Decision-Making Processes While Online Grocery Shopping

Study Overview
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Brief Summary
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Individuals living with food insecurity are disproportionately affected by overweight and obesity and associated chronic health problems. There remains a lack of sustainable and scalable interventions targeting widespread barriers to access to healthy foods in this population to increase the nutritional quality of foods purchased for preparation and consumption at home. This randomized controlled proof-of-principle trial was designed to examine the feasibility and initial efficacy of a default option in enhancing the nutritional quality of groceries selected via the online shopping service of a local grocery store under conditions that mimic the financial constraints typical of individuals living with food insecurity. In behavioral economics, the default option refers to the option a consumer selects if no active choice is made. The notion of the default option is based on the concept of asymmetrical or libertarian paternalism, which seeks to subtly shift consumer behavior in a manner that promotes welfare, but without overtly interfering with the individual's freedom to choose. It was hypothesized that the default option effectively increases the nutritional quality of foods purchased online, compared to monetary incentives and psychoeducation about nutrition. Female undergraduate students (n = 60) selected food for one week using the online shopping service of a local grocery store with a budget corresponding to maximum weekly Supplemental Nutrition Assistance Program (SNAP) benefits. Before completing the task again, participants were randomized to: (1) a small monetary incentive for selecting groceries that meet nutritional guidelines (n = 17), (2) an educational brochure (n = 24), or (3) a default pre-filled online shopping cart containing a nutritionally balanced selection of groceries to which they could freely make changes (n = 18). Primary outcome measures capture the nutritional quality of groceries selected/ purchased.

Official Title
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Decision-Making Processes While Online Grocery Shopping

Conditions
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Nutrition Poor

Intervention / Treatment
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* Other: Default option
* Other: Psychoeducation
* Other: Incentive


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age 18 or older fluent in written and spoken English able to provide informed consent Exclusion Criteria: significant dietary restrictions (i.e., meat avoidance, food allergies, religious dietary restrictions, etc.) likely presence of current eating disorder diagnosis (score >/= 2 on SCOFF screening measure)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Default<br> | Other: Default option<br>* The default option is a behavioral economics construct that refers to the option a consumer selects if no active choice is made (e.g. opt-out 401K plans, which significantly increase enrollment, compared to active sign up). Participants in the default condition were presented with a pre-filled online shopping cart containing a combination of groceries that meet macro- and micronutrient requirements for their gender and age, and told that they are free to delete, add, and exchange any item they wish to finalize their selections.<br>|
| Active Comparator: Psychoeducation<br> | Other: Psychoeducation<br>* Participants in the psychoeducation condition were instructed to read a brief psychoeducational brochure adapted from materials currently utilized by the New York State Office of Temporary and Disability Assistance (Eat Smart New York).<br>|
| Active Comparator: Incentive<br> | Other: Incentive<br>* Participants in the incentive condition were informed that they will receive a gift card to a major retailer of their choice if they select groceries that meet recommended nutritional guidelines for macro- and micronutrient requirements. Participants were given examples of macro- and micronutrients to ensure that the instructions were clear.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Nutritional quality | The Thrifty Food Plan Calculator (TFPC) was used to quantify the nutritional quality of groceries selected by study participants. The TFPC was developed using U.S. Department of Agriculture nutrition and consumption data and is designed to have users input information about the relative amount of money spent on various categories of food and provides comprehensive information on caloric, macro-, and micronutrient content of the foods selected based on participant age and gender. | Single laboratory visit, <1.5 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Proof-of-principle, Feasibility