Child as change agent. The potential of children to increase healthy food purchasing.

Shoppers make many food choices while buying groceries. Children frequently accompany caregivers, giving them the potential to influence these choices. We aimed to understand low-income shoppers' perceptions of how children influence caregivers' purchasing decisions and how the supermarket environment could be manipulated to allow children to serve as change agents for healthy food purchasing in a primarily African-American community. We conducted thirty in-depth interviews, five follow-up interviews, one supermarket walk-through interview, and four focus groups with adult supermarket shoppers who were regular caregivers for children under age 16. We conducted one focus group with supermarket employees and one in-depth interview with a supermarket manager. Qualitative data were analyzed using iterative thematic coding and memo writing. Caregivers approached grocery shopping with efforts to save money, prevent waste and purchase healthy food for their families, but described children as promoting unplanned, unhealthy food purchases. This influence was exacerbated by the supermarket environment, which participants found to promote unhealthy options and provide limited opportunities for children to interact with healthier foods. Caregivers' suggestions for promoting healthy purchasing for shoppers with children included manipulating the placement of healthy and unhealthy foods and offering opportunities for children to taste and interact with healthy options.