Appendix. Domain, theme, and subtheme coding scheme that emerged from qualitative analysis of 45 in-depth interviews.

Table of domains, main themes and subthemes and selected illustrative quotes as determined from in-depth interviews conducted with low-income pregnant Latinas (N=45).

Domain Definition Summary of Key FindingsSOCIAL SUPPORT Support is the presence of persons or systems that provided assistance.

“…like if somebody goes to like a group or something and then go to that group, and then they say hey, you got a friend or somebody that’s interested. And then if that person likes it, of course the other person is going to like it. And say oh, I’m going to invite you to this group, and you’re going to like it. And just at least it’s an indication at least try and just watch and basically show about this group. And then if you like it and if you got any friends or other people that you know that they’re pregnant or not pregnant, they can bring their friends over to the group. And it’s like an encouragement thing.” (ID134, p.20)

Social support was the primary distal factor driving increased prenatal F&V intake.

Themes/sub-themes Illustrative Quotes CommentsFamily/friends “Because they know that I don’t eat them – like, that well. So they just made me buy fruits with

juices or water – whatever. They just do like frappe stuff with the fruits, so that help me to eat it – the fruits, and I do. They keep telling me, “Oh, you have to eat it. You have to.” So I know I have to eat it. So they make me eat it.” (ID106, p.2)“A lot – like every single day they keep helping me. They also do my juice because I don’t do them. Like the frappes, I can’t even see the fruits. So they just made it for me. They put it – like, you know, have a big cup, and I just drink it.” (ID106, p.2)“Support of the family [to start eating fruits and vegetables again], I think. If I have a good family, as I have, I think it is the best thing to do. Call my mom or call someone. “Can you help me?” …There’s some ways so, “I want to start again. Can you come and help me? Can you give me a supper to try to begin everything again?” And I know if that happened, I will have them help me. My mom, my sisters. I’m not going to say my father because he doesn’t cook. He only eats. But he’ll be on my side. He’ll tell me to eat because there’s a little person growing inside of you. So you have to do it.” (ID111, p.8)“My man and my family, basically…By telling me to eat more stuff. Eat for, eat fresh, eat fruits…They, so when I ask for it, and they’ll buy it.” (ID121, p.2)“..once you start working and you’re like full-time, and then you have like, you know, a home, and you move out and your parents doesn’t clean after you and doesn’t cook, and so you’re just like, you know, “I had a long day, I’m just gonna stop by McDonald’s and get some fries.” Or “Let’s go out to eat to Chili’s,” or anything.” (ID124, p.5)“[eating more fruits and vegetables because] I had a lot of encouragement with friends and family and boyfriend.” (ID134, p.2) “Like my first pregnancy with my son, I didn’t have too much encouragement and not too much support. So that’s why I was eating less vegetables, less fruits. So that was not encouragement enough for me to eat vegetables and fruit. Now that I have this is my second pregnancy, and I have a lot of people encouraging me, now it’s like oh, my brain is now telling me to eat fruits and

Family and friends created the primary support system for pregnant Latinas.

vegetables.” (ID134, p. 12) “I think it’s safe, something healthy. I tend to eat fruits more and people will scold me and say, “No, you need to eat regular food.” I just tell them to leave me alone. I tell them I like to eat healthy. Now that I’m pregnant I’m eating more fruits and vegetables.” (ID139, p.3)“But I always listen to many people saying that. That it’s good to eat green.” (ID155, p.2)

Partner “I'll put it like this, if my boyfriend's cooking then I'll be like okay, veggies and fruits. I'll eat something like that if he's cooking. If he's not cooking then it turns me to junk food…So…like it's more of if he's cooking and I smell it, I'd be like oh my God, smells so good. I'm like oh, I can have some tomatoes or some lettuce or some carrots or something with this and then if he's not home, he's not cooking, it's like more of I don't feel like cooking, maybe some junk food tonight so that's what just makes me just turn the other way…” (ID101, p.3)“If he's in the house and he sees me eating junk food, he'll start talking up a storm. What's wrong with you? That's not healthy. That's got too much grease, this is this, this is that. I just think then I would like but you're eating it, too. So you're not making the situation any better. You're not helping me so I'll completely lay and just tell him you're not helping me…but I'll be like okay, maybe he's right, maybe I am eating too much junk food and then I'll you know, I'll turn me completely the other way where I'll just start eating veggies and start eating different things then I'll be like well, can you go make me this or go make me that because I'm just at the mood where I don't feel like cooking for some reason. I don't feel like doing anything anymore. I just wanna lay in bed and just eat all I could. That's not healthy either.”(ID101, p.3)“He just encourage me, like “Remember, you have to eat this.” And you know. And it is another reason for me to keep my sugar in level. Telling me every meal I have to eat it.” (ID102, p.3)“…So he eats everything that you can imagine he will eat. Cooked or uncooked. Of course, there’s some ways that he likes more. So he goes, “No, you’ve got to eat this because it’s healthy”…”It’s good for your brain.” Or, “It’s good for your heart.” “It’s good for this.” So he also encourage me. He’s a little tired of me, but he tries.” (ID111, p.3)“He [husband] is always encouraging me to eat fruit because it’s good for me. He prefers I eat fruit than any other type of things.” (ID128, p.1)“He [husband] serves a dish with fruit, fruit salad, or he tells me to eat a specific fruit because it’s good for my health and for the baby.” (ID130, p.2) “My boyfriend, he brings me food and vegetables so he supports me too.” (ID131, p.1)“When I ask him to buy fruits he’ll buy them. If I ask him to cut up an orange for me or if I want a watermelon he’ll bring me one.” (ID136, p.2)“He’s the one who buys the fruits and vegetables for me.” (ID158, p.2)“He motivates me to eat more fruit because they are good for the baby. Sometimes I’m in the bedroom and he brings some fruit for me to eat.” (ID174, p.2)

Partners provided support to participants whether or not they were living within the same home. Support primarily consisted of cooking, purchasing, serving F&Vs as well as educating and motivating participants to eat F&Vs.

Mother/Father “Well, when I'm here and she's [respondent’s mom] cooking, she takes out lettuce. She takes out tomatoes. She takes out this. She takes out that. I say what are you doing? And she does you know, this whole different thing and I'll be like okay and I just start picking and I start picking until everything's gone and then she has to do it all over again because [she] can't believe I just

Mothers, and less often fathers, also provided participants’ support in consuming more F&Vs during pregnancy.

picked that thing too much.” (ID101, p.4) “Because they [mother and aunt] know that I don’t eat them – like, that well. So they just made me buy fruits with juices or water – whatever. They just do like frappe stuff with the fruits, so that help me to eat it – the fruits, and I do. They keep telling me, “Oh, you have to eat it. You have to.” So I know I have to eat it. So they make me eat it.” (ID106, p.2)“I like them [carrots] cooked. I don’t like them uncooked. She said, “Uncooked, they have more vitamins.” I don’t know if it’s true or a lie, but that is the way that she tells me…And she said, “Okay, so you want me to cook for you?” And if I say yes, she’ll go and cook for me. Like put the carrots to cook. But if it’s uncooked, I don’t eat. So she helps me, she encourages me in those ways. If there’s things that I don’t eat, she says, “You have to because of this and that.” And if there’s something that I eat, but it’s not the way that I like, she’ll go and do it for me.” (ID111, p.3)“My mom will always be like, oh I bought some fruits for you and she does vegetable – you know she cooks it or whatever. So she'll make sure she'll give me healthy stuff and stuff like that. Yeah, so I felt like I used to eat better. (ID115, p.3) “Yes, she be like you better eat healthy, your baby is not going to come out healthy. Do you want that? It’s going to be on your conscious. She kind of makes me feel guilty… So that kind of changes my attitude [inaudible] so like I could start eating fruits one, two, three days, but then I will stop again…And like I will not eat as like – cause she’s telling me oh, take one to work. Like because she’s working on the food, so she take – brings up apples and stuff and says take one to work. Take one wherever you go. Just – you know it doesn’t matter – because she notices that I don’t eat a lot so she like doesn’t matter you’re not hungry. Just like little bites, little bites, by little and you know.” (ID120, p.5-6) “My mother always says that it’s good to eat fruits and vegetables.” (ID155, p.2)“From my mother who tells me to eat more fruits and vegetables…because she tells me it feeds the baby better than eating food from outside.” (ID158, p.1)“Even before she tries it, she’ll be like: someone told me this was good; let’s try it. So even before she has tried it herself, she’ll try to see if we want to try it with her” (ID166, p.3)

Mothers made F&Vs more available and accessible to participants by cooking F&V-based meals, providing F&Vs as snacks, and purchasing them for participants. Mothers also imparted F&V beliefs and knowledge to their pregnant daughters to encourage and motivate them to eat healthier.

Grandmother “…Because sometimes the way that you cook, for example my grandma, she taught me how to cook. She taught me how to clean a house. She taught me how to wash clothes. She taught me everything. Well, the way that she does, is not going to be the same way that I do it …” (ID111, p.8)“Well, she’s from Puerto Rico…she was raised on like farm and growing your own stuff so she’s really like she knows what she’s doing. So I don’t know, she’s trying to get me to eat more because she doesn’t like me feeling weak. And she’s like that’s because you don’t eat your vegetables. You need to eat your foods. So she makes me do it. She’ll call me and ask me to make sure that I’m eating them. So she shows me dishes and stuff and I learn and then I do it at home.” (ID122, p.4)

Grandmothers provided additional support to some participants by encouraging more F&Vs and teaching cooking.

In-laws No 99 quotes identified. Not applicable Sister/Brother “She [respondent’s sister] takes away my junk food. She hides it from me.” (ID120, p.7) Sisters and brothers usually

served as guardians over what the participants ate, such as removing unhealthy food from the house.

Aunt/Uncle No 99 quote identified. Not applicable Children No 99 quote identified. Not applicableProviders “And then I do have like a nutritionist that I go to every week…She encouraged me to, to eat

more fruits and vegetables.” (ID102, p.2)Health care providers offered primarily encouragement to increase prenatal F&V intake.

Food assistance programs WIC Instrumental

“I do get WIC, but they give you like $6 worth. So it doesn't last long either… every time I get fruits and vegetables, it's like lasts a couple of days and then after that, eat it no more till next month. So maybe once a month I'm eating three or four days good, healthy, and then the rest so and so. Yeah. Just eat to fill myself up, not like eating to be healthy. I find like eating healthy is expensive, as well.” (ID115, p.7)“I think money is the only barrier, if they were not so expensive I would eat them. I also have the support provided by WIC which helps me with fruits and vegetables.” (ID116, p.2)“I just got into the WIC program and they provide me with food and vegetables and they help me out.” (ID131, p.1)“It’s a resource; they give you food stamps which are especially for fruits and vegetables. It’s mostly to buy fruits such as apples. If you go to Stop & Shop then you can buy apples or lettuce with the food stamps provided by WIC. So I think it would be a good resource.” (ID139, p.2) “Because they have fruits and vegetables on the check. It’s easier for me to get fruits and vegetables if that’s what I’m supposed to get. With the food stamps, it’s not written. You can get whatever you want as long as the grocery store, but the WIC says fruit and vegetables. Get this much. So it encourages me to buy it. If I buy it, I’m not going to waste it. I want to eat it.” (ID144, p.3)“…the programs that support me is WIC and my food stamps. Especially the WIC because it has fruits and vegetables on the check…I still buy fruits and vegetables [with food stamps] but it’s like with food stamps, I could buy something else if I want. Like the WIC helps me stay on track more because I don’t want to waste a check. I don’t want to waste the fruits and vegetables. So I want to take advantage of it. So I just get it and stuff. But I get fruits with my food stamps and stuff too.” (ID144, p.3)“…I feel like any person if you’re getting a whole bunch of WIC every month and you’re getting food stamps, I don’t think there is a reason why you shouldn’t buy fruits.” (ID144, p.5)“It helps that the WIC gives the money for the fruits. So they give the two checks of $5 each, so it helps because that’s money that we don’t have to spend on it ourselves. So it’s different kind of fruits that we can get to make sure that we’re still eating fruits and vegetables, stuff like that.”

For some participants this allowed them to have more expendable money, while others didn’t feel it was enough for F&Vs. Participants expressed that it was easier to utilize WIC checks for F&Vs rather than food stamps since WIC specifically provides checks for F&Vs.

(ID160, p.3)Informational“They actually do classes and they show you like what you should be eating, what’s healthy especially for pregnant women, because you are eating for two.” (ID122, p.5) “And they give you little brochures and like menus of tips of things that you can eat, they give you pamphlets and stuff…vegetables and fruits, she shows you pictures and she says that you’ve got to have like five food groups a day. And she will explain to you and show you pictures – and one time I remember I didn’t have neither or in my body. I was just looking at the picture like – I didn’t even have a clue. And then I learned, so now I know what to do, what to eat.” (ID122, p.6) “Well, when I go to my WIC appointment, they encourage me to eat more fruits and vegetables, or my doctor.” (ID158, p.1)

Informational support from WIC came in the form of nutrition education classes and pamphlets.

SNAP InstrumentalNo 99 quotes identified.

Not applicable

Domain Definition Summary of Key FindingsFAMILY STRUCTURE

Family structure is the composition of the participant’s nuclear and/or extended family. Family structure was the main predictor of the social support received by the participant.

Themes/subthemes Illustrative QuotesAlone /single mom “If I'm home alone, I don't have the energy to get up and cook. I don't have the motivation to get

up and cook.” (ID101, p.4)“I mean I find myself – this pregnancy, I've been (by) myself. I find that for – when I was pregnant with them [her other children], I had my mom around; I had my husband around, and his mom. So they will constantly send me food. I felt like I was eating better. You know like now I'm by myself so sometimes there's days that I'll want to cook so much because I have something to cook and I'll eat, and then there's most of the days I'll just make something for them [her children], you know to comfort them and it's like I don’t eat good. You know? Cause I'm like why I'm gonna do a bunch of rice and beans and I'm gonna throw it away anyways cause I don’t know how to cook a little bit for me.” (ID115, p.2) “…I don’t have no family over here. See over there I had my mom, you know, I have my brothers, I have you know my mother-in-law, you know I have people around me… my mom will always be like, oh I bought some fruits for you and she does vegetable – you know she cooks it or whatever. So she'll make sure she'll give me healthy stuff and stuff like that. Yeah, so I felt like I used to eat better. Definitely.” (ID115, pp.2-3) “I really like hate to like open a can of vegetables and make it and then it's just – I'm two or three days eating the peas, or like the green beans. Like just so it don’t go to waste, you know?” (ID115, p.3) “No, like I’m saying for my kids pregnancy. It was more like supported and you know? I’ll cook, more people will eat. It was different. Now these kids are so picky, they are so picky. The only one that will eat is like my daughter and that’s it. Yeah, sometimes I – like yesterday was a day that I was like, I’m not gonna cook. I have certain things to cook so I’m like I’m not gonna cook

Women described either being alone (or lonely)/single mom, having a nuclear family, and/or having an extended family and the influence that had on eating F&Vs. They expressed how not having family around them, being lonely, or being home alone discouraged them from cooking and healthy eating, subsequently affecting their F&V intake.

so they can throw it out. You know I just make sure they ate and I didn’t even bother to eat, myself…” (ID115, p.4)“..sometimes when you have so much to do and cooking, and you just don’t want to eat. Just the whole appetite goes away... That's why I drink a lot of ensures when I can because I feel like I don’t put enough vitamins in my body.” (ID115, p.4) “I'll make a dinner and eat it sometimes cause I find myself throwing everything away. Yeah, I have nobody to like eat some vegetables so they won't go to waste.” (ID115, p.5)

Nuclear No 99 quotes identified. Not applicableExtended family No 99 quotes identified. Not applicableDomain Definition Summary of Key FindingsF&V ACCESS F&V access refers to the factors that facilitate or hamper the ability to purchase and consume

F&Vs.F&V access was influenced by the presence or absence of social support.

Themes/Subthemes Illustrative Quotes CommentsPhysical Built environment “If I had like a supermarket around the corner and more money, yeah [I would be able to eat

more fruits and vegetables during pregnancy].” (ID115, p.6)“Cause if there was like a little market, I've gone around here...there's no fresh vegetables anywhere. And then I gone to save-a-lot and it's like – most of the time it's empty and it's like the same fruits; like grapes and apples, and oranges. There's a lot of – you know like you don’t have a big [supermarket] let's say Stop & Shop has so much to pick from.” (ID115, p.9) “Yeah, if I had like nice fruit market around the corner, definitely. Definitely cause sometimes I hate like buy the little varieties they have and then it just goes away so quick.” (ID115, p.12)“…it's what people see, what's promoted around, like if you walk and you see like all these fruits and vegetables look nice, you're gonna go in there, you're gonna want to buy it, you're gonna want to eat it.” (ID115, p.14)“Yeah, so like I was saying there's in the (referring to another city), there's these mobile homes, that's what you call it. A trailers with hot meals for the homeless. But you don't really have to be homeless, you could just start on the line and get in and they give you like the milk with the bread and the fruit, and like fish. They give you chicken Marsala, they give you really good foods and it's really good, and they have vegetables and it's very very good. You know and it's healthy.” (ID115, p.1, pt 2) “…I over there I had so much more to pick than over here. I'm just so used to it. And that [city] is a bigger city. There's much more things over there. Life is faster over there, so you know? I'm used to that. You know I'm not used to the quiet and humble and barely nothing around. After 5:00, you rarely see people in the street. Like yeah, I'm not used to it at all. But if I had a lot more around me, yeah, I would definitely think I would change my ways of eating. Definitely. (ID115, p.2, pt 2)“I just recently got a job and like right there next to it there’s this place where they sell all kinds of sandwiches and stuff like that. And they have like these little containers of fruits and all that. I

Immediate neighborhoods lacked local, easily accessibly supermarkets, limiting access to a variety of fresh F&Vs. Local convenience stores within walking distance didn’t offer a variety nor fresh F&Vs.

buy that.” (ID120, p.3)“Like if I can grow them all in my backyard and have my own space back there, I would be fine.” (ID122, p.9) “There won’t be a week where I won’t miss eating a salad. There won’t be because if it’s not in the house it’s somewhere out there. I’ll end up finding a fruit or a vegetable to eat. If it’s there it’s there. Since I’ve made it part of my life is everything I go.” (ID156, p.19)“…I would look for a place where fruits are cheaper so I can afford them.” (ID172, p.3)

Transportation “I don’t know the area, I don’t know how to get down there. Then I don’t have no money to like take a taxi back home with the food and stuff, so I say the traveling, too, really sucks.” (ID115, p.8)“…when I get my food stamps, I wait for my friend, for the kids father, he comes from (another state) sometimes and visit and I will wait till one of them come – they come and then I'll go do the big [supermarket] – I just buy – I just spend the whole thing so I could just have everything in the house cause I know – I don’t know when is the next time somebody [can drive me]– cause everybody's busy.” (ID115, p.8)“…Stuff like that like [supermarkets] do have things, but you need a car. You know like it's not walking distance. Then the transportation here sucks. Then you can't – you know sometimes you don’t have money to come back in a cab and you know it's a lot. I need a car, definitely.” (ID115, p.9) “Yeah, I think if I had a car, things would be so much different cause I could just get in the car…Like I have four other kids, I don’t want to get on the bus. It's cold now and everywhere I go they want to run over here, run over there. So it's like I just want to stay home. Sometimes their behavior just makes us stay home and you don’t want to do much. You know so it's not easy.” (ID115, p.9)“I'm like time to get on the 31 bus and to go all the way down there for just a couple of fruits is too much. I wish I had a car. I could be like you know I'm gonna go and get it.” (ID115, p.12)“Sometimes it’s difficult to get [F&Vs], because there’s no transportation. So me walking being this pregnant it’s kind of hard. So sometimes, like getting to places is difficult, because I don’t like always going to – to just corner stores. I like to go to a supermarket. But I mean, I can get there, I just got to wait for when it’s convenient for someone to take me, which is hard.” (ID122, p.9)

Participants expressed that transportation is crucial to accessing fresh F&Vs within Hartford. Given the far distance to local supermarkets, accessing them without a car limits F&V options to corner stores within walking distance. Participants expressed frustration with local transportation and relied on others to provide them with a ride to the supermarkets, thus limiting when, where, and how long they could shop.

Work/food environment

“…where I work at, …it’s a fast food restaurant. So they brought in …like real juices…now they brought like a different kind of like mangos or like teas and they are very good. So I don’t drink Pepsi no more.” (ID120, p.9)

Access to healthier foods at work provided an opportunity to eat healthier.

Material Money “When I was over there [in the place where she used to live], I could just – it's so – everything is

so close, you know, so many things. I used to go like to the Chinese people and the fruit markets. People get the fruits for a dollar and stuff like that. Chopped up fruits and stuff. Over here is like $5, $6 for little thing like that. So it's like you know I got to buy enough for the month. I got to buy what my kids like. So I do get my fruits and vegetables, but not a great amount. You know?”

F&Vs were expensive and did not last throughout the month. Monthly food budgets determined quality and amount of F&Vs as well as food

(ID115, p.7).“Like I say like every time I get fruits and vegetables, it's like lasts a couple of days and then after that, eat it no more till next month. So maybe once a month I'm eating three or four days good, healthy, and then the rest so and so…I find like eating healthy is expensive, as well.” (ID115, p.7) “We're buying everything that's on special. I mean, even if you want to buy something that is good, we buy all the cheap stuff…you know if the wheat bread is a few cents more expensive than the white bread, we're gonna get white bread and you know what I mean? And the cheap cheese, and the cheap mayonnaise. All of that is not really healthy, you know?” (ID115, p.8)“Sometimes things are more expensive, that’s why sometimes I don’t buy them. For example, they have told me that blueberries, the blackberries are nutritive but I have only tried them once because they are very expensive.” (ID116, p.3)“…we are obligated to work and save money that we’re making in case there’s no more food stamps for the month then hey, we’re running out of this and that…fruits and vegetables are expensive now” (ID156, p.12) “I would have to come up with a new plan of how much more and how much I’m able to spend on fruits and vegetables…so we could add it to our plates.” (ID156, p.14)“Well, I think some of the money aspects, too, because eating healthy is, expensive. I know it’s cheaper to just go and get something fast that you shouldn’t be eating. But like I feel like when we try to eat healthy at home, it’s like more money. So then we just go back to how we were eating because of that.” (ID160, p.5)“Well, there are sometimes where we can’t go buy them, or that we don’t have enough money, that they are very expensive.” (ID172, p.2)

purchased. Thus, participants were more likely to purchase cheaper, less expensive foods and fewer F&Vs.

Food assistanceprograms

“…sometimes I find that I eat better when I first get my food stamps than I do – grocery shopping, I can buy my fruits, I can buy my vegetables. But then, when it finishes, I won't eat good again until next month because I can't buy fruits and vegetables fresh all the time.” (ID115, p.5)“I say financially, I wish I get more food stamps and yeah, definitely, I'll do better grocery shopping and I'll be eating way better than what I eat.” (ID115, p. 8) “Because of the economy right now. It’s very hard. I only get a certain amount of food stamps…so with the food stamps I have to make sure that I get a little bit of everything, mostly healthy.” (ID156, p. 12)“…we could spend a whole day without milk, soda – we could spend a whole day without no meat or two days. That’s fine because we know the third is coming, but sometimes what if we don’t get that assistance anymore at that time? What are we going to do? ” (ID156, p.18)

With food assistance benefits available at the beginning of each month, F&Vs were more accessible to women at that time rather than at the end of the month when food assistance benefits had run out.

Seasonality “I think during the winter it’s kinda hard to eat, to pick a fruit just because they’re always like coming from somewhere else instead of being like organic or local. So that’s kinda hard to kinda, you know, decide like watermelons, it’s not in season, or like strawberries, they’re not in season. Or like strawberries, they’re not in season so they have to be imported. So things like that. As far as veggies, corn, I love normal corn, like the actual corn that grows organically. But in the winter I always have to get it canned. (ID124, p.10)“No, only if they’re not available. Like the watermelon? There aren’t any because the weather is

Certain F&Vs were not available or were more expensive at particular times of the year, which limited F&V choices, preventing women from consuming specific F&Vs, or requires them to choose an

still too slow. I’m waiting for the big watermelon. That would be one of the things that would prevent me from [eating], not being able to find them.” (ID139, p.3)

alternate option

Access is not a barrier “I have more than enough access. If I don't have access home, I have access on my mom's, I have access as my sister's – everywhere and anywhere I go. I have an uncle who works at a fruit market so if I don't have access to buy them, he brings a lot of fruits home so there's times where my mom calls me and it's like okay, there's fruits here…” (ID101, p.7)“Fruits and vegetables it’s actually not expensive at all. It’s like cheaper than a bag of chips, a bag of Doritos you can get a bag of grapes and some carrots, it’s way cheaper than that.” (ID122, p.9)

Support from family/friends and having enough money helped many participants maintain access to F&Vs throughout their pregnancy.

Domain Definition Summary of Key FindingsF&V PREFERENCES

F&V preferences pertain to women’s as well as family F&V likes and dislikes. Family preferences for F&Vs influenced women’s F&V preferences. Taste/smell, freshness, appearance, and cultural preferences all influenced F&V preferences. F&V preferences are influenced by social support from family/friends.

Themes/subthemes Illustrative Quotes CommentsTaste/smell “And you be like, “What’s that?” And you don’t eat it because you don’t know how it tastes and

stuff. Either if it’s gonna be like sweet or sour or some. I don’t know.” (ID102, p.4)“But me, there’s certain things that I like to eat. There is certain things that I don’t like to eat. Like I like the taste, for example, onions. If it’s cooked, I eat. But my husband, if he gets home right now, if he sees that onion the way that it is, he just washes it and puts a little bit of salt and he’ll bite. I would die, but I would never do this. It’s not me. I can’t. But he does it.” (ID111, p.6).“I guess I don’t make a lot of fruits and vegetables because my kids are so picky… they like nuggets, and fries, and burgers, and hot dogs. They don’t really like – like if I do rice and beans and meat and vegetables, they don't want to eat none of that.” (ID115, p.1) “Yeah, I’ll still eat it but I won’t taste it. It gives me more – like a different taste of it that I wouldn’t expect. Like squash; I won’t eat squash but they’ll mix it like with the corn beef. As long as they won’t tell me that it’s squash, I’ll eat it. But if they tell me when they’re doing it, then I won’t. I’ll just taste it.” (ID133, p.2)“It [buffalo chicken] was so good and finger licking. Then we need to find the same way to feel that way for fruits and vegetables because they are good too.” (ID156, p.15) “The smell of it, the taste of it – I literally – my stomach says no and it just throws all this gook from inside to prevent this onion to get inside my body. My – I’m – my nose gives the message. Just the smell of onions gets the message and before I even goes close it’s like my taste buds start shaking already. Oh, no. Onions. There's no way in hell onions will come to my body. That’s

The taste and/or smell of raw or cooked F&Vs was a key preference factor. F&Vs had to taste and smell good for participants to consume them. Participants expressed clear dislike for particular F&Vs that had distinct, unpleasant tastes and/or smells.

the only vegetable I know I’m an enemy to. I would not challenge it – nothing. Onions – no way.” (ID156, p.20) “Some of the vegetable is the smell that stops me from eating it.” (ID157, p.3)“Like broccoli I hate – I used to like them, but last time in point, but now I just don’t like the smell at all.” (ID157, p.3)“But I want to try new stuff, but it’s just hard because I don't know how it’s gonna taste so I get afraid.” (ID160, p.1)

Cravings “I crave more for fruits…like for grapes and oranges…well, just carrots, that’s it.” (ID100, p.3-4)“It's probably depends more on what fruit and vegetable it is. Like let's say [inaudible] boiled strawberries in my face, I'll eat them all if I have to. If it's pineapples, listen, I'll eat them all and then I'll keep eating them because I just don't know, I just have a thing with them and then with vegetables, it's the same thing like tomatoes. If I have them sliced up, I'll probably put like a little bit of salt on it and then I'll eat them like I'll try different things with it to eat them. I never tried to do that before but I've been doing that lately. It just depends on what it is mostly.” (ID101, p.1)“Cravings, I have a lot of cravings…I have the craving where I just wanna eat fruits all day where I wanna just eat veggies or fruits all day together. I'll probably buy a platter and just start eating everything that there is on it but it mostly depends. It's my cravings that really get to me so if I stay here and I say okay, let's eat a whole platter of veggies and fruits all day then that's what I'm gonna do. Then if I have a craving of chocolate, of junk food, then that's where it's gonna turn me to.” (ID101, p.6) “I guess… I can’t shove something down my mouth [fruits and vegetables] that I don’t crave or I don’t want to eat.” (ID120, p.1)“Sometimes I just be so tempted [to eat sweets], then I crave it. I just feel like I really want it. So it’s kind of hard for me.” (ID120, p.4) “…if I’m like craving junk food I try to tell my mind like I’m going to eat fruit instead of junk food, but then like I could take a bite of it, but then I run to the store and buy the junk food.” (ID120, p.10) “Like I said, it all depends because this pregnancy has caused me to eat more fruits. Of course, I eat fruits regularly but I have been craving for more fruits with this particular pregnancy.” (136, p.2)“…my own temptation [prevents me from eating fruits and vegetables], that’s it. Because I don’t understand why if you’ve got WIC and you’ve got food stamps that there would be any barriers for you to buy fruit.” (ID144, p.4)“…I have my times during the month where I just want fruits. So I’ll go out and we’ll get fruits and I’ll make me a fruit salad for like lunchtime. And then the next day I’ll make another fruit salad for lunch, so it’s like a couple days together that it’s just like all I want is fruits.” (ID160, p.6)

Cravings changed participants’ preferences, at times increasing their F&V consumption while at other times, decreasing F&V consumption. Some had cravings for specific F&Vs, while others just wanted F&Vs overall.

Prefer taste of fruits “Well, fruits, I don’t have a problem eating fruits, it’s vegetables; they don’t taste good to me.” Fruits were preferred more than

than veggies (ID100, p.2)“I eat usually what I always was eating. Fruits, there’s some fruits that I am more interesting. Like particularly ones. But vegetables, I am a very difficult person to eat. I eat, but very little. Before and after the pregnancy is the same.” (ID111, p.1)“It’s just the taste. Really, it’s the taste. Like I said, fruits – I won’t say that I eat all of them, but I eat most of them. Vegetables, I don’t know, the taste for me is the thing.” (ID111, p.6)“Fruits – I’ll eat any, kind of, fruits because fruit doesn’t only just taste good…it has the sweetness and the sourness to it that you can bare every day all day. Vegetables it depends because the, kind of, vegetables that I eat is salad, potato…”(ID156, p.2) “Definitely nothing. Fruits is fruits. That’s something I could just grab and throw in my mouth.” (ID156, p.6)“But there's no limit of me eating fruits. I like all, kinds of, fruits. I haven’t tasted…raspberries and blueberries, but those are fruits that I would eat. I just have to start buying them.” (ID156, p.7)“Vegetables are like strangers to me. I have to get to know them in order to eat them and like them.” (ID156, p.22)“I eat more fruits than vegetables. Vegetables I don’t eat as much.” (ID157, p.1)“The fruits I just like them” (ID157, p.3)“Yes. Because I don’t eat a lot of vegetables as it is…I would eat a lot of fruits because I like fruits. So I know what they taste like so I know that that’s what I want. So I don't know if I want salad or carrots and stuff because I don’t eat that.” (ID160, p.6)“…I have not had the opportunity to eat a lot of vegetables. I have tried them and I have not liked them. If I were to have the opportunity to like them I would eat them every day.” (ID164, p.1)

vegetables. Fruits were juicy, sweet, flavorful, and didn’t require a lot of preparation. The taste of vegetables deterred more consumption. Not knowing what vegetables tasted like also prevented participants from consuming more vegetables.

Junk food, fried food “[We do fry a lot] especially because my kids – they like…fried meat. If I do it stewed, they don’t want to eat it. If I do it in the oven, they don’t want to eat it. So it's like – they like their chicken crispy…They like everything fried and crispy and stuff like that. Yeah, so it's kind of hard.” (ID115, p.6)“Because as a Latino you tend to get more careless and they tend to go more toward greasy foods, less vegetables so I think they should have more information.” (ID136, p.5)“Yes. Because I would only be eating carbohydrates, carbohydrates, carbohydrates, carbohydrates. You need to eat fruits and vegetables.” (ID155, p.4)

Junk food and fried foods were commonly consumed and preferred foods, especially among women’ children. Children’s habitual eating of unhealthier foods created an environment that didn’t support F&V consumption making it challenging for women to consume more F&Vs during pregnancy.

Taste transmission from mom to baby/other children

“[If I don’t eat more fruits and vegetables during pregnancy], the baby won’t like fruits and vegetables.” (ID100, p.4)“[If I don’t eat more fruits and vegetables during pregnancy] I think my baby will not like them.” (ID102, p.6)“…when they reach a certain, certain type, certain weeks or certain trimester…the baby can taste

Women believed that eating F&Vs stimulated their unborn baby’s preferences for F&Vs. They felt their F&V consumption transmitted flavors

what you’re eating, or they can smell what you’re cooking. So if I’m constantly eating that, then there’s a chance that my baby is gonna want nuggets and fries all the time instead of fruits and veggies and, and stuff like that.” (ID124, p.13) “I think it’s better because you want to taste the vegetable and the baby, too, because then the baby is going to get used to.” (ID134, p.8) “So the baby can be healthy. The baby eats whatever I eat. Right now, she has a lot of chips and candy.” (ID144, p.1)

or smells that would influence infant preferences outside the womb. They also discussed how their own F&V preferences influenced other children in their household (via role modeling).

Fresh “…I like to buy fresh fruits…I don’t really like the canned fruits. The only thing I'll eat like canned is like the oranges. I do buy canned vegetables and stuff but I don’t know I'll eat it sometimes. Like I'll make a dinner and eat it sometimes cause I find myself throwing everything away. Yeah, I have nobody to like eat some vegetables so they won't go to waste.” (ID115, p.5)“…not even the stores around here have something fresh for you to eat. Like you know I mean me, I like fresh. I don’t really like the canned stuff. It doesn't taste that good to me. Yeah, I rather the fresh stuff. I don’t know, I guess if I had like a fruit market, definitely if I had a fruit market. The fruit market has mangoes, it has so much more to pick that you see them cut up in little things and you – it makes you want to eat it. You know like oh, that looks good. Or watermelon, you barely find watermelon in the stuff like that.” (ID115, p.13)“I mean, you can always go to a corner store, but some corner stores just – they don’t look fresh. I mean, I still somehow will get on a bus and go and get it. So I can eat more.” (ID122, p.10)“I used to look at the food bowl and it didn’t have any fruits in it, so what I used to eat was food. Yogurt, ice creams, because I used to buy hamburgers a lot, everything frozen, pizza, all that is what I used to eat. But now I don’t frozen things in the fridge, just things to cook and fruits.” (ID147, p.5)“I would look for a place nearby where produce is fresher.” (ID172, p.3)

Participants preferred fresh F&Vs, but would purchase canned F&Vs due to the longer shelf life even though they were considered less tasty. Purchasing uncanned, fresh F&Vs meant typically consuming them within a short time frame following purchasing to avoid having them spoil and throwing them out (i.e. wasting).

Food safety “Like I think if they’re fresh not rotten like most stores sell, they usually have rotten stuff or even on TV how they say that the gardeners put some type of peroxide for to kill the little animals. Sometimes, I’m scared to eat vegetables, and that’s the reason why. Is it safe to eat this? Is it not safe to eat it?” (ID134, p.9)“I’m already used to preparing shakes with fruits; bananas, strawberries with milk, papaya, pineapples, those are the juices I prepare. If I don’t prepare them, it’s not the same as if you buy them in cans. I think they have a lot of – to be able to be preserved in the cans.” (ID137, p.2) “First [inaudible] you have to wash your fruits, especially when you're buying them in open public supermarkets and stuff. You have to wash your fruits. You have to look for those soft patches. You have to study your fruits and vegetables. If they look spoiled it’s not good. Throw it away.” (ID156, p.6)“I have to make sure that we eat everything at a certain time limit frame before it gets spoiled because I do not want to waste it away.” (ID156, p.12)

Washing F&Vs due to potential contamination from handling and concern over pesticides on the F&Vs made some participants cautious about which F&Vs they consumed and how they were consumed.

Appearance “Some vegetables I don’t like … I just look at it and they look weird to me, and I don’t, I don’t eat it.” (ID102, p.4) “Sometimes I don’t eat fruits because they look kinda weird....” (ID102, p.4)

Participants were less likely to try “weird” or unappetizing looking F&Vs.

“Like mushrooms…I just look at it like it comes from the floor. It’s just like nasty. You know it has like little black stuff on it? I’ll just like look at them like how do you know it’s not rotten?” (ID133, p.2)“Just like if it looks nasty, I won’t eat it. Like the mushrooms...I just don’t like how it looks, like the hair and stuff.” (ID133, p.3)“Vegetables and fruits – fruits especially have to look beautiful. They have to look like they just – like you just picked them off a tree.” (ID156, p.6)“I’ve never been a fan of vegetables like that. But when my mom started cutting them up, I would say: oh, it looks good; let me try it” (ID160, p.2)

Cultural preferences And you be like, “What’s that?” And you don’t eat it because you don’t know how it tastes and stuff. Either if it’s gonna be like sweet or sour or some. I don’t know.” (ID102, p.4) “Yeah, I like that kind of food, too. I like all kinds of food. I'm not picky. You know and I find like other cultures are even more healthier because they have like more healthier things in their dishes. Not like us, we do a lot of rice, beans, and meat. You know and a lot of – we fry a lot of stuff. I find that we fry – we do fry a lot of stuff.” (ID115, p.6)“I mean people are picky… Like they're so used to eating things from their culture that they won't go outside the box...” (ID155, p.14)

Participants expressed uncertainty about tastes of unfamiliar F&Vs from other cultures, limited their desire to try new F&Vs.

Subgroup differences No 99 quotes identified. Not applicableDomain Definition Summary of Key FindingsF&V KNOWLEDGE F&V knowledge was defined as both informational and instrumental knowledge. Information

knowledge referred to knowledge acquired through educational attainment and instrumental knowledge referred to hands-on learning.

F&V knowledge is influenced by social support.

Themes/subthemes Illustrative Quotes CommentsInformational Yes, because fast food is not nutritive while the fruits are more nutritive and nourishing because

of the vitamins they have. (ID174, p. 3) Health benefits for

mom and/or baby “But now since there’s a baby, I don’t know what’s in, what’s in the restaurant’s food. I try to prevent like any food poisoning, so I’m sure like if I make it at home, it’s better, I know what’s going in, I know my portions, I know like, I made sure I educated myself that way.” (ID124, p.1)“Once I found out I was pregnant, I definitely started eating at home more and like just watching what I ate at all times. Because they tell you all the things you can eat and what you’re banned to eat, and it’s, it’s just like, it’s very hard. Like you would think that when you’re pregnant you can eat anything, but you can’t.” (ID124, p.1) “…There was a list that I found that told me all the types of food that I could eat to like prevent Down Syndrome or to prevent any type of infections or to prevent any kind of disease or anything. So not only does it work for me, but it also works for my baby. So I just went by kind of that guide, and I make sure that I did my research…” (ID124, p. 3)“So I just did my research…I need to know. And then if I can’t have blue cheese, then can I have ranch? Or can I have – what else can I have? Like egg? I can’t have sunny side up eggs because of some, you know, salmonella or anything, so can I have it poached? Can I have it boiled? Can I have it here and there, or can I, do I have to ban it? (ID124, p.4)

Informational knowledge about F&Vs was comprised of biological knowledge about the benefits of F&Vs for the mother and baby. F&Vs were generally regarded as healthy and nutritious due to containing vitamins and minerals,

“Orange provides the body with vitamin C. Carrot, I think vitamin A, for the eyes.” (ID149, p.1)“It helps with digesting food out of your body. Yeah, fruits mainly I believe is good for all that.” (ID156, p.7)“But what motivated me more was when I started college to study medical assistant and then in my biology class I learned how the body works…The main source to a body is food and it also could be the main enemy to the body...” (ID156, p.8)“… your body can do a lot, but there’s also a limit. Our body can only do so much for certain length of time and by knowing what you are eating you have the education of knowing what you are eating and what you’re drinking is what helps you balance it all out.” (ID156, p.8)“[if I didn’t eat fruits and vegetables] I wouldn’t have enough vitamins in my body, vitamin C.” (ID170, p.2)“[to motivate increase in fruit and vegetable intake] letting us know that all the vitamins and the iron that they have are good for the baby.” (ID174, p.1)

Instrumental

Cooking/recipes “So, but once I found out I was pregnant, that definitely changed, and I was like “Okay, I really need to start cooking for myself.” And like I said, it was just a matter of knowing what I am cooking and my portions, and what’s going in my food and, and my system.” (ID124, p.5)“He teaches me how to make it [vegetables] not the way I see it – like he says don’t do it in the microwave because it’s bad. It’s better either in the oven. Or don’t fry it because it’s bad. Just do everything with water…He usually likes steamed vegetables like carrots especially. He usually teaches me how to steam the carrots instead of baking them.” (ID134, p.2)“Well, my brother and sister…[help me eat more vegetables] because I’m picky with eating vegetables, but they just show me different techniques like oh, try this with ranch, or try this with cheese, or try this with different techniques, different dressings or stuff like that” (ID134, p.2)“He actually – he showed me – he tells me watch this video, watch this homemade video of eating fruits and vegetables. And even though he’s showing it, he’s actually teaching me how. And then he usually teach me how to do the broccoli like how to boil it and then put the salt or whatever and put the cheese on it. So basically, he’s like the recipe guy.” (ID134, p.3) “Well, I’m more confident now that since my boyfriend is the recipe guy, he’s telling me that he’s giving me ideas to do it myself and not him all the time.” (ID134, p.7)“He [mom’s father] just said like oh, he used to show me because he’s like another – he cooks, too. So he just shows me the portion. Like this little bit of rice, little bit of meat, and then a huge, large amount of vegetables.” (ID134, p.13)

Also described learning from a nutritionist through groups.“Or like go to a nutritionist [to learn how to eat more fruits and vegetables], go to like a group. Because I know a long time ago, they used to have a group with how they showed a video of how to start eating vegetables… I actually went there because it’s like not even a block away from where I live at. And then I asked hey, do you still do that nutritionist group? They’re like no, we

Instrumental knowledge comprised of hands-on learning about cooking and recipes as well as technology related to F&Vs. Learning about cooking and preparing F&V recipes occurred through different sources including pregnancy support groups, family, and friends. Participants described how they would be taught healthy cooking methods/recipes for F&Vs, which empowered them.

stopped it…but I think it was a big encouragement because now, usually, they show and give like papers and pamphlets. They usually bring the stuff. Like they brought steamed broccoli, steamed carrots, all different types of vegetables and fruits. And then people just tried it. And then people had different opinions… I went there when I like got the – like they had the demonstration. And they were like no, we stopped it like two or three years ago. I was like what? Are you kidding me? Because my friend used to be pregnant, and she was like oh, you should come with me to this group… But it was good. A lot of people because it started with a small group. And then all of a sudden, it was a big group. And there was a lot of people that were enjoying it... They actually – because I felt like I was in school again. They actually, give you like a quiz on the fruits and vegetables like how many should you eat or this and that or how many do you eat. It was fun. And then they had this big chart that they show. And then there was like a big portion of fruit and a big portion of vegetables. And then they had it was like a whole pyramid thing.” (ID134, p.16-18)

Technology (cell texting, internet)

“So then I would go online and I would like research and see what’s better. Like I mean, I saw that almonds are good for allergies, to prevent allergies. And like a couple of things, like they have their benefits if you eat them while you’re pregnant.” (ID124, p.3)“The nutrition with the pyramid, I think it’s a good idea what they did because it tells you the portions to have of different protein. I think milk, bread, and rice and fruits and vegetables, especially like the new pyramid that I’ve seen on the computer that has more vegetables and more fruit, and then the other proteins and stuff like that. I think it’s good.” (ID134, p.12)

Domain Definition Summary of Key FindingsF&V HEALTH OUTCOME EXPECTANCIES

F&V health outcome expectancies describe participants beliefs about what will happen as a result of consuming or not consuming F&Vs during pregnancy.

Women identified three main areas of F&V health outcomes expectancies: for the mom, for the baby, and for both.

Themes/Subthemes Illustrative QuotesMom Control gestational

weight gain, gestational diabetes; satiety; nutritious

“And I don’t think there’s any limit of eating them [fruits and vegetables] so I can eat as much as I can with them. I get filled with it.” (ID133, p.2)“I think if I stop eating fruits and vegetables, I’ll go and chase more sweets and stuff. I think once I started like if I gain a lot of weight and stuff like that I think that would wake me up. I’d be like let me try again eating the fruits and vegetables.” (ID144, p.7) “I would eat them to avoid gaining weight…Of course, because if you don’t eat vegetables, you get full with rice.” (ID155, p.1)“…just everything about fruits fills you up. Vegetable itself – lettuce with tomatoes and croutons – a big bowl of that could fill you up…when I go to a restaurant that’s the first thing I order to start.” (ID156, p.2)“When I was younger I was all about just junk food…but now as a 30-year old mother with three – with two children and one on the way, and with my age, and with my weight now – even with the baby – yeah, it’s a better way to keep healthy and limit my weight.” (ID156, p.7)

Participants felt consuming F&Vs helped enhanced satiety (i.e. filled them up) and discouraged overeating, subsequently helping them control gestational weight gain and prevent pregnancy complications including gestational diabetes, high blood pressure and high cholesterol.

“I just won’t probably get the right vitamins in my body.” (ID157, p.4)“…I don’t want to eat a lot of fat, that way I don’t gain weight.” (ID162, p.1)“Well, I would get very fat. I get fat when I don’t eat vegetables.” (ID162, p.3)“Yes, I believe that if I start eating only rice and meat and pizza or those things that would increase anyone’s weigh a lot.” (ID162, p.3)“I started eating more fruits and vegetables because I have gained a lot of weight and I don’t want to have any risks when the baby is born” (ID174, p.2)

Prevent pregnancy complications

“You’re just making harm if you’re not eating healthy because you can get high blood pressure, your cholesterol can be off the roof. Like there’s a lot of things that can now, can happen to you that can affect the baby as well.” (ID124, p.14)

Participants knew the long-term maternal health implications on health of eating/not eating F&Vs during pregnancy. Participants described how poor eating habits during pregnancy leads to maternal chronic diseases (i.e. sickness) and obesity in the future.

Improve energy levels

“In the first place [if I don’t eat enough fruits and vegetables], I won’t be feeling fine, I won’t be in a good mood during the day, I won’t have energy. It has happened to me before that when I stop eating fruits or vegetables I don’t have enough energy.” (ID116, p.3).“…usually a lot of people don’t eat that at all and they feel sick a lot. So if you eat more fruits and vegetables it will make you feel more energy you know. So I would say, yeah, I would rather eat a lot more fruits and vegetables.” (ID122, p.1)“…it’s really important for me to have them [fruits and vegetables]. If I don’t, I feel weak. It’s like something is missing in your body. Like you are just feeling weak, you feel like you are about to pass out. But when you eat right, you feel your – your energized like you can feel it. You feel it and it’s important. (ID122, p.10)“…if you were to eat McDonald’s every day, you’re just gonna feel sick and you’re gonna feel like, wah, I don’t want to do nothing, be a couch potato. Unlike if you were to eat veggies, then you’re like more motivated, you’re more active, you’re – like it just gives you a boost of energy.” (ID124, p.12)“[if you don’t eat more fruits and vegetables during pregnancy] it will make you lazy. Your mood, it changes a lot. You’re not in the mood to like eat like certain types of things like junk food. You’re not in the mood until you’ll be like since you’re used to eating fruits and vegetables. And then if they take it away, like they’re not going to do that. But it changes. Your brain won’t function right… Like you would be in bed all day and not exercise. And exercising you need vegetables. Like not full of energy. You would be just lack of energy, gaining weight.” (ID134, p.13)

When women reduced or stopped consuming F&Vs, they described feeling weak, sluggish, and less energized. Lack of F&Vs in their diet affected their mood, making them feel unmotivated. They also described feeling sick when F&Vs weren’t consumed often, suggesting that poor nutrition influenced their health

Prevent obesity and chronic diseases

“…it's gonna get to a point where I'm not gonna be a healthy person anymore. I'm gonna walk around always who knows, with asthma, diabetes, high cholesterol…and I'll be like oh my God, what did I do to myself? Because I did it to myself, nobody else did it to myself. So yeah, I do sit

Women described how poor eating habits during pregnancy leads to maternal chronic

here and be like if I don't eat healthy and I'm constantly eating this junk food, what's gonna happen to me? I know in the long run, all that junk food affects you somehow.” (ID101, p.8)“…If you don't, if you're constantly eating McDonald's, Wendy's or something that's not healthy and you don't put something healthy in your diet it's more of how's that gonna affect you in the long run? That's how I see it. How is all that junk food going to help you in the long run? Because I know that you know they say that oh, you know, if you eat a carrot, it's good for probably like cholesterol, your high blood pressure or this or that.” (ID101, p.12)“…after my pregnancy I have to eat healthy, so let’s say after, I won’t be diabetic anymore. I have to start eating healthy, so those are the things that I will be eating [fruits and vegetables] so I won’t get it again.” (ID102, p.8)“I think if I ate more fruits and vegetables I wouldn’t be at high risk at the point that I’m in right now.” (ID113, p.5)“Cause I know if you don’t eat good, the baby just sucks you up. They get all the nutrients and stuff they can from your body, so I don’t know. I mean, maybe in the future, when I'm older, it'll come out. Something will come out in my body cause I didn't eat good when I was younger, I guess.” (ID115, p.11)“[if you don’t eat fruits and vegetables during pregnancy] ….You are going to have a hard time being an old lady, when you get old you are going to be real sick.” (ID122, p.10) “…my grandmother, she’s like almost probably 80 years old. She eats so good. She can actually jog. She can walk up and down the stairs and there’s – my friend’s grandma who doesn’t eat like that at all, she just sits on a chair and she gets up she’s like ah, I can’t move. So there’s a difference. Like my grandmother does and you see her, she’s energized and she’s an old lady. So I see the difference. (ID122, p.10)“I won’t be as healthy as I am. I think that’s what gives you vitamins and things that just fight off viruses.” (ID133, p.3)“[if I don’t eat more fruits and vegetables during pregnancy] I think I will become Diabetic. Because if I keep eating only candy and stuff like that, I think eventually I will be Diabetic.” (ID144, p.5)“When you eat well you feel good because a vegetable is something soft, it’s not something that has fat that you know that will be bad for your health.” (ID155, p.1)“Because I always think about overweight that brings on a lot of diseases, there are a lot of diseases you can get if you gain a lot of weight.” (ID162, p.1)

diseases such as diabetes, high cholesterol, and obesity in the future.

Baby Poor fetal growth and

development“My son for example, I ate McDonald's throughout my whole entire pregnancy. I had a 10-pound-baby. I couldn't even believe it was a 10-pound-baby. My son had a seizure when he was 6 months old. He was only 6 months and I was like oh, my God, could this have been because of all the McDonald's I ate? All of the unhealthy things I did, you know, I sat there and I was like oh, my God, I'm pregnant again. Could this happen to my daughter now? My son has asthma. I think about it so I'd just be like what am I gonna do? Should I keep eating the way I'm eating or should I turn somewhere else?” (ID101, p.9)

Lower F&V intake was believed to cause poor fetal growth and brain development and lead to birth defects, poorer immune system (i.e. lower defenses), and smaller infants at birth.

“Because I know for my baby it’s health – for like the skin, the bones and stuff like that, so that’s why I eat it.” (ID106, p.1)“I know that the baby needs more source of those things [fruits and vegetables]. Like more vitamins that those things can offer. So because of the baby, not because of me.” (ID111, p.1)“I think so [having the ability to eat more fruits and vegetables] because of the baby. I think, for them, I have to do it. I don’t know. I think this way, it’s a life inside of me. So everything that I can do to improve in any problems, any conditions – like the bad conditions of birth defects or something like that, I will do it.” (ID111, p.4)“So, for the baby, I have to at least try to eat certain things that I don’t like to eat. And if I don’t like, I don’t like. But sometimes, you know, it gets through. I can go with for three or four forks of, for example, collard greens. I eat at least three, so I have at least a little bit.” (ID111, p.7)“I would love to eat more fruits [inaudible]…Because I feel like if I don’t my baby’s not going to come out I guess as healthy as I want him to come out healthy.” (ID120, p.1)“[…if not eating more fruits and vegetables] I’m not giving him what he needs or my body. I mean, I’m not giving my body what it needs for my baby to grow nice and healthy.” (ID120, p.11) “I think it changed [eating more fruits and vegetables] once I found out I was pregnant and then during my whole pregnancy. Just because they tell you like some vegetables that are beneficial at a certain stage of pregnancy, like if the baby’s developing the brain, then they’ll tell you, you know, eat…So I guess like throughout pregnancy I’ve just changed my diet like little by little as she continues to grow.” (ID124, p.8) “So imagine doing that to an infant. It’s getting all the nutritions from you, and if you’re feeding it fries and burgers and, and stuff like that, it’s like they’re not gonna want to develop as quickly or – I just feel like they’re just not gonna develop as well as if I was to just eat veg, eat my veggies and eat my fruits…” (ID124, p.12)“And there’s just things like heart attacks, you can get a heart attack. You can get a stroke. Because your blood, like, your blood level just increases once you’re pregnant, so you’re putting all that junk food in. It’s, it’s kinda working the heart a little too much and working your body a little too much, and then you’re trying to grow this fetus, so your body is obviously gonna try to help you out and not the baby.” (ID124, p.14)“[If I don’t eat more fruits and vegetables during my pregnancy] the baby is probably going to come out less healthier and smaller…[the baby] Probably won’t be like as big, like fully-grown, he probably be like a small baby.” (ID125, p.5)“[If I eat more fruits and vegetables during my pregnancy] it will develop good with the brain – like functioning more with the brain and functioning with itself like the heart, the sugar, blood flow. Just with the baby itself with the brain and stuff.” (ID134, p.1)“They encouraged me like you should eat more fruits and vegetables because you don’t want the baby having trouble like Down syndrome or any type of trouble with the baby. You never know if the baby is going to have pneumonia or any just heart disease.” (ID134, p.2) “The baby, it would like – when it’s born, it’s going to have a lot of – it probably is going to be in a NICU hospital for a while. Probably would have some type of disease. Or sometimes, they’re

not going to make it. Sometimes they do, sometimes they don’t. And then they will have like Down syndrome or any type of mental illness issues. So it’s worse for the baby than humans because the baby will get sick faster than adults because adults can take the cold and flu pill and just feel better. But for the baby, the immune systems are very weak I think.” (ID134, p.14)“I’ve learned that not only certain foods can affect me- it will definitively affect the baby first” (ID156, p.10)“…the infant will be more vulnerable than me inside my belly to all these pathogens …So if I’m not healthy most likely I will be risking my baby.” (ID156, p.11)“Just because I know it’s better for the baby” (ID160, p.1) “If you don’t eat fruit or the prenatal pills, I think the baby will have very low defenses, that’s why it’s very important to eat fruits and vegetables during pregnancy.” (ID174, p.2)It is very nutritive especially for the baby, because of the vitamins they have. (ID174, p.1)

Mother and baby Poor health during

pregnancy“One of my motivations are my baby and my healthy, too, because if I don’t eat healthy, my life is at some risk and the baby’s too. That’s why it makes me motivate to eat more fruits and vegetables.” (ID106, p.1) “…I think [that if I don’t eat fruits and vegetables] I would eat more junk food – so … maybe I would gain more pounds. That baby’s not gonna come out like that healthy. Like, my blood sugar – whatever – my pressure’s gonna be bad maybe. That’s what I think if I don’t eat fruits.” (ID106, p.4)“I think if I don’t eat right and good, like those fruits and vegetables, I think it’s not like the baby can grow more. Weak or with some birth defects. I believe those things. So imagine if you eat fast food every day. I don’t think those things are healthy. Imagine, every day you stop at the fast food and grab those greasy – like I said once a week, once in a month, I don’t think it will kill you. I don’t think it will have any problem with the baby. But like, every day, every day just eating unhealthy, I don’t think it’s good. Either for you or for the baby. I don’t think that’s a good thing.” (ID111, p.7) …I like it [to eat more fruits and vegetables]…it’s healthy…With the baby and yourself, basically. With your teeth, eyes, your bones.” (ID121, p.1) “If you’re not eating [fruits and vegetables], the baby won’t be healthy.” (ID121, p.1)“I just think [eating fruits and vegetables] it’s healthy throughout your whole pregnancy, not just for you but for the baby, as well. So I just have to keep that in mind.” (ID131, p.1)“Because it’s good for the baby and yourself, but more for the baby to grow healthier. You don’t want any trouble while being pregnant like high blood pressure, diabetes, or high cholesterol or low cholesterol. And I think it’s healthy.” (ID134, p.2)“We think that it’s not good for me or the baby. So we say, one apple will be good for both of us.” (ID149, p.2)“Because I have to think about my baby. It’s not only about me anymore. It’s also him.” (ID149, p.3) “[If I stopped eating fruits and vegetables] it would harm both the baby and me because its

Participants felt that maternal and fetal health were linked during pregnancy. For some, this appeared to be sequential, specifically that lack of maternal consumption of F&Vs led to poorer health for the mother during pregnancy, subsequently affecting fetal health. For the majority, they understood that F&Vs provided nutrients to both mother and fetus and that poor F&V intake negatively affected both maternal and fetal health outcomes during pregnancy.

defense would be low and I would end up very bad maybe after having him because you end up weak and without all the nutrients all those things provide I think it would affect a lot.” (ID149, p.4)“So I don’t want to come into that point where if I’m pregnant and I catch a disease or an infection and the baby will be more vulnerable than me” (ID156, p.11)“Well that the baby and I would not be healthy…We would get sick quickly due to a lack of fruits and vegetables. (ID172, p.2)

Domain Definition Summary of Key FindingsSELF-EFFICACY Describes the belief in one’s ability to complete a task or reach a goal. Self-efficacy improved when

women were already consuming and enjoying F&Vs, felt they could improve health outcomes for themselves and their infant, and were able to make the choice to eat F&Vs.

Already consuming F&Vs/Enjoy eating F&Vs

“I have never been one month without eating fruits, I don’t think I could. If one day I have not eaten any fruits or vegetables I feel the need to eat it, so I think that after a month my body would feel strange. I would have to return to the habit of eating fruits.” (ID116, p.3)“…Just because I am a veggie freak and a fruit freak. Like, and now that summer’s coming and like there’s more fruits and everything can be organic and it’s just like, I’m so excited. And I am a veggie, like I just know, I just love my veggies and I love my fruits.” (ID124, p.8)“In my case, I don’t like junk food, I don’t like it. Each pregnancy is different but I prefer to eat bananas or apples. When I’m in a hurry because I have an appointment I do that, but for breakfast I drink juice and I have a good breakfast.” (ID137, p.1)

Enjoyment of F&Vs can lead to improved self-efficacy and subsequently increased consumption.

Improving infant/maternal outcome

“I think that [if I gave up eating fruits and vegetables] I have to think, “That’s not for me. That’s for the baby. The baby comes in first place.” Because he doesn’t ask to be born. So everything that I could do for her or for him, I have to do it. If you want to be a mother.” (ID111, p.8)“I think that if you are used to not eating them, it is difficult to change that habit, but if you get the habit of eating them, then it is possible, especially if are aware that you’re pregnant and you have a baby inside that needs the best in order develop well, I think that for the love of that baby they would start eating them. I think that any mother could start eating fruits and vegetables.” (ID116, p.3)“It’s mostly my health. It doesn’t matter if I have money or not. I will find a way to eat.” (ID156, p.23)“Because I know it’s good for the baby. And if I was able to get ways that it would help me, then I know it would be easier to eat them.” (ID160, p.4)

Participants also felt confident they could eat more F&Vs during pregnancy knowing the health implications improving intake would have for their baby.

Decision-making (ability to choose)

“Sometimes I do feel like eating more vegetables and fruits but then there's times where I'd just be like I don't want to because it's just like, I don't know, you don't wanna overstuff yourself with something or try to like eat something that you really don't want to so I'd just be like I'd be iffy about it. There's times that I try then there's times that I'd just be like no.” (ID101, p.1)

Women expressed that eating F&Vs was a choice, which enhanced self-efficacy by placing the decision to eat

“I have the ability to eat more fruits and vegetables. I just chose sometimes not to.” (ID101, p.2):Well, like put in my mind that I haven’t eaten fruit and vegetable in awhile, so that it’s like – from a diet or is better for me. So that’s like something that I will have in my mind to eat it – eat them again for the next month even if I don’t want, because I’m used to – maybe to junk food. But I would try all over again.” (ID106, p.5)“No, if I like the fruit I’ll eat it, but (if) I don’t like it I won’t eat it.” (ID120, p.2)“Yeah, if I didn’t have the money, I would probably just eat fruits and stuff like that, but when I have the money – like temptation like I have to go buy me my M&M’s.” (ID122, p.9)“…nothing keeps me from eating fruits and vegetable. It’s just maybe myself. Maybe I’m – maybe I don’t – maybe I’m just – maybe I don’t feel like eating it. That could be a cause to it. Maybe I don’t have the money for it. It depends. It all depends on me. That’s the only thing that will prevent me from eating fruits and vegetables.” (ID156, p.18)“Because you have to like something in order to want it. But I’m the type of person I like to eat fruits and vegetables so I would end up eating it.” (ID156, p.18)

F&Vs in their own hands.

Domain Definition Summary of Key FindingsINTENTIONS Defined by Schwarzer et al. as, “intentions comprise a person’s motivation towards a goal or

target behavior in terms of direction and intensity”1Internal and/or external motivation influenced prenatal F&V intake among women.

Internal (i.e. change mindset, think positively, change attitude, personal choice)

“If I'm motivated [to eat more fruits and vegetables], I'm motivated because of myself, because that's what I want, not motivated by someone else or anything else.” (ID101, p.2)“Well, there's times when I'm laying down and then I just started thinking what can I eat? I wanna eat something but I don't wanna eat like nothing junky. I'll probably like think about something healthy so then I'll think about like maybe some fruits or maybe some vegetables or something different, something that's gonna fill me up and I'm gonna be like oh, that was good or I need to try that again or you know, maybe I can eat that tomorrow but it's mostly just like I said, just comes from within myself because it doesn't come within myself then there's no way I would do it.” (ID101, p.2)“…it’s in me that I have to eat it.” (ID106, p.1)“ It’s internal on me. It’s like…I have to eat this, because of – it’s better for me.” (ID106, p.1)“I could [eat more fruits and vegetables during pregnancy]. I know I could I just choose not to.” (ID113, p.2)“Nothing prevents me I just choose I choose not to eat fruits and vegetables sometimes I choose to eat junk food that I do.” (ID113, p.4)“Like I just think motivation. Like I would really have to say in mindset, I would have to be like, ‘I really need to eat my veggies,’ or ‘I really need to eat my fruits and stuff.’” (ID124, p.16)“I don’t think there’s anything specific that can help you eat more fruits and vegetables because

Some women felt that changing F&V eating behaviors had to be generated internally within themselves; outside sources couldn’t influence their decisions as strongly as internal motivation.

1 Schwarzer R, Sniehotta FF, Lippke S, et al. On the assessment and analysis of variables in the Health Action Process Approach: Conducting an investigation. 2003. Available at: http://userpage.fu-berlin.de/gesund/hapa_web.pdf. Accessed on: February 16, 2016.

if you don’t want to eat them, you won’t eat them. It’s just all your mindset: you either want to eat fruits or you don’t.” (ID131, p.2)“It’s all about in the person...You could try to convince them, but if they don’t want to do it, they’re not gonna do it. So it’s kinda hard.” (ID131, p.3) “… nothing keeps me from eating fruits and vegetables. It’s just maybe myself...maybe I just don’t feel like eating it.” (ID156, p.18)“If I don’t want to I won’t.” (ID156, p.19)“Just to eat it more. Encourage yourself to eat more. (ID158, p.2)“Because if you put your mind to it you will achieve what you want.” (ID162, p.2)“My negative side that could be it. I have a negative attitude. Like I am like ‘I can’t eat this and I don’t like this.’ If I were a person that went, ‘I am going to eat this, I am thinking of eating this. I can do this.’ But I feel that I can‘t do it because of my negativity. I don’t make an effort, and I always say that I am going to try to eat them but I don’t.” (ID164, p.2)“I would motivate myself to eat the fruits and vegetables I used to eat.” (ID170, p.2)

External (i.e. modeling others)

“…It's the same thing like if I was at one of my sister's house, she showed me this thing with cucumbers that she does. She has like this own recipe where she just takes the dressing and some other things that she does but I really don't know the recipe. I need to get them. I just start dipping my finger and I start tasting things and after I start tasting things, it's more of okay, let me dip this in it. Let me dip that in it. Maybe let me try this. That's what got me to start eating more stuff. Like I started eating carrots in there. That was good. Cucumbers, she showed me the cucumbers, started eating those. Tomatoes, I dip some tomatoes in there like it's been good but it's mostly if I'm at someone's house and I smell you cooking. I see you cooking, I get the urge to wanna eat veggies or fruits or whatever it is that you're cooking and then I start wanting to okay, let me eat healthy.” (ID101, p. 4)“He helps me buy them, makes me motivate – like, “You have to drink it. Come on, I’ll drink it with you.” He takes some – take a little bit of it, and he drink it with me. That’s how he help . He go and buy them and stuff like that.” (ID106, p.2)“I think if a nutritionist would have spoke to me to tell me the goods and the bads probably it would make me eat even more.” (ID113, p.2) “Here at home we eat fruit. My husband likes fruit very much and he motivates me to eat fruit. My children also like fruit very much.” (ID130, p.2)“They [friends] got me trying just different vegetables. It’s similar to what my family does, but they actually make me eat it like make me like oh, try this. And I just eat it. (ID134, p.3)“…so many people encourage me to eat fruits and vegetables that I’m like I just go to the fridge and eat and pick out strawberries or eat a banana or anything.” (ID134, p.11)“He’s [mom’s father] like oh, you don’t want to be just like me. Like I should have eaten vegetables and fruit when I was younger because now I have diabetes. And then he had a heart problem. And then he’s like I should have listened to my mama. And he’s encouraging me because he don’t want me to go through the same thing that he had.” (ID134, p.13)“I believe I would need someone to motivate me. Like friend that would tell me to eat more fruits

Some women required external motivation from family/friends/coworkers to initiation action/coping planning strategies.

because it’s what is best for my baby, and for yourself.” (ID164, p.1)Domain Definition Summary of Key FindingsACTION AND COPING PLANNING STRATEGIES

Action planning behaviors are those that help identify when, where, and how behavior change will happen. Coping planning behaviors are those that help one to cope with potential barriers that could inhibit change.

Action and coping planning strategies were influenced by intentions. These behaviors were instrumental in helping change prenatal F&V intake.

Goal setting (i.e. plan ahead; establish routine)

“Having a routine, get up, you know, if I had an apple, you know, about a month ago, I can have an apple again in the morning.” (ID101, p.11)“I would establish some goals, to see what my health is like. Probably, if I haven’t been eating fruits and vegetables I will have gained more weight, so I would establish a goal. I would see what my health is like and how I feel and try to find the way to start eating fruits and vegetables again.” (ID116, p.3)“So you can prepare yourself, because sometimes you wake up in a day and you are brushing, your cleaning, you’re doing everything – you are going around doing what you got to do. And then when it’s time to come home, you have no clue what you are going to make. So you just put anything together. But if you prepare it like you know what you are going to do, it should be a lot easier. (ID122, p.11) “Like I keep saying, I need my crockpot. I need the crockpot. Mine’s broke, but the crockpot helps a lot too, because it’s so easy. You wake up in the morning, while you are eating breakfast, you start putting stuff together and you got a healthy little meal.” (ID122, p.11) “Just encourage myself or push myself to eat fruits and vegetables just to start one day at a time and not rush. Oh, I have to eat five portions of vegetables in one day. No. Just eat like two servings of vegetable each day…But you don’t have to eat a big portion, just a small portion to see if you like it. And then just start little and then medium and then large.” (ID134, p.16) “I think you can plan your week food and say, well, I will cook today but I will also include broccoli and beans. Always include some vegetables with that and then for dessert, instead of eating cookies or pie, to eat some fruit.” (ID149, p.4) “I’m already halfway, almost to halfway of becoming 100 person that eats fruits and vegetables. I wouldn’t want to back down.” (ID156, p.22)“Making a plan to eat vegetables and fruits…Like on Monday I will eat grapes, on Tuesday I can eat an apple. (ID170, p.1)

Goal setting, which included planning ahead and establishing routines, was one strategy participants identified to help them increase F&V intake.

Self-monitoring (i.e. planning a menu/determining what will eat)

“…there's times where I sit on and I'll be like maybe if I write down what I've eaten during my day, I can probably change that the next day. If I ate McDonald's probably like all day, I'd probably be like okay, maybe tomorrow I'll try not to eat McDonald's and try to replace the McDonald's with something healthier like maybe a fruit or maybe a vegetable, maybe something different…” (ID101, p.10)“…Like I said, maybe if I write down what I ate the day before, the next day I can change it.” (ID101, p.10)“I’ll make the salad and I’ll eat it for the whole week.” (ID102, p.1)

Women identified self-monitoring techniques, such as developing a menu/meals, writing shopping lists, documenting consumption patterns, to help them increase F&V intake during pregnancy.

“Or if like I go to the store I leave like mostly – like if I only say like five dollars, I’m like okay this five dollars could just be like – because if I take my whole wallet than I know I have money there to buy whatever I want. So now I just leave my wallet at home and like take five, three or four dollars and I be like with this I have enough junk food to buy whatever I want. (ID120, p.13)“Probably like a menu, you write your menu down.” (ID122, p.11)“I guess like probably like writing it down. Like writing a grocery list down before, I go to the store. (ID125, p.7) “[To eat more fruits and vegetables] I guess I start writing my food down. Like if I start writing it down like this is what I want to eat today and make sure that I actually go back and look at it and eat it maybe that would help me more. I’ve already started doing that.” (ID125, p.7)“[To increase fruit and vegetable intake, a strategy would be] I guess like probably like writing it down. Like writing a grocery list down before, I go to the store… The fruits and the vegetables that I want to eat and like juice and milk instead of like soda.” (ID144, p.6)“Like making a diet. This portion of fruits at such time, vegetables at this other time and so.” (ID155, p.4)“I would have to know more. How much is my income first in order to know how much am I going to spend on fruits. How much am I going to spend on vegetables? How much am I going to spend alone on meats? How much am I going to spend on boxes of cereals…that way I will balance my budget out? (ID156, p.15)“I would make a plan, a nutrition plan and I would stick to it. That could be like a strategy that I would use for myself.” (ID164, p.2)“Yeah, write them on the list when I do my grocery shopping.” (ID167, p.3)

Experiment with different F&Vs/Try new foods (e.g.,, cultural culinary practices/barriers)

“I don’t, I don’t know. Maybe in like cereal and things like that. Like if I eat a banana, I would put it in cereal. And not veggies. But yeah, fruits, I would definitely use them for breakfast and stuff, to make salads.” (ID102, p.1)“I’ll do like a mix, mix of fruits. Like I say, I have to like throw things there, like cheese and things like that, so it could, it won’t affect me and my sugar level.” (ID102, p.7)“Try different fruits and vegetables and see which ones I like and then I would start buying them. Like if I like grapes more than bananas, if I like broccoli more than carrots, I could start buying the…broccoli.” (ID113, p.6)“Trying different stuff…Because I always buy the same fruits. Isn’t nothing different about it. (ID121, p.5)“I would change different things. If I get tired of eating fruit, I would start eating vegetables, or I could make some fruit juice or a fruit shake if I get tired of eating fruit. I could eat raw vegetables and if I get tired of that I could add them to a stew with chicken, or with meat.” (ID130, p.2)“Yes, if I get tired of a specific fruit, I can try with a different fruit I’m not very familiar with, like kiwi, melon, or things like that.” (ID130, p.3)“I would say instead of making it like helping with family and friends, just make it on your own style. If you don’t want cheese on your broccoli, you could use something else. Or instead of

Different methods of experimentation included adding mixing new F&Vs to preferred foods or varying F&V preparation method.

ranch, use something that you like. Or you can mix – like some people, I saw this crazy – or do like crazy cravings. If you’re craving pickles and ice cream, you can do that. Or use pickles and pineapple and just have like this sour sweet thing. I think it’s a good idea. (ID134, p.6)“Just doing like not eat like the same vegetable like every day. Like just [inaudible] something like the same day a week, pick a day that you want to eat certain kinds of vegetables, not all the time, not in one day eating vegetables. Like today, I could eat broccoli. And then tomorrow or two days later, I could eat carrots. Then the next day, you could eat cabbage or spinach. Because then some people I think with pregnant women, they be thinking oh, we have to eat the whole five get table thing in one day. But that’s what I did at the beginning. That’s the reason why I was not a very big fan of vegetables because I thought I was supposed to eat asparagus, broccoli, cabbage, and spinach in one day.” (ID134, p.15)“…It’s the way you mix it or complement it with each other. Instead of rice, and beans, and meat all the time – which – it fills you up, but it, kind of, opens up your stomach to eat more of it. I want some more of that buffalo chicken. It was so good and finger licking. Then we need to find the same way to feel that way for fruits and vegetables because they're good, too.” (ID156, p.14)“I will eat more. It’s just I have to meet a vegetable. Vegetables are like strangers to me. I have to get to know them in order to eat them and like them.” (ID156, p.22) “Adding different kinds of things with what you like…if you was to take the fruits that you like, like strawberries, pineapples, grapes and …like once a month add something new to it, like watermelon and seeing how it tastes.“ (ID160, p.9)“I don’t really try a lot of new things, but I think if I was to try to prepare something with a vegetable, or something that I didn’t taste and didn’t know that it was a vegetable at first, and tried it before I knew; I might end up liking it. Because I know if it’s something that I’ve never had, I don’t want to try it.” (ID160, p.2)“Trying new things. Because I know that sometimes when I see things, like I said, they look good but then I don't want to try them because I don’t know how they taste. Or I’m afraid to taste it and not like it at all. But trying new things would be the only thing.” (ID160, p.2)

Change home environment

“…my boyfriend sometimes brings home junk food and I could be eating something like the healthiest thing and I'll see him with something and I'll be like okay, let me try that or give me some of that. (ID101, p.7)“Maybe like tell my friends – I mean like my family, “Can you help me because I’m like stop eating this? I need more of you.” Stuff like that when I go places – I just go and see more fruits than junk food. So I can eat more healthier.” (ID106, p.6)“Buy…like more healthy stuff for our house – less junk food.” (ID106, p.6)“In order to eat more fruit, I should have the fruit dish full of fruit so I would feel tempted to eat more fruit. Because when there is no fruit I eat something else, like chocolate or things like that. If I see the fruit I will eat it.” (ID116, p.1)“I see the fruit and I feel like cravings and I eat it” (ID130, p.2)“My daughter eats lots of fruit because she wants to lose weight; it’s a way to buy more fruit and to motivate you. When you see the fruit you eat it, when you don’t see it you don’t eat it. In some

Women expressed how they were influenced by their home environment, including seeing others eat junk food, lack of F&Vs in the home. Making F&Vs more available and visible in the home were behavioral strategies that helped change the home environment and encourage more F&V consumption.

way she motivates me to buy more fruit to eat.” (ID137, p.1) “…although you might not think it’s true, when you have them before your eyes you want to eat them.” (ID137, p.2)“I would prefer to buy it and when I want to eat it I have it there.” (ID137, p.2)“I could tell my family, my brothers and sisters, my kids to eat vegetables and fruits.” (ID143, p.2, April 2)“[to eat more fruits and vegetables] Stop buying candy and chips. Yeah, just stop buying the junk food and stuff. Like stop being tempted to eat a whole bunch of sweets and things like that. Fruits are sweets too, but it’s just candy is so good.” (ID144, p.4)“…like bring in healthy stuff with me. Like if I go to the store, you know how sometimes you’ll be shopping and you see like Taco Bell and Wendy’s and all that right there. So that’s the first place that you go. I think if I start bringing things with me that I could just eat it while I’m shopping, I don’t have to go to the fast food place. I could simply just go in my bag and me and the kids could eat the little stuff that we bring like granola bars or something like that…Eat that instead of running across the street real quick and eating a big Wendy’s meal and going back.” (ID144, p.6)“…when you don’t have the choice of eating an ice cream, eating something… and you have the fruit right there, you have somewhere to choose from.”(ID147, p.3)“Yes. Because if we have a nacho bag in front of us, we will say, oh nachos! We tend to go with the not healthy things some times.” (ID149, p.1)“I would leave a fruit on every corner of the house to find it more easily… At least having a little basket of fruits in the room, another one in the kitchen, another one in the dining room.” (ID149, p.4-5)“I think in order for me to eat fruits and vegetables I would need to have them in front of me...It helps me remember that I need to eat more.” (ID151, p.2)“No, just the main thing is to have it [fruits and vegetables] around the house, so that you have them [inaudible]. You don’t have to go out to the store; it’ll be there so you can get it. (ID167, p.3)

Family shared meals, not eating out, home cooking

“[to eat more fruits and vegetables] find a way, have friends, have a fruit party, have a vegetable party, I don’t know. Something to motivate you to eat it.” (ID115, p.12) “Once I found out I was pregnant, I definitely started eating at home more…I just like being at home and making my own food just because I know what’s going in there, I know what it is. And so if I was to get sick from anything, I’ll know it’s one of these items. Because we used to eat out all the time, and if I was to get sick, I would be like, I don’t even know. Like we had McDonald’s for breakfast and then we went and had Chinese for dinner, and in between we, we like picked up Taco Bell, so it’s like which one got me sick, you know?” (ID124, p.1-2)“So it, so now that I do cook at home and I do make my own stuff, it’s like either I can pick if I get, was to get poison, food poisoning or anything.” (ID124, p.2)“Well, not eating so much food from outside and feed myself with fruits and vegetables…[instead of] McDonald’s, Burger King, goods like that.” (ID158, p.2)

Increasing the frequency of cooking and eating at home promoted more shared family meals, creating a support system which encouraged more F&V intake during pregnancy. Eating at home also fostered less consumption of fast food and also provided a sense of security in the safety of the food eaten.

“Well, if I stop eating fruits and vegetables, I would have to eat more food – not from outside, but more home food. At least. I have to feed the baby anyway.” (ID158, p.3)

Change food purchasing patterns/food preparation patterns

“I hope to eat more fruits and to spend the money on that instead of buying things that are not so nutritive.” (ID116, p.2)“…to buy more of those things instead of buying sweets or other type of things. I have always heard that it’s preferable to go to the supermarket with your tummy full so that you are not tempted to buy other things, so that’s what I try to do.” (ID116, p.3)“Going to the store and getting the – picking those out first before anything else.” (ID125, p.6)“…I think that’s the first thing I do when I go grocery shopping. Just go to the fruit and vegetable aisle first.” (ID134, p.10)“I think a good strategy for me is to like bring fruits with me when I go out. Because the first thing I see like when I go in a store to purchase an item, I just grab, you know, like a bag of chips and just open it or something like that. I feel like if I bring the fruit with me, I’ll be able to just go in my bag and say, oh, I have something with me. I don’t even have to go in the store and look at all the good candy and everything.” (ID144, p.2)“Buying less snacks, less snacks to buy more fruits, to replace them... Like potato chips and buying less ice cream, less potato chips and cookies, replacing them for healthy things.” (ID152, p.2)“So knowing that fruits and vegetables can get spoiled I would have to tend to add fruits and vegetables to everything I eat.” (ID156, p.13)“There is no oh…fruits is only for breakfast. Fruits is only for snack. No it’s not. Fruits and vegetables, you can eat at any time in the morning. You can have salad for breakfast…you can have that with an oatmeal. You can have it. It’s just a food.” (ID156, p.14)“Well… buying a lot and eating them on a daily basis.” (ID158, p.3)

Women described purchasing more F&Vs in place of junk food, visiting the F&V aisle first, and budgeting more for F&Vs purchases. Due to purchasing more F&Vs, participants described consuming them more frequently and in unique ways (i.e. mixing with different foods) to ensure they didn’t spoil.

Self-remind, self-motivation

“Probably putting a reminder on my fridge, reminders you know, oh, make sure you buy this or buy that, having a lot of people, have a lot of electronics now. That’s very important in our role for some reason, setting a reminder in my calendar, oh, don’t forget to buy this, you know, reminder so I’ll remind myself to buy things.” (ID101, p.12)“Because of the baby. Like I said, I think for her or him, because I don’t know what it’s going to be yet. But I think it’s the healthy way to do it. There is no other way.” (ID111, p.7) “I mean, a fruit or vegetables. There won’t be because if it’s not in the house it’s somewhere out there. I’ll end up finding a fruit or a vegetable to eat. It’s there. It’s there. I – since I’ve made it a part of my life it’s everywhere I go.” (ID156, p.19)“Maybe when my mom – I would say to myself like when she offers: instead of saying no, try it a little bit. Like hers. Like I would do that sometimes: let me just try yours, and if I like it, I’ll make myself one. You know? So even then just to – not force myself, but to say: just try it; you never know how it’s gonna be.” (ID160, p.8)

Women explained that putting reminders out for themselves or encouraging themselves to eat F&Vs (i.e. being self-motivated) would help them improve their F&V intake.

Force yourself “[to eat more fruits and vegetables] I have to force myself. Like put it as a goal… (ID120, p.11)“But I would suggest that you just do it, you force it, even if you have to put it in a blender and drink it or something because - you need to do it.” (ID122, p.7)

Women used different methods to force themselves to eat unwanted F&Vs, knowing the

“…but pregnancy too as well, you are so picky and sometimes you just feel like you don’t want anything. But I think that you should force it. Even if you don’t like something if it’s good for you, you should just force it and get it over with and put it in your body.” (ID122, p.7) “…I kind of force myself – like I don’t like green peppers. I’ve been finding myself cutting them in slices and just dipping it in like a humus and eating – and forcing it – and just getting it over with. It’s not going to kill me.” (ID122, p.7)“Because there’s a lot of vegetables and a lot of fruits. Like you don’t’ have to just eat a specific kind. If you don’t like a specific kind, try a different kind. See which one you really like and try to eat all of them.” (ID122, p.8)“I’ll just start eating them – I just basically just…force myself to eat it.” (ID157, p.4)

importance of consuming F&Vs during pregnancy.

Bidirectional role-modeling (what mom eats, child eats and vice versa; co-workers)

“…I have a 4-year-old so if I'm eating junk food, then he's gonna want to eat junk food so we're mostly trying to cook in the house…” (ID101, p.7)“Yeah, and I put it on my kids plates but they’re like EW, I don’t want this. I’m like, but try it. You know? I try to encourage them. I be like look, it taste good. I eat it…” (ID115, p.6)“…You know cause I do have my daughter, she's like but why you don’t eat? I'm like you know, you don’t know what it is not to sit down – to sit down and not enjoy a meal. It's like very annoying. It's really annoying. So sometimes I rather not eat. I mean try my best to maybe change the routine. I don’t know how much can I change it, but yeah. I don’t know.” (ID115, p.11)“…if my daughter doesn’t see me eating them [fruits and vegetables] she’s not going to eat them. She’s not going to want fruits and vegetables. (ID120, p.14) “Because everything she eats, I got to eat too. Even if I don’t want it, like she comes and puts it in my face and I have to eat it.” (ID120, p. 14)“She thinks that I need to show my kids how to eat right, because they think it’s okay to just go get like a TV dinner and all because it has corn it’s healthy. It’s not healthy. You got to really make the stuff and yeah, she teaches me a lot.” (ID122, p.11)“…I know my co-worker, personally I’m eating fruits and constantly taking them to work, and she’s like, “I see you eat healthy and I want to do it, too.” So it can also be like who you, who you’re with and who – what is that word I’m looking for? Like who you spend your time with and who’s, who’s influencing you as well.” (ID124, p.16)“The majority of the time when I eat fruits – my mother-in-law eats lots of fruits so my father-in-law sometimes will make like fruit cocktail with lemons, he’ll use watermelon, melons, grapes. He throws in a lot of fruits and pieces of lemons and that’s all. And my mother-in-law eats a lot of vegetables.” (ID139, p2) “But watching him exercising, watching him eating differently I had to cook differently.” (ID156, p.9)“Like my mom…she tries to add more healthier things into the food. And now she’s eating salads and stuff like that. So it’s like- no puts pressure on me , but I see how she’s able to do it and I see how she’s able to do it…her eating healthier makes me want to eat healthier…” (ID166, p.3)

Women were aware they served as role models to their children, prompting them to eat more F&Vs. They also observed others modeling optimal F&V behavior, increasing their motivation to consume more F&Vs.

↓ junk food & candy to “Cut out the junk food and replace it with like fruits or vegetables or something.” (ID100, p.5) Women reduced their junk food

↑ F&V intake “Instead of eating like a little cupcake they [my mother-in-law and boyfriend] would say well eat a banana. I’ve been choosing the fruits instead of the junk food.” (ID113, p.1) “I know I have to push the junk food aside and just say you know what I’m just going to buy apples, grapes, strawberries and all that. So to put my baby and my health in the right place that I’m supposed to do.” (ID113, p.3)“Instead of buying junk food, eating junk food, I could buy the fruits and vegetables that me and the baby needs.” (ID113, p.3)“Maybe not to buy so many sweet things and buying more fruits. Fortunately, I have a strong will power so even though there are sweet things to eat or when my in-laws or my family offers me chocolates or sweet things, I try not to eat them. Usually, I try not to buy them.” (ID116, p.2)“And I will start eating more fruits and vegetables. I started cutting down on my junk food. I don’t eat as much as I did before. But I’m starting too, yes.” (ID120, p.12)“Eat them frequently, I would stop eating so much fat and eat fruit… Like fried food, like [eat less] chino [chinese food], fried potatoes, hamburgers, sodas, and eat more fruits.” (ID130, p.1)“..in the morning have your breakfast and have your fruit next to it. And in the afternoon, when you’re hungry, just grab a fruit instead of grabbing munchies or chips or all that stuff.” (ID131, p.3)“[strategy to motivate you to eat more fruits and vegetables] Watching your weight by avoiding fast foods and keeping in mind that you might gain double the weigh.” (ID136, p.1)“Well, yeah. I’ll probably just gain weight again because if I don’t find – most likely if I don’t find something healthy to eat to substitute a fat food and fill me up most likely I’m going to grab a chips or a snack. I’m going to grab something in order to prevent myself from feeling hungry. And I know that fruits and vegetables – they fill you up.(ID156, p.23)“An effort to stop eating the things that are not so good for me and start eating vegetables and fruits, a little bit more.” (ID162, p.4) “Maybe stop eating candies and eat more fruits instead.” (ID166, p.3)“Buy less junk food. When I get hungry a little bit, there’s only fruits that’ll be there for me to eat, so I will do that.” (ID167, p.2)“For example if I have to buy a thing that is not very good I would change it for fruits and vegetables.” (ID172, p.2)“I should eat less junk food and more fruits and vegetables.” (ID174, p.2)“I’d rather eat a banana or an apple or strawberries or a yogurt rather than junk food. That helps my nutrition and the baby’s as well.” (ID174, p.2)“At first it’s difficult because you’re used to eat junk food but, as I said, we have to make the effort to eat fruits and vegetables for the baby’s development.” (ID174, p.3)

intake by purchasing less, having less within the house, or not accepting it if it is offered. Instead, they would make conscious choices to purchase and consume F&Vs in place of junk food, knowing it is better for them and their baby.

Cooking/recipes “…It's just more of if I cook, I'd probably eat more healthier and then if I don't cook then it's [inaudible] like we shouldn't be like that. So I should be eating healthy all the way around but I'm not which I can be really honest about that.” (ID101, p.6)“Having someone to teach us, like me for example, a better way to do it. For example…I went to Panera Bread two or three weeks ago and I had that soup they call cheddar broccoli? And I love

Women expressed desire to learn different methods to cook healthy, tasty F&Vs for themselves and their families. Not having recipes or being

it. I love it. I love, love, love. It has the cheddar on it, the cheese. But probably [there is] another way, more light that people like know. Like those chef people or I don’t know. Another way to do it.” (ID111, p.2)“Because like the [broccoli] soup, I know that it has the cheddar cheese. I’m sure that it’s not the low fat. If you eat that every day, it has broccoli, but it has the cheddar cheese so it’s not good for you every day. It has a lot of grease and all those things…I don’t think that’s going to kill you or make you bad, like sick. But every day? Yes. Every day, yes. So a [a healthy strategy would be a] way that you can eat certain vegetables, certain fruits but in a different preparation, probably.” (ID111, p.2)“If I said, I’m thinking about vegetables, I don’t know if it’s something from my mother, but for me, I don’t like the way that I cook them. So for me, something doesn’t taste good. So if I had a help for some nutrition or a chef person or a cook or something. That they can teach me like, if you do broccoli like this, the broccoli is going to be lovely. You know?” (ID111, p.5)“The way that I cook. The way that I make it. Yes. Probably, yes. I never had this help before. So I’m not saying that it can be like 100 percent, that it will taste good. But it’s one of the things that I would love to have. So I can be like, “Yes, if I do collard greens like this, it will taste better.” (ID111, p.5)“[to help plan to eat more fruits and vegetables during pregnancy] Try to Google some different recipes. Different ways to try to make them. I think it’s a good thing. A good way for me.” (ID111, p.8)“Maybe recipes will help. Yeah, definitely recipes cause that’s sometimes I don’t know what to do. I think recipes will work. Having other people’s ideas and their opinions will definitely work. You know cause sometimes you’re so overwhelmed with your life, you don’t – okay, open a can, put salt and butter, eat it, that’s it. And I don’t think that’s even that healthy, you know?” (ID115, p.14)“Exactly. Exactly, and even if they could give stacks of paper with a recipes and you know, you buy something, you have a recipe. Oh, let me try this out. You know? It's all about experimenting and stuff to see what go happens in the community, you know? That's the way I see it. Yeah.” (ID115, p.2, pt2)“Yes, things like, I want to eat broccoli but I don’t know how to cook it. That would be a way of educating me; to learn how to cook it, something like that. Perhaps look up a recipe…But I don’t know how to cook it so that’s what stops me from eating it.” (ID139, p.3)“I know that would help a lot, because if I knew different ways to make it so it doesn’t taste – not so bad because it’s not bad, but just so I don’t think of it as – you know, like very nasty or something, then it would help when I eat it.” (ID160, p.2)

concerned about not cooking F&Vs well prevented them from experimenting with F&Vs. Women felt they would consume more F&Vs if they had better, healthier recipes and if they were given cooking demonstrations.

Masking Vs flavors, VF’s blends

“I never in my life ate broccoli before. I hated broccoli. I couldn't stand the smell of it, the sight of it, nothing… Before I got pregnant then my sister did something with the broccoli. I don't know what she did. I guess she added cheese or whatever she did to it. That's what made me start to eat broccoli.” (ID101, p. 5)“They just do like frappe stuff with the fruits, so that help me to eat it – the fruits, and I do.”

Blending F&Vs in smoothies, hiding vegetables in different foods, or preparing foods with F&V purees were different methods used to mask F&V

(ID106, p. 2)“Like, adding more spices – like sauce or – I don’t know – like dressing, cheese – stuff like that that makes me – like kills the flavor of the vegetable or the fruit where I can eat it.” (ID106, p.5)“But I like the taste of fruits, but the vegetables, the problem is the way that I make them, that’s not good for me. For me it doesn’t taste good. So strategies is probably for me the way they do it. If people can teach me how to do it a different way. Like for example broccoli. If instead of steam the broccoli you cook and put this, this and this, it would taste better. The way that it’s prepared.” (ID111, p.1)“…like if you don’t like tomatoes, you can blend it and add something else with it to make you – you know even if you could drink it, but you need to eat the fruits and vegetables. So I don’t know, maybe a blender is a good strategy? Or sneak it in your food, I don’t know…That helped me eat a lot more vegetables, because I kind of don’t like a lot of vegetables.” (ID122, p.2)“But my mom – my grandmother, she blends – she blends like – she makes like a V8 juice, but instead of buying it, she actually makes it. And she – it doesn’t taste that bad. Because she’ll add a fruit in there that will give it like a kick.” (ID122, p.2)“I know one of them was a green drink and I drunk it, because it looked so nasty I didn’t want to. But when I drunk it, it tasted good. It had like a pineapple flavor to it, but she told me it had spinach, broccoli and a little avocado in it. (ID122, p.2)“…I make like white rice or anything I kind of will put like little pieces of spinach in the rice and they won’t even know. So I kind of like hid it – or if a salad I will add the tomatoes and little carrots and stuff. Sometimes, they will pick it out, but if you make it good, it’s just got a catch to them. (ID122, p.3)“Like the carrots, my son can’t stand carrots. So when I make like my little beans, I put the carrots and I mash it and it’s like in the juice, so he doesn’t even know. Oh, that tastes good. Did you know you just ate carrots? You got to like hide them, I don’t know.” (ID122, p.3)“Yeah, they [aunts] mix the vegetables with the fruit.” (ID133, p.1)“Because they mix probably like vegetables that I wouldn’t eat and they’ll mix it with the food so that I don’t taste it…Like squash; I won’t eat squash but they’ll mix it like with the corn beef…they don’t tell me what they put they just give it to me, they’ll be like ‘it’s good because I put squash or I put different stuff, a different kind of greens you don’t like.’ Like I don’t like collard greens. They’ll like chop it up. ” (ID133, p.2)“Not just judge how it looks, mainly like the vegetables. Don’t just judge it because it looks nasty because that’s how I base it on. Like mushrooms, I would never eat mushrooms. But they mix it and say they made mushrooms…So they don’t tell me and they just put it in there” (ID133, p.2)“Like he made the steamed carrots, I’m not too happy about. But he’s like oh, try peanut butter or try ranch or try with bread or try it with rice or mix it with something that you like.” (ID134, p.3)“Like, so that way the kids eat vegetables. They don’t eat broccoli, they don’t like that, so I blend it.” (ID147, p.4)“Yes. Because I worked at a restaurant and I used to see the owner making blended vegetable soup. So you can’t see, because I used to get full with soup and I was not seeing the carrots

flavors. Participants often relied on family/friends to implement these methods for them, knowing that knowledge of the contents of the blends might also stop them from consuming those F&Vs.

there.” (ID147, p.4)“I like my lettuce. I can't eat it plain. It has to have a taste to it – so ranch is usually what I use.” (ID156, p.3-4) “As long as it has ranch on it…ranch dressing I would definitely eat. I would definitely challenge any vegetable. ” (ID156, p.3)“…if I don’t smell it, then I’ll probably would be able to eat it.” (ID157, p.3) “…if I was to try to prepare something with a vegetable, or something that I didn’t taste and didn’t know that it was a vegetable at first, and tried it before I knew; I might end up liking it. Because I know if it’s something that I’ve never had, I don’t want to try it.” (ID160, p.1)“Like because I know I never ate tomatoes before – or lettuce or any of that – but now if we do tacos at home or something, I know that if I cut the tomatoes small enough and the lettuce is shredded, I can put it on my tacos and I’ll be able to eat it without feeling overwhelmed…”(ID160, p.2)Adding different kinds of things with what you like. So like my fruit salads, I don’t know watermelon or zucchini or I don’t like cantaloupe and all that. But if you was to take the fruits that you like, like strawberries, pineapples, grapes and all that; and just one time like once a month add something new to it, like watermelon and seeing how it tastes. Because when I eat fruit salad, I don’t eat one fruit at a time anyway, so. Not that I won’t taste it, but maybe I will like how it is. (ID160, p.9)

Healthy snacking/healthy meals (breakfast, eating out)

“You can eat them [fruits and vegetables] as a snack instead of like chips or something, grab a fruit or something.” (ID100, p.6)“I think it’s safe, something healthy. I tend to eat fruits more and people will scold me and say, “No, you need to eat regular food.” I just tell them to leave me alone. I tell them I like to eat healthy. Now that I’m pregnant I’m eating more fruits and vegetables.” (ID139, p.3)“I’m hungry and I get a fruit or some fruit to eat. A frozen banana and I can hold on up to lunch time again.” (ID147, p.3)“When I go to a restaurant that’s the first thing I order to start. When I get my appetizer halfway through I’m already full and it’s because of the salad, and the croutons, and the tomatoes that it had- whether it’s a Caesar salad or a house salad it fills you up.” (ID156, p.2)“So it’s become half healthy eating, half fatty eating, but I can say I haven’t ate fat food for a long time. It’ll be something small of each that I would eat. Not like before –“ (ID156, p.9)

Women recognized that snacking on F&Vs or choosing F&V based meals, increased satiety and decreased consumption of unhealthier options.

Convenience (e.g.,, ensure, supplements, chopped fruits)

“I guess sometimes it's easier when you know when you go to a restaurant that you – they serve it. It's like more better to eat cause it's more appetizing to you.” (ID115, p.3)“…if I had a place where to go eat or like the elderly people, they bring those nice meals of trays and food. Like maybe was – if I could qualify for a program that brings food, maybe I'll eat way better than what I eat now. You know?” (ID115, p.4)“Yeah. That's why I drink a lot of ensures when I can because I feel like I don’t put enough vitamins in my body.” (ID115, p.5)“Yeah, I do eat some times fruits, but I buy the – like the food already chopped… If it’s chopped fruit I can eat it. If it’s not chopped then I won’t eat it” (ID120, p.3)

Fruits were considered more convenient than vegetables as most fruits were could be washed and eaten immediately, while most vegetables required cooking. Chopping and storing F&Vs in advance or purchasing pre-cut F&Vs increased consumption.

“Well, fruits is more easier to eat, because you can just take some grapes and eat the grapes. You can’t just take spinach and take it out of the bag and eat it.” (ID122, p.3)“One thing that I do is when I do buy, like, when I do get my grapes or I do get my cantaloupes or, like, my even my watermelons that are gonna come up, then once I get home, I cut them, I make sure I cut them into – and dice them, and I put it in a container, like a shoe container that you can get at Walmart or wherever. And I just like mix in all my veggies so it makes like a fruit salad. And, and I do that with my veggies as well. Like I’ll cut my celeries and I’ll buy the baby carrots, and I either stick them in zippy bags so they can be like a grab and go...” (ID124, p.14)“And he [boyfriend] be making fruit salads, even with fruits that I don’t eat. He just cut it up and do it in like a fruit salad. Instead of eating it by itself just only grapes, he just puts grapes, pineapple, strawberry, banana, cantaloupe, oranges. And then he just makes a fruit salad.” (ID134, p.5)“It’s quicker. It’s convenient. It’s faster…I don't know if you could add fruits to a sandwich, but you could make a sandwich with peanut butter, jelly, and some bananas cut in it…There's a lot of ways to add fruits and vegetables to your breakfast, lunch, and dinner.” (ID156, p.14)“… I don't know what keeps us from eating lettuce and tomatoes and stuff. What keeps us eating lettuce and fruits when those are the only, kinds of, foods that are easily to get to eat, easily to eat without cooking it or anything?” (ID156, p.13)

Domain Definition Summary of Key FindingsMATERNAL HEALTH STATUS

Prenatal health status refers to the health status of the mother during pregnancy. Maternal health status influenced F&V knowledge. It empowered women to gain more knowledge and change behavior regarding F&V intake.

Themes/subthemes Illustrative QuotesGaining excessive weight during pregnancy

No 99 quotes identified. Not applicable.

GDM; other pregnancy complications; stress

“…it should be part of my meals every, in the lunch and dinner because I have diabetes now, so it’s just I have to eat it.” (ID102, p.2)“I can’t eat a lot of fruits because they’re sweet, so I kinda stay away a little bit from fruits because my diabetes. And I have to, if I do eat fruit, I have to like mix it with something salty or cheese or something that you, you would be like “Oh my God, it doesn’t match.” But I have to do it.” (ID102, p.5)“If it wasn’t for that [having gestational diabetes], I will eat more. I, I feel like that’s kind of stopping me from eating them. Ever since I found out that I was diabetic, I kinda stopped eating more the fruits. Not the veggies, but more the fruits.” (ID102, p.5-6)“I know – I've eaten healthier for my other kids, way healthier. You know now is like – everything's a struggle. Sometimes you feel stressed out. You don’t want to eat. That's what happens to me, I'm like I don’t want to eat because then I eat and then I deal with the kids and

Fruits had to be limited for those with gestational diabetes to avoid sugar fluctuations. Others felt eating more F&Vs would help reduce their pregnancy risk.

then my food boils up in my stomach, then I have a stomach ache. Then I'm laying down with a stomachache. Yeah. It's kind of hard being a mom by yourself. Yeah. Definitely.” (ID115, p.10) “Because I come from a family who have diabetes, so I have a high risk of getting that diabetes when I’m pregnant. And she, and one of my passions is rice, white rice, so she was just telling me to cut down, to try to cut down on the white rice and the pastas just because they converts into sugar, and we don’t want anything to just – just trying to avoid any consequences.” (ID124, p.6)“They [my boyfriend and mom] scare me with Diabetes. So I’m able to, you know, say I don’t want this candy because I don’t want Diabetes. So I just eat the fruit. They don’t want me to be like my cousin. When she got pregnant, she just started eating very bad. One day, her sugar was really low, and she didn’t know. When she got to the hospital, they told her she had Diabetes. After she had the baby, she stayed with it. It never went away. So I don’t want to end up that way. So like when I eat candy and stuff my mom is sure to remind me. You don’t want to end up like you’re cousin with Diabetes. Make sure you eat right and the baby and stuff like that. So that’s what helps me out too.” (ID144, p.2)“[My cousin] ate fruits and vegetables like I do, but more than the fruits and vegetables she was eating a whole bunch of fast food and going to the Comerío. You know, once you go in there, you’re not leaving. So she was always going there. One day, her sugar was really low. They told her she was Diabetic. So I’m afraid if I get it and it never goes away. So I don’t want that.” (ID144, p.5)