Exploring barriers to meeting recommendations for fruit and vegetable intake among adults in regional areas: A mixed-methods analysis of variations across socio-demographics.

Fruit and vegetable consumption is low compared to recommendations worldwide. Few studies have investigated intakes of fruit and vegetables and barriers to meeting recommendations in a mixed-method design. Moreover, there is a need to better understand differences in these barriers by population subgroups. This study aimed to examine fruit and vegetable intake and barriers to meeting recommendations and differences by sex, age and socio-economic groups. Data on adults from the cross-sectional Greater Bendigo Active Living Census 2014 were used. Participants self-reported intake of fruit and vegetables and completed an open-ended question on barriers to meeting recommended intakes. Logistic regression analyses were used to examine odds of meeting recommended intakes. Leximancer was used for thematic analyses of barriers. A total of 13,788 individuals (54% female, 52.1 (SD 17.7) years) were included in the quantitative analyses. Qualitative data were available for 5649 of these individuals. Only seven percent of participants met recommended intakes for fruit and vegetables. Barriers were lack of time, that guidelines were perceived as unachievable, the wide variety of other foods available and the high cost and limited availability of fresh fruit and vegetables. The most relevant barriers by subgroups were: taste (12%) and lack of appetite (18%) for males and females, respectively; lack of time (26-28%) and lack of appetite (70%) for young to middle aged adults and older adults, respectively and cost (35%) and availability of fresh fruits and vegetables (22%) for rural and disadvantaged groups. Findings have implications for the design of healthy eating strategies, which may benefit from being tailored to key population groups.