abstract: 'Background: Good nutrition is important during pregnancy, breastfeeding

  and early life to optimise the health of women and children. It is

  difficult for low-income families to prioritise spending on healthy

  food. Healthy Start is a targeted United Kingdom (UK) food subsidy

  programme that gives vouchers for fruit, vegetables, milk, and vitamins

  to low-income families. This paper reports an evaluation of Healthy

  Start from the perspectives of women and health practitioners.

  Methods: The multi-method study conducted in England in 2011/2012

  included focus group discussions with 49 health practitioners, an online

  consultation with 620 health and social care practitioners, service

  managers, commissioners, and user and advocacy groups, and qualitative

  participatory workshops with 85 low-income women. Additional focus group

  discussions and telephone interviews included the views of 25 women who

  did not speak English and three women from Traveller communities.

  Results: Women reported that Healthy Start vouchers increased the

  quantity and range of fruit and vegetables they used and improved the

  quality of family diets, and established good habits for the future.

  Barriers to registration included complex eligibility criteria,

  inappropriate targeting of information about the programme by health

  practitioners and a general low level of awareness among families.

  Access to the programme was particularly challenging for women who did

  not speak English, had low literacy levels, were in low paid work or had

  fluctuating incomes. The potential impact was undermined by the rising

  price of food relative to voucher value. Access to registered retailers

  was problematic in rural areas, and there was low registration among

  smaller shops and market stalls, especially those serving culturally

  diverse communities.

  Conclusions: Our evaluation of the Healthy Start programme in England

  suggests that a food subsidy programme can provide an important

  nutritional safety net and potentially improve nutrition for pregnant

  women and young children living on low incomes. Factors that could

  compromise this impact include erosion of voucher value relative to the

  rising cost of food, lack of access to registered retailers and barriers

  to registering for the programme. Addressing these issues could inform

  the design and implementation of food subsidy programmes in high income

  countries.'
affiliation: 'McFadden, A (Corresponding Author), Univ Dundee, Coll Med Dent \& Nursing,
  11 Arlie Pl, Dundee DD1 4HJ, Scotland.

  McFadden, Alison, Univ Dundee, Coll Med Dent \& Nursing, Dundee DD1 4HJ, Scotland.

  Green, Josephine M.; McCormick, Felicia, Univ York, Dept Hlth Sci, York YO10 5DD,
  N Yorkshire, England.

  Williams, Victoria, Food Matters, Brighthelm Ctr, Brighton BN1 1YD, E Sussex, England.

  Fox-Rushby, Julia, Brunel Univ, Hlth Econ Res Grp, Uxbridge UB8 3PH, Middx, England.

  Renfrew, Mary J., Univ Dundee, Coll Med Dent \& Nursing, Dundee DD1 4HJ, Scotland.'
article-number: '148'
author: McFadden, Alison and Green, Josephine M. and Williams, Victoria and McLeish,
  Jenny and McCormick, Felicia and Fox-Rushby, Julia and Renfrew, Mary J.
author-email: a.m.mcfadden@dundee.ac.uk
author_list:
- family: McFadden
  given: Alison
- family: Green
  given: Josephine M.
- family: Williams
  given: Victoria
- family: McLeish
  given: Jenny
- family: McCormick
  given: Felicia
- family: Fox-Rushby
  given: Julia
- family: Renfrew
  given: Mary J.
da: '2023-09-28'
doi: 10.1186/1471-2458-14-148
files: []
issn: 1471-2458
journal: BMC PUBLIC HEALTH
keywords: 'Food subsidy programme; Food vouchers; Healthy Start; Low-income

  families; Maternal and young child nutrition; Fruit and vegetable

  intake; Nutritional inequalities'
keywords-plus: 'PUBLIC-HEALTH; VEGETABLE CONSUMPTION; INSECURITY; PREGNANCY; FRUIT;

  WOMEN'
language: English
month: FEB 11
number-of-cited-references: '46'
orcid-numbers: '杜, 美晨/0000-0002-1562-1155

  Renfrew, Mary/0000-0003-2905-403X

  McFadden, Alison/0000-0002-5164-2025

  Fox-Rushby, Julia/0000-0003-0748-0871

  McLeish, Jenny/0000-0002-9289-857X'
papis_id: 31376593a88c91e4c6d2d600e8cd41d5
ref: Mcfadden2014canfood
researcherid-numbers: 'Renfrew, Mary J/A-2440-2010

  杜, 美晨/S-4063-2016

  '
times-cited: '46'
title: 'Can food vouchers improve nutrition and reduce health inequalities in low-income
  mothers and young children: a multi-method evaluation of the experiences of beneficiaries
  and practitioners of the Healthy Start programme in England'
type: article
unique-id: WOS:000331306100001
usage-count-last-180-days: '1'
usage-count-since-2013: '82'
volume: '14'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2014'