Understanding the dissemination of technology in a food incentive program: a qualitative evaluation applying the diffusion of innovation model

Healthy Food Incentive (HFI) programs, also known as Nutrition Incentive programs, enhance access to nutrient-dense, low-calorie foods like fruits and vegetables by increasing consumers' purchasing power and improving dietary quality for participants, especially for those with limited resources. This study aimed to explore the facilitators and barriers to implementing an electronic redemption system among farmers' markets, farm stands, and community-supported agriculture involved in an HFI program, while also demonstrating the evaluation process using a theoretical framework. Qualitative semi-structured interviews were conducted with staff members at the participating HFI sites. The analysis of the interview transcripts was guided by Greenhalgh's diffusion of innovations model, adapted for a non-health-care, community setting. The evaluation highlighted the necessity of localizing the dissemination of technology. Six facilitators, such as streamlined electronic program reports, and ten barriers were identified through the interviews. Challenges included a cumbersome registration process, technological difficulties, the risk of losing customers, and insufficient capacity. To address these barriers, suggestions included pre-registration before the market season, assigning a dedicated person from the HFI program to each site for support, and collaborating with the state-level nutrition program. The findings underscore the importance of timely evaluation to tailor the dissemination process and enhance sustainability. Utilizing theoretical frameworks during the evaluation can effectively optimize health promotion practices.