Chronic Disease Self-Management During the Monthly SNAP Cycle (P04-193-19)

OBJECTIVES: This study explored chronic disease self-management over the monthly benefit cycle among primary food shoppers from households receiving Supplemental Nutrition Assistance Program (SNAP) benefits in Philadelphia, Pennsylvania. METHODS: In-depth interviews, participant observation and surveys were conducted with the primary food shopper of SNAP households (n = 18). Interviews and surveys were conducted in a clinical setting, at participants’ homes, and in food procurement settings including grocery stores, food pantries and soup kitchens. RESULTS: All households had at least one member with a chronic disease or condition; 5 with a diet-related chronic condition, 5 managing the chronic condition of a family member, and 13 with overweight or obesity. Households reported that the dietary demands of managing chronic illnesses were expensive and mentally taxing. Food and financial shortfalls at the end of the benefit cycle, as well as reliance on charitable food assistance programs, often had negative impacts on chronic disease self-management. CONCLUSIONS: Drawing from nearly 50 hours of in-depth qualitative interviews with SNAP participants, this study highlights the dual cognitive burden of poverty and chronic disease and elucidates the particular challenges of food procurement and maintenance of diet quality throughout the benefit month faced by SNAP households with diet-related chronic diseases. Interventions targeted at reducing the cost of medically appropriate, healthy foods may help to improve chronic disease self-management within SNAP populations. FUNDING SOURCES: This work was supported by the University of Pennsylvania Leonard Davis Institute of Health Economics, the University of Pennsylvania Graduate and Professional Student Assembly Provost Award for Interdisciplinary Innovation, the NIH NIDDK Pediatric Endocrine Fellowship Training in Diabetes Research, and the Investment for the Future Initiative in Community Practices, University of Pennsylvania School of Nursing. The sources of financial support had no role in the design, analysis, or writing of this abstract.