SNAP Outreach Team:

2012 Washington County Senior Focus Groups Report

Partners for a Hunger-Free Oregon thanks Washington County community partner sites and staff members for hosting our focus groups, including the Forest Grove Loaves and Fishes, the Tigard Loaves and Fishes, the Hillsboro Senior Center and the Elsie Stuhr Senior Center in Beaverton.

Partners for a Hunger-Free Oregon also thanks volunteer Kate O’Donnell, MPH, for focus group support and the preparation of this report.

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Executive Summary

The Supplemental Nutrition Assistance Program (SNAP) is a major source of nutrition assistance for people across the United States. Although older Americans can also benefit from this program, many do not participate. A variety of studies have explored why senior participation rates are relatively low compared to other high-need populations. This qualitative study seeks to explore the persistent barriers to access among seniors living in Washington County, Oregon and to understand how a messaging campaign might address these barriers. Four separate focus group discussions among 31 individuals (24 women, 7 men) were held in four Washington County senior centers during August and September 2012. The data indicate a complex network of barriers related to perceptions of and information about SNAP, including some positive and negative personal experiences with the program. Findings supplement existing research on this topic and have implications for future PHFO programs and outreach within Washington County.

Introduction

The Supplemental Nutrition Assistance Program (SNAP) is a major source of nutrition assistance for people across the United States. Formerly called the “Food Stamp Program,” SNAP served nearly 45 million people in 2011 (USDA, 2012). This program is administered by the United States Department of Agriculture, which sets national income eligibility guidelines. Oregon uses an expanded Categorical Eligibility option that allows the state to certify SNAP households at 185% of the federal poverty level, and to disregard resources for most households.

As of 2011, approximately 1 in 7 Americans relied on SNAP to supplement their daily nutritional needs (Ibid.). These rates vary considerably among the states. For example, 1 in 5 Oregonians participated in SNAP in 2011. Despite these participation rates, many individuals who would otherwise qualify for the program do not receive benefits. The USDA estimates that only 72% of eligible individuals received SNAP benefits in 2009 (USDA, 2011). These rates also vary among states. For example, SNAP participation rates in Oregon range from as low as 42% in Benton County to as high as 97% in Jefferson County (PHFO, 2011).

Older Americans also benefit from SNAP. According to a recent USDA report, in 2010 approximately 8% of national SNAP participants were age 60 or older; 73% percent of these individuals lived alone (Ibid.). Seniors living on a fixed income are especially vulnerable during times of economic recession. According to the USDA, nearly 11% of seniors currently face the threat of hunger as they struggle to pay for

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food, rent, and medication (PHFO, 2012). It is therefore surprising that SNAP participation rates among seniors have long been relatively low compared to other high-need populations (Gabor, et al., 2002).

In Oregon, and across the nation, only 1 in 3 eligible seniors participate in SNAP (USDA, 2012). There is a common misperception that seniors can only qualify for low SNAP benefits ($16) and this has often been cited in other studies as a reason for lower senior participation rates. However, the average benefit for a senior household in Oregon is actually about $90 per month (Ibid.). This statistic suggests that low senior SNAP participation is the product of a complex set of factors.

In 2008, Partners For a Hunger-Free Oregon (PHFO) conducted a series of focus groups among seniors in Washington County, Oregon to understand some of the barriers this demographic faces in accessing nutrition assistance programs. Washington County is a diverse geographic area, with an estimated population of approximately 550,000 (US Census Bureau, 2012). Residents of this county, located just outside of Portland, live in a wide range of settings, including rural communities, towns, and suburbs, and represent a variety of demographic and income groups. SNAP participation rates in Washington County are also relatively low; as of 2011, only 61% of eligible individuals received benefits through the program (PHFO, 2011).

Seniors in the 2008 focus groups reported a range of factors preventing them from accessing SNAP benefits, including stigma, lack of information, SNAP office issues, mobility limitations, and a fear of “taking away” benefits from others (PHFO, 2012). These findings are consistent with other national and regional studies of seniors and food assistance programs (e.g., Gabor, et al., 2002).

Based on the results from these focus groups, Partners For a Hunger-Free Oregon initiated an intensive four-year effort to reach out to seniors living in Washington County. A messaging strategy was crafted to address misconceptions about SNAP, as well as to encourage seniors to apply for benefits. PHFO staff collaborated with DHS partners to incorporate feedback and positive messaging from focus groups into new outreach brochures designed to reach Oregon seniors. PHFO staff also created 2 Power Point presentations, featuring the health impacts of senior malnutrition, and the process for a senior to apply for and use SNAP benefits. Both presentations were shared widely with local community partner agencies. Additional outreach efforts were targeted at local senior centers and communities of faith to directly engage unconnected individuals. Local DHS staff and PHFO collaborated at regular senior site tabling opportunities to utilize senior-specific pre-screening tools to address benefit and eligibility concerns.

In 2012, PHFO convened a second series of focus groups to understand how SNAP participation and perceptions may have changed among Washington County seniors. The following provides a summary of the methods and findings from these focus groups.

Methods

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Four focus groups were held in Washington County senior centers in August and September 2012. In this study, “seniors” were identified as anyone who received services through a local senior center. The Partners For a Hunger-Free Oregon SNAP outreach team chose Washington County senior centers that had served as outreach sites during the previous four years. The Senior SNAP Outreach Specialist received permission from each center’s manager to hold the focus groups onsite. The Outreach Specialist then conducted outreach to publicize the focus groups. Advertisements were placed in the center’s newsletter and two posters were displayed onsite. A sign-up sheet was set in a central location with information about the focus group. Participants were also recruited during mid-day meals at the senior centers. The Senior SNAP Outreach Specialist called each site prior to the focus group date in order to ensure that at least five seniors had signed up to participate.

Focus groups were initially limited to 10 participants, although one site generated enough interest that 12 individuals were included. Participants were not screened or surveyed for demographic characteristics, although information about each participant’s gender was recorded during the group. Individuals received a $5 farmers’ market token, tote bag, and small notebook for their participation. Each participant was also enrolled in a raffle to receive a free cookbook. In the interest of privacy, the focus groups sessions were not recorded. However, a PHFO volunteer was onsite to record shorthand notes from each session’s discussion. Each focus group lasted approximately 1 hour. Table I (below) outlines the number of participants at each site.

Table 1: Focus Group Participant InformationFocus Group Site # Women # Men Total

Forest Grove 7 0 7Tigard 4 2 6Hillsboro 6 0 6Beaverton 7 5 12

Based upon feedback from PHFO staff, the following research question was developed: “What are the persistent barriers to accessing SNAP benefits among Washington County seniors and how can our messaging address these barriers?” A semi-structured interview guide was created to answer this question. PHFO also drafted four “messages” about SNAP to test among focus group participants. Participant reactions to these messages were intended to help PHFO craft a relevant messaging strategy for future SNAP outreach. See Appendix A for an example focus group guide.

Following the first focus group, the PHFO SNAP team met to revise the focus group guide. A new section was added to the guide in between Question 1 (“General Perceptions of SNAP”) and Question 2 (“Barriers among Seniors”). This new section was intended to address misconceptions about SNAP and to answer any questions that may have arisen during the first focus group question. PHFO felt it was important to add this section in order to respond to participant concerns and questions.

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A PHFO volunteer hand-coded the notes from each focus group session and summarized these codes in a qualitative codebook. These codes were then checked for consistency by PHFO staff. From these codes, five “themes” were created to represent the information gathered from focus group participants. A draft results summary was then written and presented to the SNAP outreach team for feedback.

Results

Focus group participant discussions can be grouped according to four overarching “themes.” These themes represent participant responses to focus group discussions of SNAP and barriers to access among seniors in Washington County. Themes include: general perceptions of SNAP, personal experiences with the program, reported barriers common to seniors, as well as suggestions to increase access among this demographic.

Seniors in our focus group reported a broad range of perceptions about SNAP (and assistance programs in general). Many participants had positive perceptions of the program, often related to their personal experiences with SNAP. Other participants expressed more negative perceptions of SNAP, particularly with issues related to “personal responsibility” or perceived “misuse.”

One positive perception senior participants reported was the SNAP helped people “get the amount of food they need.” Some seniors described first- or second-hand knowledge of hunger and how the program has helped address this problem. For example, one participant from the Tigard focus group said:

My daughter gets food stamps. It helps her family get the amount of food they need [p. 1].

Similarly, many participants described how the recent recession has made it difficult for seniors and families to meet their nutrition needs. This economic context was mentioned in every focus group session. For some seniors, SNAP has proven critical in these dire circumstances. For example, one participant at the Hillsboro group said:

Before 2008, they didn’t even bother because the need wasn’t there. Then there was less and less money to cover expenses, so they didn’t think they would be able to take care of themselves. Even professionals are now using SNAP [p. 3].

Many focus group participants expressed confusion about SNAP being the new name for food stamps. The term “Supplemental Nutrition Assistance Program” can be difficult to remember and some seniors expressed frustration with this. As will be discussed below, some seniors also cite the name change as being a barrier for seniors who would otherwise access the program. This problem was the second most

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frequently raised “perception” that focus group participants had in relation to SNAP. A Tigard focus group member summed it up this way: “SNAP, I’ve never heard of. But I remember food stamps” [p. 2].

Other focus group participants had varying perceptions about the funding source for the SNAP program. Reactions to learning about the source ranged from positive to somewhat negative, as was also reflected in their response to the message “SNAP dollars help our economy.” For example, one participant at the Hillsboro group expressed some surprise and disappointment about the funding source:

Oh, it’s federal! I thought it was state-funded. So, the government’s borrowing money to give to the State of Oregon? [p. 3]

Another participant was happy that federal dollars were feeding into the local economy:

Yes, you need to have the word “profit.” “You are helping our state profit.” Just using SNAP, that’s what that does! [Tigard, p. 4]

Some participants expressed very negative perceptions or concerns about SNAP. These were generally related to ideas surrounding dependency or misuse. A few focus group participants described their feeling that government programs create a culture of “dependency.” Often these perceptions were not necessarily related to firsthand interactions with the SNAP program or participants, but came through something the participant had read or heard. For example, one Tigard participant said,

Generation to generation kids are raised on food stamps. For some reason they’re not trained to get off of food stamps [p. 2].

Other participants expressed concern that SNAP benefits were being misused. This issue was the most frequently raised perception among focus group participants when discussing SNAP. These perceptions were also not necessarily related to direct experience – or even seniors. However, this concern was often mentioned in direct relation to the program. One Hillsboro participant expressed this opinion:

A lot of people would buy alcohol or unnecessary things. I don’t know if the office controls what people buy… [p. 2].

Other perceptions arose about SNAP that may be related to the discourse in the 2012 Presidential Election about the role of government and citizenship issues. One focus group participant expressed concern about non-citizens receiving benefits. Another described a fear of “government overreach.” This participant from the Hillsboro focus group said, “I think this creeping socialism is really scary for my generation” [p. 3]. For these participants, SNAP was directly linked with government intrusion into the private sphere.

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Another key theme that emerged from the focus group discussion related to the workings of SNAP and participants’ personal interactions with SNAP. Many participants had questions about the program itself (such as income qualifications and benefits). Others described their positive and negative experiences with SNAP and the application process.

A surprising number of focus group participants (n=18) volunteered their stories of direct interactions with outreach or caseworkers, as well as their personal experience using SNAP. Many participants reported using SNAP benefits at one point in their lives. For example, a participant in the Hillsboro group related, “In 1975, I got $120 worth of food stamps” [p. 1]. Another described a fairly seamless application process:

The process was easy: knowing where to go after you came here and I talked with you. I had no problems [Tigard, p. 2]

Other participants were not so lucky. One participant reported not feeling welcome when s/he went to apply for the SNAP program. This feeling may be related to some of the personal barriers (e.g., confidence) seniors describe below. The Tigard focus group participant reported:

[So many people] don’t feel welcome in the process of applying. And they just get up and walk out the door [of the office]. [p. 2]

Other participants described problems related to mobility or transportation. For some, getting to the SNAP office has previously been a problem. Other seniors spoke of friends, neighbors, or family members who were housebound. One Hillsboro participant described her experience:

There’s a lack of knowing where to go and how to get there. I still can’t drive because I get lost. [p. 4]

Some seniors spoke about problems related to technology or the telephone. A few participants pointed to their lack of Internet access as being a barrier to finding SNAP information, which is sometimes posted online. One Forest Grove participant said:

You talk about fax. I don’t have a fax! I don’t have a cell phone. The only thing I have is a regular phone. I don’t have email; I’m in the backcountry! [p. 3]

Others discussed their previous problems with trying to speak with a caseworker over the phone. For example, a Beaverton participant described this experience:

Sometimes if you want to do something, you call up a random government number and they give you a number and it’s not the right number... And you’re in a maze trying to figure out who you have to talk to and what you have to do! [p. 3]

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By far, the biggest issue seniors discussed about SNAP was eligibility guidelines. Many seniors expressed confusion about how they could qualify for the SNAP program. Even if they had heard of SNAP previously, some misconceptions persisted about income guidelines. For instance, one Hillsboro participant said, “You almost have to have zero income to qualify” [p. 1]. Many participants wanted more information on program qualifications, as well as deductions.

In the same way, a large proportion of focus group participants were confused about the application and benefit process. Some participants were unfamiliar with the Oregon Trail card and EBT process as well. These questions from the Hillsboro focus group are representative of the general questions participants had about SNAP:

Do you get a bank statement? How do you know how much is on there? [p. 3]

Similarly, many participants had questions about which items or services are covered as part of the SNAP program (“purchase power”). For example, participants had questions about which food items qualified. Others wanted more information about the farmers’ market program or the cash assistance benefits. One participant’s question at the Forest Grove focus group is representative of these questions: “Can you use SNAP for prescription drugs? Can you buy vitamins?” [p. 2].

Many participants specifically described problems related to obtaining information about SNAP benefits. Issues ranged from not receiving enough information to receiving too much information about the food assistance program. Seniors most frequently brought up the problem of an “information gap” among seniors. This subject came up 19 separate times in the four focus group discussions and highlights the fact that many qualified seniors are simply not hearing about the program. For example, one participant at the Beaverton focus group described the problem this way:

I know they had a thing about food stamps in the paper, but they never have information about where to sign up for food stamps. Because I know there are a lot of people who are hurting for food stamps, but they don’t know how to get it. I need the information myself because I’m on a very low income and want them too [p. 1]

Another participant at the Forest Grove focus group described her cousin’s experience applying for SNAP benefits:

Whoever had talked to her first had given her incorrect information. She simply didn’t know what she could get help with. And she desperately needed help with it [p. 2].

In these cases, participants described a clear need for assistance, but a lack of information about qualifications and/or the process of applying.

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On the other hand, some participants talked about the problem of receiving too much information about assistance programs. One respondent at the Tigard focus group said:

When you turn 62, you get a flood of stuff in the mail and you don’t know what’s OK and what’s not […] It’s confusing! [p. 3]

Specifically, participants pointed to the problem of determining what information is “legitimate” and what is not. This issue of clarity feeds into some of the personal barriers to access (i.e., confidence) that will be described below.

In addition, some participants reported learning about the program from a friend or caseworker, but failing to understand the particulars of the benefits or application process. For example, a respondent at the Forest Grove group reported speaking with a caseworker about qualifying for SNAP, but not being able to follow up: “Well, it was probably sent to me in a letter and I didn’t understand what they meant” [p. 2].

Another theme that emerged from the focus groups related to the personal barriers seniors experienced in accessing the program. These barriers often grew out of internal feelings of shame or a lack of confidence that prevented participants from reaching out for help. Other barriers related to a self-described generational need for self-sufficiency.

To begin, a few participants were concerned about being a “burden” on the system. This specifically arose out of a fear that their participation in the program would take something away from others. As one Beaverton participant said, “You feel like you’re taking money from someone else” [p. 3].

But by far, the most common personal barrier participants described related to feelings of pride or embarrassment. In this sense, participants reported either feeling too proud to reach out for help, or feeling ashamed for receiving assistance. One Hillsboro participant described her experience receiving SNAP benefits, but then dropping out of the program:

We kept on the program for about 3 months because we found it insulting in a sense that my husband couldn’t support us […] Well, “insulting” isn’t right. He was… “I’m gonna stand up and I have these 6 kids and I’m gonna take care of them” [p. 1].

Another Hillsboro participant described an unacknowledged feeling of “pride” as preventing her from asking for help:

But I know what you’re saying. When we were going through some hard times, I said, “We’re going to keep making mortgage payments.” Even though we’re going to starve to death, at least it’s going to be in privacy of our own home! [p. 4]

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In this same vein, many participants believed that they did not “need” help. This was the second most common personal barrier among participants. Some participants made a clear distinction between “wanting” something and truly “needing” it. Although feelings of “pride” were not explicit in most participants’ statements, pride and a need for self-sufficiency clearly underlie this sentiment. For example, on Hillsboro participant stated: “I fit all the guidelines, but I don’t need [SNAP]” [p. 2].

Another barrier related to “need” and “pride” is the stigma a few participants reported as being associated with SNAP. Although some believe that the stigma is lessening with the introduction of EBT and debit cards, it still persists in others’ minds. For example, a Hillsboro said:

I think there’s less of a stigma involved in that you can now go to a grocery store and go to the self-checkout. But nevertheless people behind you are noticing [p. 1].

Other focus group participants described a fear associated with SNAP, particularly related to having something taken away from them. One Tigard participant said, “They’re afraid that if they say too much or maybe they will have too much and they’ll take more away from them” [p. 2]. Others simply felt intimidated by the process of applying for SNAP.

Wrapped up in these perceptions is a lack of confidence reported by some focus group participants. Some participants were not confident enough to ask for help or to even begin the process of applying for benefits. This was especially evident among widowed women, many of whom had never been in a position to advocate for themselves. One Forest Grove participant described her experience:

A lot of older women don’t have the confidence. “I’m not going to qualify, so why try?” And if you had a husband who always controlled everything, you’re so used to doing what you’re told. And you don’t know who to ask or how to ask. Like, when my husband had a stroke, I was suddenly left with it […] I didn’t have a clue what they were talking about! [p. 2]

As indicated by this respondent’s story, many of these personal barriers arise during difficult life transitions, such as a move or death in the family. Like the Forest Grove participant, some focus group members spoke about suddenly facing new responsibility or negotiating services in a new environment. One Hillsboro participant said:

I had a bad period when I moved to Oregon last year. I didn’t know how to apply – period. There were a lot of issues related to being new [p. 3]

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A few focus group participants felt that seniors need to be persistent in order to receive SNAP benefits. One Tigard participant described her approach, which she felt had helped her in the past:

I’ve never met a stranger. If I walk into a place and I don’t know where I’m going or where I should go or whatever… I’ll find out! Some people are absolutely afraid to ask a question of a stranger. Take someone like me, there are no strangers! It’s next to impossible if you’re shy [p. 3].

The final theme that emerged from the focus groups related to suggestions for outreach to seniors. The focus group moderators had asked for specific feedback on this theme from participants. Their answers can be grouped according to a few key areas: information, advertising, points of contact, and messaging.

Participants expressed a desire for increased advertising about SNAP during all four focus group sessions. There were a wide variety of methods suggested for reaching out to seniors in this way, including print media, radio, and television. One Tigard participant suggested:

Probably promotion on TV. Where you actually have someone sit down to explain. You know, “The kids are saying you don’t have enough snacks at home and stuff.” Well, seniors they need to do that same thing! I think there should be playacting on TV. Having other seniors saying, “Well, there used to be a stigma attached to it” [p. 3].

Another participant in Forest Grove suggested,

Put it in writing. What I read, I understand. If you put it on the phone, I don’t hear that well. I don’t see too good either! But don’t put it on the Internet [p. 3].

Many seniors had ideas for the information needed in these advertisements. Most seniors wanted advertisements to contain information about (1) what SNAP is; (2) who can qualify; (3) how they can apply for benefits. As described above, many participants were confused about the name “SNAP,” and so recommended increased visibility of the program through advertisements. Because participants believed that many seniors are unaware that they qualify, they recommended increased promotion of eligibility guidelines in a clear and straightforward manner. Many participants expressed frustration or confusion with the application process, so they recommended advertisements that would clarify this process.

Another suggestion from focus group members related to points of contact for reaching out to seniors. This does not refer to advertising, but rather outreach strategies for connecting qualifying seniors to the program. For instance one Tigard participant recommended having information available at the rental office of apartment buildings. Other participants at the Forest Grove group recommended larger signs and more visible brochures at their senior center. Another participant suggested having a

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questionnaire at the senior center tables for senior to fill out to see if they qualify for the program. Another Tigard participant recommended asking ministers to publicize the program during sermons and/or in church bulletins. Others suggested having information visible and available at public spaces such as the library or the doctor’s office.

In order to further help seniors connect with these resources, some focus group participants expressed the need for advocates and support networks. These concepts referred specifically to one-on-one interactions with either caseworkers or family members that would help connect seniors with information and services. Advocates generally referred to someone (usually a family member) who could act on behalf of a senior in navigating the benefit application process. For example, a Forest Grove participant said:

My sister takes care of me and does my papers and things like that. Having someone to help you is important. An advocate [p. 3].

Others spoke about broader support systems, such as communities, neighbors, or extended family networks. Many focus group members talked about problems that have arisen because traditional networks are disintegrating. For example, a Hillsboro participant said:

But there’s no neighborhood anymore. There’s no community for seniors [p. 4].

In most of these instances, seniors were expressing a desire to become (re)connected with support networks to help them receive critical support.

Messaging

At the end of each focus group, participants were asked to respond to series of messages drafted by PHFO staff. Participants were instructed to give a “thumbs up,” “thumbs sideways,” or “thumbs down” to indicate their feelings about each message. The messages included: “SNAP is like Social Security: You pay into it during your lifetime;” “SNAP is good for your health: Helps you afford the food your doctor recommends;” “SNAP is a common US experience: More than half of Americans will use SNAP at some point during their lives;” and “SNAP dollars help our economy.”

By far, the message “SNAP is like Social Security” received the most positive reaction among focus group participants. Respondents were especially receptive to the notion that, because their tax dollars support the program, they should be able to use the benefits when they needed them. For example, a respondent from the Beaverton focus group said, “That’s the whole idea! We pay into it, we should get something out of it” [p. 4]. Another respondent at the Forest Grove group suggested, “[When] you say Social Security, people pay attention” [p. 4]. By linking SNAP to Social Security, some

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of the negative perceptions of government assistance programs are lost. As one Beaverton participant said, “If there’s some way to disconnect the idea from welfare – that would really help. Because people think it’s welfare” [p. 4].

The message “SNAP dollars help our economy” received some positive feedback, but mostly elicited a mixed response. Many participants gave this message a “thumbs up,” but others seemed a bit confused. One participant at the Tigard group described her positive reaction:

The only thing that made an impression on me [during this focus group] was the federal dollars coming into Oregon [p. 4].

One respondent positively responded to the link between SNAP and local farmers [Beaverton, p. 4]. Another participant at the Beaverton group said that the message was good, but “only if you explain it fully” [p. 4]. To help clarify the benefit to the local economy, one person suggested PHFO incorporate the word “profit” into this message [Tigard, p. 4].

Still others did not like this message linking SNAP to a local economic benefit. For some participants, this drew upon preexisting perceptions of government program “dependency” and concerns about the program’s “funding source” (i.e., taxes). For example, on participant at the Beaverton focus group described a negative reaction:

But what if you’ve spent your whole life working hard? Some people are not going to identify with this message. They think that to help the economy, you need to build a factory or something [p. 4].

The third message, “SNAP is a common US experience” also received a mixed response. Some participants responded positively to the idea of SNAP being a “common experience.” For instance, some in the Beaverton focus group connected this message with the need for services brought on by the “recession” [p. 4].

Other participants did not like the statistic linked to this message. Participants in the Forest Grove and Tigard groups thought that statistics provided too much information (e.g., “Seniors don’t need to know these facts!” [Tigard, p. 4]). Other participants in the Tigard and Hillsboro groups did not feel that this statistic was “believable.” For example, a Tigard participant said,

The problem is that […] people don’t tell you the truth about things. People just aren’t sure [p. 4].

Another Tigard participant believed that seniors were already aware that many people were facing economic difficulty; therefore the message was not as powerful.

The final message, “SNAP is good for your health: Helps you afford the foods your doctor recommends” was the least positively received by the focus group

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participants. Many seniors in the focus groups connected this message to their perception that SNAP dollars are “misused” by program participants. For example, a Forest Grove participant said:

[T]here are a lot of younger families who are on food stamps, but when you see them check out, they have soda and chips, etc. Seniors do a little better with buying healthier foods [p. 4].

Another participant in the Beaverton focus group said:

The concept’s nice but… I spend my money on ice cream and Sara Lee cake! Is that what my doctor recommends? [p. 4]

Surprisingly, many participants reacted negatively to the “doctor” component of the message. These participants expressed mistrust of doctors, as well as a frustration that doctors “don’t know anything.” For example, a Beaverton participant said:

I’ve asked my own doctor when I’ve been sick to tell me the types of food… they have no idea about nutrition! [p. 4].

A Tigard participant echoed this sentiment:

No, I don’t like the “doctors recommend.” They don’t know that much about nutrition! They have no idea about it. A doctor only has one term of nutrition [in medical school] [p. 3].

Another Tigard participant pointed out: “A lot of people can’t afford to go to the doctor’s” [p. 3]. A participant from the Beaverton group linked this message with her feelings of embarrassment and shame about not having enough money to go to the doctors or afford healthy foods on her own [p. 4]. Participants recommended that the message be shortened to focus specifically on SNAP “helping seniors afford a healthy diet” {Beaverton, p. 4].

Participants provided some feedback about additional messages or phrases to incorporate in an outreach campaign. During almost all focus groups, seniors expressed confusion about the term “SNAP.” This was clearly evident during the message testing. For example, a participant at the Forest Grove group said:

I still suggest that if you put SNAP up there, also put “food stamps” so that if you only see one sign, you’ll know what they’re talking about [p. 4].

This was echoed in the Tigard group: “To begin with, people need to get educated about the word ‘SNAP’” [p. 4]. Another suggested using the term “food assistance” for clarity.

To help publicize the new name “SNAP,” some participants recommended utilizing a catchy play on this term. Participants suggested adding phrases such as “Get

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snappy!” [Tigard, p. 4], “SNAP it up!” [Tigard, p. 4], or even, “SNAP! Try it, you’ll like it!” [Forest Grove, p. 4]. This tactic may help advertise the movement away from using the term “food stamps” and encourage more seniors to seek out information about the program.

Discussion and Recommendations

Limitations of the methodology: These findings represent the perspectives and experience of the focus group participants and, due to the sampling methods used, cannot be generalized to all seniors living within Washington County. We also cannot use this information to fully assess the impact of Partners For a Hunger-Free Oregon’s outreach campaign among Washington County seniors. Information was not systematically gathered on participant exposure to numerous PHFO outreach efforts, which limits our ability to link targeted outreach to subsequent changes in participant perceptions and information.

The focus group sessions were not recorded; therefore it was not possible to completely represent each session’s discussion. The focus group transcripts were extrapolated from notes taken during the session; therefore some participant comments were not included in the final summary. Focus group participants may have also been influenced by the information presented by PHFO staff during the focus group sessions.

However, these findings are consistent with the literature on senior participation in SNAP and other food assistance programs (Summer, 2009; Birnbach, 2011). Concerns regarding “shame,” “dependency,” mobility issues, “pride,” being a “burden” on the system, as well as problems with the application process, have all been described as barriers to accessing SNAP among seniors in many studies. This suggests that many of the findings from our focus groups are consistent with “persistent” barriers to access among seniors.

Some of the strategies recommended by focus group participants have already been incorporated into PHFO senior outreach work. One example was the request for a brochure that would include information about what SNAP is, including the new name, who can qualify, and how they can apply for benefits, etc. A current outreach brochure developed in collaboration with DHS has been in use since 2008, although many participants were not aware of it.

Participants recommended increased program visibility by advertisement through print media, radio and television. Radio and television advertisement could focus more extensively on providing information about the mechanics of the program so that seniors have a better understanding about their potential eligibility and know how to apply for benefits. Media messages could be transmitted through PSAs on radio and television, and print media in selected locations. An additional feature could be seniors “role playing” a discussion about how to access SNAP benefits.

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Some seniors brought up transportation to DHS offices as a barrier to accessing SNAP. Outreach information could include a message about transportation, either to highlight public transportation that runs near DHS offices and/or to promote telephone interviews and online application options.

Participants also recommended connecting with seniors at several community sites currently targeted through PHFO efforts, including housing sites, senior centers, houses of worship and libraries. Several participants recommended additional outreach though health care providers.

Responses to currently utilized outreach messaging helped affirm PHFO’s focus on affording healthy foods and drawing comparisons of SNAP to the Social Security program. There was some support for the economic stimulus message, although the concept needs to include an explanation of the multiplier effect of SNAP dollars. The Team also heard several participants’ concern about SNAP being a “common experience,” which also takes additional explanation, and concerns about tying health messaging to physicians.

Several focus group participants brought up fraud and abuse as a concern with the SNAP program and were surprised to learn that rates were so low. Future messaging could include an increased focus on this information to address stereotypes and help lower stigma.

Conclusion

It can be very challenging to reach seniors with messaging about SNAP. Barriers to increasing senior participation include a lack of information, stigma, and technology and mobility limitations. However, positive messaging about the program seems to impact some of the barrier of shame and stigma issues, while outreach about eligibility and the application process helps to impact the barrier of incorrect information.

Partners for a Hunger-Free Oregon continues to utilize the senior-specific strategies outlined in this report, and in 2013 will expand our work to collaborate with community partners on reaching seniors through television messaging and healthcare providers.

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Works Cited

Birnbach, K. California Food Policy Advocates. (2011). An Opportunity to Boost Senior Participation in CalFresh – The Potential of Targeted Enrollment among Social Security Recipients. Oakland, CA: California Food Policy Advocates.

Gabor, V., Schreiber Williams, S., Bellamy, H., & Layne Hardison, B. United States Department of Agriculture, Economic Research Service. (2002). Seniors' views of the food stamp program and ways to improve participation - Focus group findings in Washington State. Washington, D.C.: Economic Research Service.

Partners For a Hunger-Free Oregon. (2011). SNAP 2011 Participation Report. Portland, OR: Partners For a Hunger-Free Oregon and Oregon Food Bank.

Partners For a Hunger-Free Oregon. (2012). Reaching hungry seniors. Retrieved from http://oregonhunger.org/reaching-hungry-seniors

Summer, L. (2009). Increasing participation in benefit programs for low-income seniors. Informally published manuscript, Georgetown University Health Policy Institute, Georgetown University, Washington, D.C., Available from The Commonwealth Fund.

US Census Bureau. (2012). State and county quick facts - Washington County, Oregon. Retrieved from http://quickfacts.census.gov/qfd/states/41/41067.html

United States Department of Agriculture, Food and Nutrition Service. (2011). Trends in Supplemental Nutrition Assistance Program Participation Rates: Fiscal Years 2002-2009 (Summary). Retrieved from USDA website: http://www.fns.usda.gov/ora/MENU/Published/snap/SNAPPartNational.htm

United States Department of Agriculture, Food and Nutrition Service. (2012). Building a healthy America: A profile of the supplemental nutrition assistance program. Retrieved from USDA website: http://www.fns.usda.gov/ORA/menu/Published/SNAP/SNAP.htm

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Appendix A: Sample Focus Group Guide

Forest Grove Loaves & Fishes2037 Douglas St., Forest Grove, OR 97116 August 15, 2012, 1pm – 2pm 12:30pm:  Room setup

Hang flipcharts Set out snacks Arrange chairs & table for best positioning Place note cards and pens in center of table

12:50pm: Greet guests 1:00pm:  Welcome & Overview

Thank guests for coming/senior center for hosting. Encourage them to get snacks.

Everyone introduces themselves. Explain process: We will ask questions and go around the table twice to get a

response from each person. If want to jot down a question or take notes, use the paper/pens in the middle of the table. We have a Parking Lot list for any additional questions or thoughts.

1:05pm:  Question One

Question 1 :  What do you know about SNAP?o Prompt: Are there specific places you have heard or read about SNAP in

the past 6 months?o Prompt: What have you heard about SNAP?

1:15pm:  SNAP facts in Oregon Briefly summarize conversation & present facts about SNAP in Oregon

1:20pm:   Question Two

Question 2 :  Think about a senior who has needed help paying for food in the past 6 months.  Why do you think s/he would NOT use SNAP?   

o Prompt:  What specific barriers do seniors encounter?o Prompt:  Are there barriers that are unique among seniors?o Prompt:  You’ve heard some facts about SNAP so with only 1 out of every

3 seniors who qualify for SNAP receiving it, what myths or reasons are out there that still keep seniors from applying?

1:35pm:  Message testing

Ask participants to give thumbs UP/DOWN/Sideways for each message:1. SNAP is like Social Security: Pay into it during your lifetime2. SNAP for your health: Helps you afford doctor-recommended food 3. SNAP is a common experience: Many people use SNAP4. SNAP helps your community: Economic contribution

1:45pm: Time to address other topics raised during discussion

Specific ideas to reach seniors

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Appendix A: Sample Focus Group Guide Anything in the “parking lot” (that we feel like addressing) Other issues/thoughts

1:55pm:  Evaluation and e-news Delta evaluation Announce that we are looking for people to share their stories Invite them to sign-up for our E-news

2:00 Wrap-up, share resources, and drawing Thank them for coming and sharing their thoughts Point out the resources available to them on the back table Hand out gifts Cookbook drawing

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