A Trial of Behavioral Economic Interventions Among Food Pantry Clients

Study Overview
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Brief Summary
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Obesity, unhealthy dietary habits, and food insecurity are major public health concerns, especially affecting individuals living in poverty. Food pantries, which provide free food to those in need, are increasingly interested in promoting healthy choices, but few rigorous studies have tested healthy eating interventions in food pantry settings. The overall objective of this proposal is to conduct a randomized-controlled trial among 500 regular food pantry clients to compare the influence of a behavioral economic intervention to promote healthier food choices delivered via a web-based ordering platform to usual care (control group).

Detailed Description
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The primary objective of this proposal is to evaluate the influence of a web-based behavioral economic intervention compared to a control group on the following outcomes among food pantry clients: 1) Nutritional quality of food chosen at the pantry using food transaction data; 2) Fruit and vegetable intake measured by biomarkers and food frequency questionnaires; 3) Objectively measured biomarkers of health. The web-based behavioral economic intervention will include the following modifications to the online shopping platform: 1) Healthy food shopping cart defaults, 2) healthy placement choice architecture, 3) traffic light nutrition labels, 4) social norms messaging, and 5) healthy swaps. Food transaction data will be collected from the online system at baseline and then continuously for the remaining 3 months of the study (participants typically shop monthly). Surveys and objective biomarkers will be collected at baseline and three-months.

Official Title
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A Randomized Trial of Web-based Behavioral Economic Interventions to Promote Healthy Food Choices Among Food Pantry Clients

Conditions
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Food Preferences

Intervention / Treatment
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* Behavioral: Behavioral economic intervention of online purchasing at a food pantry


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ≥18 years old primary grocery shopper for the family a regular in-person client at the food pantry (i.e., shops at pantry ≥ 1 per month) able to use the web-based touchscreen ordering system able to use a blood pressure cuff and scale provided to them for taking blood pressure and weight able to come outside their home for 5 minutes for the Veggie Meter measurement Exclusion Criteria: <18 years old not the primary grocery shopper for the family not a regular client at the food pantry (i.e., shops at pantry < 1 per month) not able to use the web-based touchscreen ordering system not able to use a blood pressure cuff and scale provided to them for taking blood pressure and weight not able to come outside their home for 5 minutes for the Veggie Meter measurement

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

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
Interventional Model Description: The researchers will recruit 500 regular food pantry clients to participate in a randomized-controlled trial that involves visiting the food pantry and selecting food using the web-based ordering system, having physical measurements collected by study staff, completing food frequency questionnaires, completing a health survey, and getting a blood draw to measure fruit and vegetable intake and health outcomes from biomarkers. Participants will be randomized to 1 of 2 conditions: 1) control group (usual care); or 2) behavioral economic intervention group.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control Group<br>Participants in this arm will view the typical web-based ordering system platform (usual care group). | |
| Experimental: Behavioral Economic Intervention Group<br>Participants in this arm will be exposed to the web-based ordering system with multiple behavioral economic interventions applied, including healthy food shopping cart defaults, healthy placement choice architecture, traffic light nutrition labels, social norms messaging, and healthy swaps. | Behavioral: Behavioral economic intervention of online purchasing at a food pantry<br>* This intervention includes multiple behavioral economic interventions, healthy food shopping cart defaults, healthy placement choice architecture, traffic light nutrition labels, social norms messaging, and healthy swaps.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Monthly change in number of units of healthier foods | Monthly change from baseline in number of units of healthier foods (labeled with a green traffic light) purchased per shopping trip using the food pantry's definition of a unit. | Collected from the online system at baseline and then each month for the remaining 3 months of participation. | 
| Monthly change in number of units of less healthy foods | Monthly change from baseline in number of units of less healthy foods (labeled with a red or yellow traffic light) purchased per shopping trip using the food pantry's definition of a unit. | Collected from the online system at baseline and then each month for the remaining 3 months of participation. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Monthly change in calories from healthier foods per shopping trip | Monthly change from baseline in number of calories from healthier foods per shopping trip. | Collected from the online system at baseline and then each month for the remaining 3 months of participation. | 
| Monthly change in calories from less healthy foods per shopping trip | Monthly change from baseline in number of calories from less healthy foods per shopping trip. | Collected from the online system at baseline and then each month for the remaining 3 months of participation. | 
| Self-reported change in fruit and vegetable intake | Change from baseline in fruit and vegetable intake as measured by the National Cancer Institute (NCI)'s fruit and vegetable module of the Dietary Screener Questionnaire in the National Health and Nutrition Examination Survey (NHANES). Scores estimate average daily cup equivalents of total fruit and vegetable servings. | Assessed at baseline and 3 months. | 
| Biomarker change in fruit and vegetable intake | Change from baseline in carotenoid levels | Assessed at baseline and 3 months. | 
| Change in Body Mass Index (BMI) | Change from baseline in BMI (weight in kg / height in meters^2) | Assessed at baseline and 3 months. | 
| Change in systolic blood pressure | Change from baseline in systolic blood pressure (indicator of heart health) | Assessed at baseline and 3 months. | 
| Change in diastolic blood pressure | Change from baseline in diastolic blood pressure (indicator of heart health) | Assessed at baseline and 3 months. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Food Assistance, Economics, Behavioral, Food Labeling, Diet Records, Biomarkers