1 Aktary ML, et al. BMJ Open 2020;10:e035143. doi:10.1136/bmjopen-2019-035143 Open access 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 Michelle L Aktary , 1 Stephanie Caron-Roy, 1 Tolulope Sajobi, 2 Heather O'Hara, 3 Peter Leblanc, 3 Sharlette Dunn, 2 Gavin R McCormack, 1,2,4 Dianne Timmins, 2 Kylie Ball, 5 Shauna Downs, 6 Leia M Minaker, 7 Candace IJ Nykiforuk, 8 Jenny Godley, 9 Katrina Milaney, 2 Bonnie Lashewicz, 2 Bonnie Fournier, 10 Charlene Elliott, 1,11 Kim D Raine, 8 Rachel JL Prowse, 8 Dana Lee Olstad 1,2 To cite: Aktary ML, Caron- Roy S, Sajobi T, et al. 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. BMJ Open 2020;10:e035143. doi:10.1136/ bmjopen-2019-035143 ► Prepublication history and additional material for this paper are available online. To view these files, please visit the journal online (http://dx.doi. org/10.1136/bmjopen-2019- 035143). Received 20 October 2019 Revised 19 February 2020 Accepted 02 April 2020 For numbered affiliations see end of article. Correspondence to Dr Dana Lee Olstad; dana.olstad@ucalgary.ca Protocol © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ABSTRACT 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. BACKGROUND Income is among the strongest determinants of diet quality 1 2 and overall health. 1 A clear socioeconomic gradient exists whereby indi- viduals with lower incomes experience higher rates of nutrition-related chronic diseases 3–5 relative to those with higher incomes. Low household income is also a key determinant of household food insecurity, 6–11 which is Strengths and limitations of this study ► This randomised controlled trial will assess the caus- al impact of a farmers’ market healthy food subsidy on the diet quality and psychosocial well-being of low-income adults and will provide evidence of the sustainability of programme impacts. ► This study will use valid measurement tools to as- sess outcomes, thus increasing accuracy of effect estimates. ► A longitudinal qualitative evaluation will explore par- ticipants’ experiences of accessing nutritious foods, perceived outcomes and how they were achieved, to inform programme improvements. ► The data are self-reported and, therefore, subject to self-reported measurement bias, and as the study is longitudinal, there is also a risk of lost to follow-up. on January 25, 2022 by guest. 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