Facilitators and challenges to access fresh fruits and vegetables in a low to middle income group in Bangladesh: Consumers' perception.

Objective: To explore challenges and barriers faced by vulnerable women and men in accessing fresh foods, and how they overcome existing barriers to healthier dietary improvements in households and communities. Study design: This study employed an explorative qualitative research design. Methods: Using purposive sampling through a local primary healthcare facility, 16 in-depth interviews (8 male, 8 female household heads) and 2 focus group discussions (8 participants each, gender-segregated) were conducted with vulnerable slum populations in Mirpur, Dhaka, Bangladesh, between September 2020 and August 2021. Participants were low-to-middle income household heads responsible for grocery shopping and menu decisions. Data were collected in the local language-Bangla, audio-recorded, transcribed verbatim, and analyzed using thematic framework analysis. Results: Key findings identified price fluctuations as a major factor impacting purchase quantity and consumption. Participants knowingly purchased stale items due to necessity, while personal food preferences often dominated healthy food choices. Limited accessibility to wholesale markets forced dependence on mobile vendors and small shops regardless of product freshness. Furthermore, product availability fluctuated with natural calamities, the pandemic, and seasonal effects, alongside intentional crises created by market intermediaries. Conversely, knowledge of healthy foods helped determine optimal family menus. Conclusions: Given the rising non-communicable disease burden in Bangladesh's urban areas, swift accessibility to fresh fruits and vegetables is vital for increasing healthy dietary intake among low-to-middle income populations.