Reducing hypertension with adults experiencing food insecurity in low-income communities: Identifying intervention strategies and facilitators/barriers

Uncontrolled blood pressure (BP) is a major risk factor of cardiovascular diseases, which is the lead­ing cause of premature deaths in the U.S. Treat­ment recommendations include increasing the con­sumption of fruits and vegetables. Individuals in impoverished areas encounter barriers to eating healthy including food insecurity, limited resources and access to fresh foods, and gaps in nutrition knowledge and skills. To improve cardiovascular health for individuals experiencing food insecurity, we sought a community’s preferences for, and per­ceived facilitators/barriers to, two categories of evidenced–based implementation strategies that increase fruit/vegetable intake and decrease BP. Participants with hypertension and food insecurity (N = 32) were recruited from Florida urban zip codes with higher rates of poverty and food insecu­rity than state and national averages. Five focus groups captured perceptions of three community health worker-led educational services (motiva­tional education session, federal food benefits, local food pantries and events) and five personal­ized services (in-store education, online recipes, online cooking videos, online cooking classes, transporta­tion). Thematic analyses captured prefer­ences and uptake facilitators/barriers. Participants supported all educational services, particularly the motiva­tional education, noting two facilitators to uptake: opportunity to learn and quality of life improve­ment. They also described access as a barrier to fed­eral food benefits indicating a need for registration assis­tance. They noted two barriers to using food pan­tries and events: lack of healthy food options and an increased feeling of vulnerability (also a barrier to using in-store education). Regarding personalized ser­vices, they preferred recipes and cooking videos (perceived as feasible opportunities to learn) and trans­portation (reduces burden). Barriers to online person­alized services included technology and inconvenience. Community input on implementation strategies among adults experiencing food insecurity demonstrated acceptability of educational and personalized services to increase fresh food access. Strategies that promote learning opportunities and feasibility, while protecting social dignity, are preferred.