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Impact of a farmers’ market nutrition coupon programme on diet quality and psychosocial well-being among low-income adults: protocol for a randomised controlled trial and a longitudinal qualitative investigation
  1. Michelle L Aktary1,
  2. Stephanie Caron-Roy1,
  3. Tolulope Sajobi2,
  4. Heather O'Hara3,
  5. Peter Leblanc3,
  6. Sharlette Dunn2,
  7. Gavin R McCormack1,2,4,
  8. Dianne Timmins2,
  9. Kylie Ball5,
  10. Shauna Downs6,
  11. Leia M Minaker7,
  12. Candace IJ Nykiforuk8,
  13. Jenny Godley9,
  14. Katrina Milaney2,
  15. Bonnie Lashewicz2,
  16. Bonnie Fournier10,
  17. Charlene Elliott1,11,
  18. Kim D Raine8,
  19. Rachel JL Prowse8,
  20. Dana Lee Olstad1,2
  1. 1Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
  2. 2Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
  3. 3British Columbia Association of Farmers' Markets, Vancouver, British Columbia, Canada
  4. 4School of Architecture, Planning and Landscape, University of Calgary, Calgary, Alberta, Canada
  5. 5Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Victoria, Australia
  6. 6School of Public Health, Rutgers University, Newark, New Jersey, USA
  7. 7School of Planning, University of Waterloo, Waterloo, Ontario, Canada
  8. 8School of Public Health, University of Alberta, Edmonton, Alberta, Canada
  9. 9Department of Sociology, University of Calgary, Calgary, Alberta, Canada
  10. 10School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
  11. 11Department of Communication Media and Film, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Dana Lee Olstad; dana.olstad{at}


Introduction Low-income populations have poorer diet quality and lower psychosocial well-being than their higher-income counterparts. These inequities increase the burden of chronic disease in low-income populations. Farmers’ market subsidies may improve diet quality and psychosocial well-being among low-income populations. In Canada, the British Columbia (BC) Farmers’ Market Nutrition Coupon Programme (FMNCP) aims to improve dietary patterns and health among low-income participants by providing coupons to purchase healthy foods from farmers’ markets. This study will assess the impact of the BC FMNCP on the diet quality and psychosocial well-being of low-income adults and explore mechanisms of programme impacts.

Methods and analysis In a parallel group randomised controlled trial, low-income adults will be randomised to an FMNCP intervention (n=132) or a no-intervention control group (n=132). The FMNCP group will receive 16 coupon sheets valued at CAD$21/sheet over 10–15 weeks to purchase fruits, vegetables, dairy, meat/poultry/fish, eggs, nuts and herbs at farmers’ markets and will be invited to participate in nutrition skill-building activities. Overall diet quality (primary outcome), diet quality subscores, mental well-being, sense of community, food insecurity and malnutrition risk (secondary outcomes) will be assessed at baseline, immediately post-intervention and 16 weeks post-intervention. Dietary intake will be assessed using the Automated Self-Administered 24-hour Dietary Recall. Diet quality will be calculated using the Healthy Eating Index-2015. Repeated measures mixed-effect regression will assess differences in outcomes between groups from baseline to 16 weeks post-intervention. Furthermore, 25–30 participants will partake in semi-structured interviews during and 5 weeks after programme completion to explore participants’ experiences with and perceived outcomes from the programme.

Ethics and dissemination Ethical approval was obtained from the University of Calgary Conjoint Health Research Ethics Board, Rutgers University Ethics and Compliance, and University of Waterloo Office of Research Ethics. Findings will be disseminated through policy briefs, conference presentations and peer-reviewed publications.

Trial registration number NCT03952338.

  • public health
  • qualitative research
  • health policy
  • nutrition & dietetics

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  • Contributors MLA, SC-R and DLO wrote the manuscript. DLO and HO obtained funding. All authors (MLA, SC-R, DLO, TS, HO, PL, SD, GRM, DT, KB, SD, LM, CN, JG, KM, BL, BF, CE, KDR and RJLP) contributed to study design and read and approved the final manuscript.

  • Funding This work is funded by the Canadian Institutes of Health Research (funding reference number 155916) and the Canadian Foundation for Dietetic Research.

  • Competing interests HO is the Executive Director of the British Columbia Association of Farmers' Markets. PL is the Programme Manager for the British Columbia Farmers’ Market Nutrition Coupon Programme. DT is employed by Abbott Nutrition.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the University of Calgary Conjoint Health Research Ethics Board (REB18-0508), University Ethics and Compliance from Rutgers University (FWA00003913), and the Office of Research Ethics from the University of Waterloo (ORE #40724).

  • Provenance and peer review Not commissioned; externally peer reviewed.