 3 Code, Operational Definitions, and Code Frequency for Qualitative Analysis of data collected among Customers of North Carolina Healthy Food Small Retailer Program Stores (N = 29)
Change in food purchasing behavior
Table 4 includes questions, responses, and illustrative quotes regarding NC HFSRP-related purchase and consumption changes. This theme was most frequently discussed by participants. When asked if their food and beverage purchasing behaviors at the store had changed since the NC HFSRP, 15 (52%) said “yes” they had increased healthy food purchasing. Most participants indicated they now purchased more fruits, vegetables, and whole grains than before NC HFSRP implementation. One participant even commented on a store’s locally made granola, “I do have a 15 year-old son. I would say buying this granola instead of store granola, I think this is better. And it’s trickled down to my husband and my son, and they truly like it.” [White Female, Edgecombe County]. Another commented, “usually I have to take a 30-minute ride to buy an apple. Now I can ride five minutes up the road and buy one.” [White Male, Halifax County]. Importantly, having the convenience of purchasing healthier items appeared to be connected with increased purchases. Overall, participants reported that having healthier items at the corner store closer to their home saved them from having to drive further distances to grocery stores, supermarkets, or supercenters to get fresh produce or a variety of healthy food items.
Table 4 Changes in Food Purchasing and Consumption Behavior among Customers in North Carolina Healthy Food Small Retailer Program Stores (n = 29 customers in 5 stores)
When asked if the overall amount of healthy food or beverage items they purchased from the store changed since the NC HFSRP, 15 (52%) participants reported that the amount had increased, 10 (34%) stated it stayed the same, and 4 (14%) had no response or were not asked the question. A participant remarked that now they put more thought into their food and beverage purchases: “… I used to be just a straight junk food kid, but now I try to balance it out.” [Black/African American Male, Onslow County]. Many participants discussed purchasing healthier foods and beverages from the store for family members, friends, and even co-workers. For example, when asked if her purchasing habits had changed, one mother said, “I noticed today when I came in that they [the store] had bananas on the rack, so we ended up grabbing one of those. My daughter loves fruits so if those are available at a gas station, we buy those.” [White Female, Bertie County]. Others noticed the healthier options in the store but had opted not to buy them.
In terms of food or beverage consumption changes since the NC HFSRP, participants were asked if the healthy food items they purchased in the store were in addition to the items they would normally buy or if they were purchasing healthier food and beverages instead of less healthy food options. Among the 27 participants who responded to this question, 12 (41%) indicated that they were purchasing healthy food in addition to their regular purchases (healthy food complements to existing purchases). An additional eight respondents (28%) indicated that they were purchasing healthier food instead of less healthy food (substituting healthier foods for less healthy food), and seven (24%) were not sure of the impact the healthy foods on their shopping habits. One participant responded he bought healthier food in addition to his regular store purchases, stating: “This is one of the few places in [town name] that at least gives you the healthier options.” [White Male, Edgecombe County]. One caregiver commented that she was buying healthy food in lieu of unhealthy food for her daughter: “Instead of getting her a piece of pizza, I bought her two bananas. She loves bananas.” [White Female, Bertie County].
Stocking suggestions for additional healthy food items
Across the interviews, participants offered 43 suggestions concerning what healthy food or beverage items they would like to see added to their store’s inventory. Fruits were the most popular response (n = 16); specific suggestions included fruit cocktail, apples, oranges, grapes, and plums. Other suggestions included vegetables (n = 3) and pre-made salads (n = 3).
Awareness of current healthy food promotion and advertising efforts
When asked if participants noticed any changes to the ways the store promoted healthier food and beverages over the past few months, 17 of 29 participants said “yes.” When asked what they had noticed, most noted increased quantity and variety of produce, signs and other promotional materials related to healthy foods, and new equipment. As one participant said, “They’ve added these fruits and veggies, and they have really cool alternative drinks to soda.” [White Male, Edgecombe County]. Another participant noticed the store started accepting federal food assistance benefits, the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as “food stamps”: “They even do the EBT (SNAP Electronic Benefit Transfer). They do that, which I think is really nice, because a lot of the organic kind of places aren’t really geared toward that. And … we’re a very poor community, and I think it’s awesome that she [the store owner] does this.” [White Female, Edgecombe County]. Some participants recalled seeing free recipe cards associated with healthy food items sold at the store, as well as promotional signs: “Advertising’s always the key to anything and what she [the store owner] started doing now with the signs, that makes a big difference. People have to know what you have to be able to come get it.” [Black/African American Male, Pasquotank County].
Suggestions for how to promote healthy foods and beverages in the future
Multiple suggestions were offered regarding additional approaches stores could use to promote healthy items. Many people suggested advertising via social media and at community functions. As one participant said, “… you just have to advertise that a little bit more so people know exactly what’s in here ….” [Black/African American Female, Pasquotank County]. Another participant suggested more outdoor advertising so people driving by could see what was available in the store. Additionally, several participants discussed wanting more nutrition information regarding specific food and beverages: “Put the little signs that it breaks down the calories and the nutrients, or what fruit has vitamin C in it or what had vitamin D in it. Just have one of those charts up.” [Black/African American Male, Onslow County].
Opinions on the NC healthy food small retailer program
While participants recognized healthy changes in the stores, among the 29 participants, only three were aware of the NC HFSRP. After explaining the premise of the program, all 29 participants agreed it was a program that could provide benefits to the community. In addition, several participants noted the program could benefit youth in their (rural) communities since they often purchase items from these stores. As one participant commented:
“I think it’s good because you got kids, little kids that come here. You know and they want stuff. And before it was like just a lot of junk food, but now, you’ve got healthy stuff like vegetables and fruits that are constantly being changed out now. This is perfect because my friend, she lives across the road. She’s got kids and they always say, ‘I want junk food.’ But now I can go, ‘Hey, instead of junk food, how about an apple?’” [White Male, Pasquotank County].
Multiple participants liked the goal of improving healthy options in their rural area. One woman who said the program was “awesome” went on to say, “In these types of neighborhoods, if you put a store with fresh fruits and have different variety … like a lot of people don’t have a car.” [Black/African American Female, Pasquotank County]. Another commented that for rural communities, this program is important for healthy food access: “… because I like to eat the vegetables and have fruit. Then I won’t have to go all the way to town. I can just come right here and get it.” [Black/African American Female, Bertie County]. Lastly, many participants discussed health issues. When one participant was asked what influenced her to buy healthy food/beverages, she said, “That everybody in my family got high blood pressure … My mom had it. My dad. I got three brothers living. I got a son. Two nephews. Yes. It’s there.” [Black/African American Female, Bertie County]. Participants noted the healthier options facilitated a healthier lifestyle that was important to prevent or ameliorate diet-related chronic diseases.
Opinions concerning NC HFSRP funding
While most participants had never heard of the NC HFSRP, when asked if the NC Legislature should continue funding it, all responded “yes”. Some explained their reasoning by stating it helped increase rural food access and it was good for health: “I hope they will [fund it]. It would help us a lot. Living out here in the county, you can’t always go to the store. Having stuff like this is helping us and everybody else too.” [Black/African American Female, Halifax County]. Another commented, “I feel like if that’s going to be a program that’s going to help people, especially when it comes to health and then trying to actually put food in someone’s home, then yeah, I feel like they should definitely fund that.” [Black/African American Male, Onslow County]. Another participant focused on program efficacy, stating, “If it’s working or if it’s profitable, you know, doing what it’s supposed to do, and the funds are actually going where they should go. Yeah [the legislature should fund it].” [White Male, Onslow County].
