Appendix A – Corner Store Intercept Survey
We are interested in learning more about what foods people eat and where they buy them. Your information will help us work toward making good-tasting healthy foods more available and affordable for everyone. As a thank you for your
participation we would like to give you a $5 gift card. Would you be willing to complete this brief survey? Feel free to skip any question or stop at any time. Please answer the following questions as best you can about your household or yourself if you live alone. Please check the box or write in your answer.
In answering the following questions, please think about roughly the last 12 months 1. Where do you buy most of your food?
☐ Corner/convenience store ☐ Small grocery store ☐ Supercenter (ex. Walmart, Costco)
☐ Supermarket ☐ Restaurants ☐ Other (please specify): ___________
2. How long does it take you to get from your home to the store where you buy most of your food?
☐ 10 minutes or less ☐ 11 to 20 minutes ☐ 21 to 30 minutes ☐ More than 30 minutes
3. How many times a week do you shop at a convenience store? ________times/week
4. What type of foods do you usually buy at a convenience store? _____________ ________________________________________________________________
5. Please indicate how often meals or snacks with fruits or vegetables were available and affordable at the following places:
Never Sometimes Often Always
Near where you live ☐ ☐ ☐ ☐
The store where you buy most of your food
☐ ☐ ☐ ☐
Small convenience stores
☐ ☐ ☐ ☐
The restaurant you go to most often
6. When you shop for food, how important to you are the following: Not important Somewhat
important Very important Taste ☐ ☐ ☐ Nutrition ☐ ☐ ☐ Cost ☐ ☐ ☐ Convenience ☐ ☐ ☐ Weight control ☐ ☐ ☐
7. Do you work full or part time? ☐ Yes ☐ No
If yes, what do you do for most meals when you are at work? (check all that apply)
☐ Frozen meal from home ☐ Other meal from home ☐ Vending
machines at work ☐ Cafeteria or snack bar at work ☐ Nearby restaurant ☐ I do not eat at work ☐ Other: ___________________
8. During a typical week, how many pre-made meals (canned, fresh, or frozen) do you eat that are:
from a restaurant, fast food restaurant or food stand? _______
from a regular grocery store like Food Lion or Piggly Wiggly? _______ from a smaller store with some groceries like Dollar General? _______ from a convenience store? _______
from a vending machine? _______ frozen meals or frozen pizzas? _______ Other ________________
9. Do you have a preferred away from home meal, such as a burger, pizza, salad, etc.?
☐ Yes (please tell us what it is):______________________________________ ☐ No 10.Compared to other people like you, do you think you eat more vegetables or
less?
☐ a lot less ☐ a little less ☐ a little more ☐ a lot more 11.How often did you eat as healthy as you would like?
☐Never ☐Sometimes☐Often ☐Always
12.What were the main things that made it hard to eat healthy? (check all that apply)
☐ Cost ☐ Availability ☐ Not convenient ☐ Family preferences ☐ Don’t know how to cook ☐ Taste ☐ Don’t like to cook ☐ Time
13.Are there some kinds of foods that you would like to buy but cannot very often due to price or availability?
☐ No ☐ Yes (please list the foods):___________________________________________ 14.Would you say that you worried whether your food would run out before you
got money to buy more? ☐ Yes ☐ No
15.Would you say that the food that you bought just didn’t last, and you didn’t have money to buy more?
☐ Yes ☐ No
16.How often did you buy food that was less nutritious or lower in quality than you wanted because you needed the money for something else (medicines, bills, mortgage/rent, etc.)?
☐ Never ☐ Sometimes ☐ Often ☐ Always
17.Please indicate how much you agree with the following statement: Having access to an affordable, good tasting, healthy frozen meal would increase your ability to eat a healthier diet.
☐ Strongly disagree ☐ Disagree ☐ Agree ☐ Strongly Agree 18.Do you have a working microwave oven?
☐ Yes ☐ No
19.How much would you be willing to pay for a healthy and good tasting frozen meal that you can microwave in 4 minutes and is 30% larger than most other brands
☐ Less than $1.99 ☐ $1.99 ☐ $2.99 ☐ $3.99 ☐ $4.99 ☐ $5.99 ☐ $6.99 ☐$7.99 ☐$8.99 ☐Other: _______
20.How often would you be willing to buy a meal like this? (i.e. affordable, healthy, and good tasting)
☐ Never ☐ 1-2 times a month ☐ 1-2 times a week ☐ 3-4 times a week ☐ 5 or more times a week
21.What would make you choose this meal? ____________________________________________
_____________________________________________________________________________ 22.We are testing a new idea for a 12 oz. healthy and good tasting frozen meal,
called Good Bowls, that you can microwave in 4 minutes. What do you think of that idea? ____________________
Now a little more information about you…
1. Number of individuals in your household: _______ Adults _______ Kids (under 18)
2. Do you or someone in your household currently receive WIC or SNAP benefits? ☐ Yes ☐ No
3. Generally, how much does your household spend on food each month?
☐ Less than $100 ☐ $100-200 ☐ $200-300 ☐ $300-400 ☐ $400+ 4. Age group: ☐ 18 to 34 ☐ 35 to 50 ☐ 51 to 69 ☐ 70 and older
5. Gender:
☐ Male ☐ Female ☐ Non-binary 6. Are you Hispanic/Latino?
☐ Yes ☐ No
7. Race/ethnicity (choose all that apply):
☐ White ☐ African American ☐ Asian/Pacific Islander ☐ American Indian/Alaska Native ☐ Other_______________________ 8. Education level:
☐ No high school ☐ Some high school ☐ High school
☐ Some college ☐ College ☐ Graduate school/Professional degree
If you have any questions about this study, you can contact Alice Ammerman at 919 966-6082. The IRB number for this study is 19-2751. If you have questions about the rights of human subjects in research, please contact the UNC IRB office at Ph: 919-966-3113.