Nutrition Education Needs and Barriers of Uninsured Clients who Utilize Free Clinics in Western North Carolina.

Introduction: Many uninsured adults rely on free health clinics for prevention and treatment of chronic disease. Little is known about the nutrition education needs of adults served by free health clinics, especially those living in counties within the Western North Carolina Appalachian Mountain Region. Methods: An in-person survey was distributed to 202 clients of two free health clinics in western North Carolina. Descriptive analyses were conducted to determine frequency distributions for food and physical activity practices, acceptable topics and strategies for nutrition education, and the acceptance and barriers for various modalities. Results: Depending on the clinic, 49-58% of participants were female with an average age of 45, and Caucasian (48-66%). Around half reported barriers to cooking. The majority frequently ate takeout and engaged in exercise. Participants were most interested in receiving local produce and recipes and were most likely to use a smartphone for nutrition information. Participants preferred actionable interventions but needed help overcoming barriers to food access and cooking. Implications: Future interventions within clinics should focus on assessing patient needs and tailoring services. As transportation was the most commonly cited barrier, clinics could leverage online modalities to enhance clinic education in this population since a majority of clients had access to the internet via smartphone and over half cited interest in online nutrition education.