Exploring the prospective acceptability of a healthy food incentive program from the perspective of people with type 2 diabetes and experiences of household food insecurity in Alberta, Canada

Objective: FoodRx is a 12-month healthy food prescription incentive program for people with Type 2 diabetes (T2DM) and experiences of household food insecurity. In this study, we aimed to explore potential users’ prospective acceptability (acceptability prior to program use) of the design and delivery of the FoodRx incentive and identify factors influencing prospective acceptability. Design: We used a qualitative descriptive approach and purposive sampling to recruit individuals who were interested or uninterested in using the FoodRx incentive. Semi-structured interviews were guided by the Theoretical Framework of Acceptability and corresponding interview transcripts were analyzed using differential qualitative analysis guided by the socioecological model. Setting: Individuals living in Alberta, Canada. Participants: 15 adults with T2DM and experiences of household food insecurity. Results: People who were interested in using the FoodRx incentive (n=10) perceived it to be more acceptable than those who were uninterested (n=5). We identified four themes that captured factors that influenced users’ prospective acceptability: i) participants’ confidence, views, and beliefs of FoodRx design and delivery and its future use (intrapersonal), ii) the shopping routines and roles of individuals in participants’ social networks (interpersonal), iii) access to and experience with food retail outlets (community), and iv) income and food access support to cope with the cost of living (policy). Conclusion: Future healthy food prescription programs should consider how factors at all levels of the socioecological model influence program acceptability and use these data to inform program design and delivery.