The Out of the Box intervention: The complexity of family food cultures

Background: The aim of this theory-guided constructivist research was to explore factors that influence fruit and vegetable consumption in low- and high-income households (a “household” was defined as one or more individuals living together in a dwelling). This research was designed to control for availability, accessibility and affordability of fruit and vegetables in order to identify other resources households need to consume more fruit and vegetables. Primary methods: An adapted ethnographic approach was used to observe twenty households in their home environment for three months. An even number of low- and high-income households representing a range of household types were recruited from across New Zealand. Each household received a free box of fresh fruit and vegetables each week, delivered to their home, and were home-visited on two occasions each week by a researcher. Observations, discussions and interventions were documented using field notes and digital technology. The researcher responsible for data collection manually coded the expanded field notes in light of the Sustainable Livelihoods Framework to develop individual household reports. Secondary methods: For the research presented in this thesis, five low- and five high-income households with children were purposively selected from the households participating in the primary research. An inductive thematic analysis of the expanded field notes using MAXQDA software was conducted. Eating behaviour is extremely complex and a myriad of factors have been shown to affect it. This approach enabled an analysis of the everyday experiences of participating households. Results: The data was organised under five major themes to describe factors influencing fruit and vegetable consumption at a household-level: early life exposures, individualised drivers to consume fruit and vegetables, adaptations to the household’s evolving socio-cultural food environment, social connectedness, and external organisations and the built environment. This research suggests that households with children required a range of resources to consume fruit and vegetables, and financial resource was not the only resource contributing to the social gradient in healthy eating. The socio-cultural context of the home environment was central to families’ eating behaviours. Family food cultures were dynamic and resources changed over time. Even when free fruit and vegetables were delivered to the home, families required human resource (personal drivers influenced by early life exposure and household dynamics) and external social networks to make use of them. When resources were limited within a household, there was a greater dependence on external organisations. Implications: Future researchers, policy makers and practitioners attempting to improve the eating habits of low-income households need to consider the breadth of resources households need to achieve this outcome. In addition, the complexity of resource access and utilisation in an evolving home environment must be considered