Clinical trial NCT06865157: Healthy Food Subsidy Project in Chile
Official title: Bolsillo Saludable: Feasibility of a Healthy Food Subsidy on Healthy Eating in Low-Income Households in Chile
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Feasibility Studies
Food Security
Keywords: Chile
Fruit and vegetables subsidy
Feasibility study
Lead sponsor: University of Chile
Sponsor class: OTHER
Collaborators: name: Bloomberg Philanthropies
First posted: 2025-03-07
Enrollment: 30
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: The Healthy Wallet program is a mobile-based initiative designed to promote healthy eating among low-income families by incentivizing the purchase of fruits and vegetables at open markets. Over the course of two months, 30 families received monthly benefits redeemable at participating stalls within the Juan Pinto Durán open market in Santiago, Chile. Registered vendors prominently displayed a distinctive Healthy Wallet identification sign with a unique code, ensuring easy identification. Beneficiaries used the mobile app to check their available funds and complete purchases by entering the stall code. Meanwhile, vendors utilized their own app to track sales and maintain transaction records, streamlining the invoicing process.
Primary purpose: OTHER

Brief summary: Feasibility Study

Objective:

The objective of this feasibility study is to develop and evaluate the feasibility and acceptability of a healthy food subsidy program within the Chilean context. The program, called Healthy Wallet, is a smartphone app-based initiative aimed at incentivizing low-income families to purchase fruits and vegetables at open markets. The findings from this study are intended to inform and potentially accelerate the implementation of similar policies in other countries.

Methods:

This study assessed the feasibility of implementing the Healthy Wallet subsidy program, designed to promote healthy eating habits among low-income families. The program incentivized the purchase of fruits and vegetables at local ferias (open markets) and was delivered through a smartphone application. The research adopted a community-based approach, leveraging existing social support systems to identify eligible beneficiaries and streamline the distribution of benefits. Open markets served as redemption sites for the subsidies.

The study engaged 30 families and 8 vendors in an 8-week pilot program conducted from June to August 2024. Data collection included pre- and post-implementation surveys, as well as focus group discussions: three with participating families and one with vendors. These methods aimed to evaluate the app's effectiveness, user experience, and overall feasibility of the program. Insights from the study will guide recommendations for scaling the initiative to a national level and beyond.

Detailed description: Study Design:

This study employed an eight-week feasibility approach (Healthy Wallet) utilizing a mixed-methods assessment. The quantitative component consisted of a pre-post single-arm study, while the qualitative component involved focus group discussions with both vendors and participants.

Intervention:

The Healthy Wallet program is a mobile-based initiative aimed at promoting healthy eating habits among low-income families by incentivizing the purchase of fruits and vegetables at open markets. The program provides a monthly electronic transfer of 16,000 CLP (approximately 17 USD) for each eligible household member, including children under 18, students under 25, and individuals with disabilities. The primary food purchaser in each household receives the transfer, which is exclusively redeemable at registered stalls in the open market.

To ensure seamless transactions, registered vendors display a distinctive Healthy Wallet identification sign with a unique code. Beneficiaries use the mobile application to view available funds and complete purchases by entering the vendor's stall code. A separate vendor application tracks sales and maintains transaction records for efficient invoicing.

Sample:

The program engaged 30 families, who received monthly benefits for two consecutive months to use at 6 participating stalls within the Juan Pinto Durán open market.

Eligibility Criteria:

Eligibility aligned with Chile's existing social protection framework, leveraging the Emergency Family Wallet government subsidy established to address rising food prices during the COVID-19 pandemic. Households that participated in the Emergency Family Wallet program (2023-2024) were eligible.

The designated household representative, responsible for receiving and managing the benefit, had to meet the following criteria:

Be at least 18 years old (legal age). Be a parent or guardian of a child aged 0-5 years. Be responsible for household grocery purchases. Vendors operating at the Juan Pinto Durán open market were excluded from household eligibility.

Subsidy Delivery Platform:

A private mobile application, originally developed for university food benefits, was adapted for this pilot program. A private company managed the entire process, including loading benefits into participants' accounts, facilitating their use at the Juan Pinto Durán open market, and ensuring payment to vendors. This company provided its services pro bono, offering technical expertise and logistical support at no cost.

Ethical Considerations:

The study was conducted in accordance with the Declaration of Helsinki. The protocol and informed consent forms were approved by the Ethics Committee of the Faculty of Medicine, University of Chile.

Eligibility criteria: Inclusion Criteria:

Households that are beneficiaries of the Bolsillo Familiar Electrónico program in 2023-2024 and have children under 5 years of age.

Availability to shop at the local open-air market (feria libre).

Exclusion Criteria:

Individuals who are market vendors (feria vendors).

Primary outcomes:
measure: Percentage of the monetary subsidy spent daily by each household, based on the records from the subsidy delivery platform.
timeFrame: Daily throughout the two months of follow-up
measure: Percentage of households that used the monetary subsidy at least once per month, based on the records from the subsidy delivery platform
timeFrame: Weekly throughout the two months of follow-up
measure: Perceived utility of the subsidy program among beneficiaries, evaluated through online surveys
timeFrame: At the end of the study, at two months of follow-up
measure: Perceived utility of the subsidy program among vendors, evaluated through online surveys
timeFrame: At the end of the study, at two months of follow-up
measure: Self-reported satisfaction of the subsidy program among beneficiaries, evaluated through focus groups
timeFrame: At the end of the study, at two months of follow-up
measure: Self-reported satisfaction of the subsidy program among vendors, evaluated through focus groups
timeFrame: At the end of the study, at two months of follow-up
measure: Perceived utility of the subsidy platform among beneficiaries, evaluated through online surveys
timeFrame: At the end of the study, at two months of follow-up
measure: Perceived utility of the subsidy platform among vendors, evaluated through online surveys
timeFrame: At the end of the study, at two months of follow-up
measure: Self-reported satisfaction of the subsidy platform among beneficiaries, evaluated through focus groups
timeFrame: At the end of the study, at two months of follow-up
measure: Self-reported satisfaction of the subsidy platform among vendors, evaluated through focus groups
timeFrame: At the end of the study, at two months of follow-up
Secondary outcomes:
Other outcomes:
measure: Self-reported monthly expenditure on all fruits purchased from the open market, based on a questionnaire
timeFrame: At baseline and at the end of the study (0 and 2 months of follow-up)
measure: Self-reported monthly expenditure on all vegetables purchased at the open market, based on a questionnaire
timeFrame: At baseline and at the end of the study (0 and 2 months of follow-up)
measure: Self-reported monthly expenditure on all fruits and vegetables combined, purchased from the open market, based on a questionnaire
timeFrame: At baseline and at the end of the study (0 and 2 months of follow-up)
measure: Self-reported monthly combined fruit and vegetable purchases (in kilograms) from the open market, based on a questionnaire
timeFrame: At baseline and at the end of the study (0 and 2 months of follow-up)
measure: Self-reported monthly fruit purchases (in kilograms) at the open market, based on a questionnaire
timeFrame: At baseline and at the end of the study (0 and 2 months of follow-up)
measure: Self-reported monthly vegetable purchases (in kilograms) at the open market, based on a questionnaire
timeFrame: At baseline and at the end of the study (0 and 2 months of follow-up)
measure: Self-reported monthly vegetable purchases (in units) at the open market, based on a questionnaire
timeFrame: At baseline and at the end of the study (0 and 2 months of follow-up)
measure: The Global Dietary Recommendations (GDR) score from the Diet Quality Questionnaire (DQQ), range 0-18
timeFrame: At baseline and at the end of the study (0 and 2 months of follow-up)
measure: The Non-Communicable Disease-protect (NCD-protect) score from the Diet Quality Questionnaire (DQQ), range 0-9
timeFrame: At baseline and at the end of the study (0 and 2 months of follow-up)
measure: The Non-Communicable Disease-risk (NCD-risk) score from the Diet Quality Questionnaire (DQQ), range 0-9
timeFrame: At baseline and at the end of the study (0 and 2 months of follow-up)
measure: The Food Group Diversity Score (FGDS) from the Diet Quality Questionnaire (DQQ), range 0-10
timeFrame: At baseline and at the end of the study (0 and 2 months of follow-up)
Locations:
city: Santiago
country: Chile
facility: Feria Libre Juan Pinto Durán
state: Macul
Study officials:
affiliation: Institute of Nutrition and Food Technology, University of Chile
name: Camila Corvalan, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Huangfu P, Pearson F, Abu-Hijleh FM, Wahlich C, Willis K, Awad SF, Abu-Raddad LJ, Critchley JA. Impact of price reductions, subsidies, or financial incentives on healthy food purchases and consumption: a systematic review and meta-analysis. Lancet Planet Health. 2024 Mar;8(3):e197-e212. doi: 10.1016/S2542-5196(24)00004-4.
citation: Andreyeva T, Marple K, Moore TE, Powell LM. Evaluation of Economic and Health Outcomes Associated With Food Taxes and Subsidies: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022 Jun 1;5(6):e2214371. doi: 10.1001/jamanetworkopen.2022.14371.
citation: Berkowitz SA, Curran N, Hoeffler S, Henderson R, Price A, Ng SW. Association of a Fruit and Vegetable Subsidy Program With Food Purchases by Individuals With Low Income in the US. JAMA Netw Open. 2021 Aug 2;4(8):e2120377. doi: 10.1001/jamanetworkopen.2021.20377.