Evaluation of the Feasibility and Construct Validity of a Novel Method to Measure Household Fruit and Vegetable Procurement in Low-Income Community Settings

Background: Many interventions focus on improving fruit and vegetable (F/V) procurement for those experiencing low incomes or food insecurity. To address current F/V procurement measurement limitations, a novel F/V procurement tool was developed. Objective: The main objectives are to describe the tool and evaluate the tool's feasibility and construct validity. Design: This cross-sectional study used baseline data from the ongoing Mobile Food Market Cluster Randomized Trial, conducted in the Twin Cities metropolitan area of Minnesota. Participants/setting: During 2023, participants (mean age = 64 years) residing in subsidized housing completed surveys and three 24-hour dietary recalls, and they recorded 4 weeks of F/V procurement using a novel tool submitted weekly by mail. The tool captured F/V items and amounts procured for the home from any type of procurement location, including food pantries. For inclusion in analysis, Wave 1 and 2 trial participants (N = 161) must have completed at least 3 of 4 F/V procurement booklets; 87% (n = 140) met this threshold. Main outcome measures: Main outcomes were Healthy Eating Index-2020 score, Healthy Eating Index-2020 Total Fruit and Total Vegetable component scores, and daily F/V servings consumed. Statistical analyses performed: Descriptive statistics assessed feasibility data (eg, booklet completion rates) and F/V servings by location/source data. The F/V procurement tool's construct validity was assessed with adjusted linear models testing associations between average weekly servings procured of F/V combined, fruit only, and vegetables only, and dietary and survey measures. Results: On average, 58% of weekly F/V servings procured were from a supermarket and 19% from a food pantry. In adjusted models, each 10-serving increase in F/V procurement was significantly associated with a higher Healthy Eating Index-2020 score by 1.8 points (95% CI, 0.6 to 2.9), Healthy Eating Index-2020 Total Fruit component score by 0.2 points (95% CI, 0.1 to 0.4), and daily F/V intake by 0.2 servings (95% CI, 0.1 to 0.3). No other measures were significantly associated with F/V servings procured. Conclusions: This novel F/V procurement tool may be a feasible method for comprehensively measuring various ways F/V enter households. Construct validity was observed for most diet quality and dietary intake measures examined.