Understanding barriers and facilitators of fruit and vegetable consumption among a diverse multi-ethnic population in the USA.

A diet high in fruits and vegetables (F&V) has been associated with a decreased risk of certain cancers, reduced morbidity and mortality from heart disease, and enhanced weight management. Yet to date, most of the US population does not consume the recommended amount of F&V despite numerous interventions and government guidelines to promote consumption. Research has found various impediments to F&V consumption, such as high costs, an obesogenic environment and low socio-economic status. However, studies have not sufficiently focused on barriers and enablers to F&V intake among adult multi-ethnic populations. The present qualitative study examines 147 focus group participants' perceptions of impediments and enablers to F&V consumption. Twelve focus groups were conducted among African American, Hispanic and Caucasian men and women in North Carolina and Connecticut. Focus groups were audiotaped, transcribed verbatim and entered into QSR NVivo Software. Text data were systematically analyzed by investigators to identify recurrent themes both within and across groups and states. Focus group results indicate that most participants were aware of the health benefits associated with a diet rich in F&V. Yet many admitted not adhering to the Health and Human Service's recommendations. Individual impediments consisted of the high costs of F&V and a perceived lack of time. Early home food environment was perceived as affecting F&V consumption later in life. Other barriers reported were ethnic-specific. The African American participants reported limited access to fresh produce. This finding is consistent with numerous studies and must be addressed through health promotion intervention. Both the church and primary care clinics were described by African Americans as appropriate settings for health behavior interventions; these findings should be considered. Hispanic participants, mostly immigrants, cited inhibiting factors encountered in their adopted US environment. There is a need to improve the availability and access to fresh F&V commonly available in the home countries of Hispanic immigrants.