Formative Activities in Support of an Evaluation of the New York City Health Bucks Program

Background: Limited access to healthful foods may contribute to higher obesity rates in underserved urban areas. To increase access to and purchase of fresh fruits and vegetables in three underserved New York City neighborhoods, the Health Bucks program distributes coupons for the purchase of fresh fruits and vegetables at farmers' markets. SNAP participants receive one $2 coupon for every $5 in benefits spent at participating markets. Additionally, local neighborhood community organizations distribute coupons to clients. We conducted formative evaluation activities to inform a process and outcome evaluation of the Health Bucks program. Methodology: Document review, administrative data analysis, informant interviews, and site visits supported development of (1) a program logic model and narrative description; and (2) process and outcome evaluation plans, including focus group guides and survey instruments. Results: Health Bucks intends to influence individual-level outcomes by increasing consumer purchases of healthful foods, and community/systems-level outcomes by improving farmers' market access and community partnerships. Participating markets vary considerably in volume of SNAP purchases. Community organizations are key facilitators of Health Bucks access and consumer education. Discussion: Findings suggest that multiple partnerships between city and public health departments, community organizations, and farmers' markets support program success. Farmers' market staff training and additional outreach/education for consumers may increase appropriate use of Health Bucks. Process and outcome evaluations will describe factors influencing successful program implementation and outcomes at the individual and community/systems levels. Results will support ongoing development of the Health Bucks program and inform other localities considering similar access initiatives.