A Trial of Behavioral Economic Interventions Among Food Pantry Clients

Not Applicable

Completed

Conditions: Food Preferences

Interventions: Behavioral: Behavioral economic intervention of online purchasing at a food pantry

Registration Number: NCT04011384

Lead Sponsor: Abramson Cancer Center at Penn Medicine

Brief Summary: 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: 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.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 286

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

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Behavioral Economic Intervention Group	Behavioral economic intervention of online purchasing at a food pantry	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.

Primary Outcome Measures

Name	Time	Method
Mean Monthly Change in Number of Units of Healthier Foods	Collected from the online system at baseline and then each month for the remaining 3 months of participation.	Average monthly change from baseline across 3 months of participation, 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.
Mean Monthly Change in Number of Units of Less Healthy Foods	Collected from the online system at baseline and then each month for the remaining 3 months of participation.	Average monthly change from baseline across 3 months of participation, 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.

Secondary Outcome Measures

Name	Time	Method
Mean Monthly Change in 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.	Average monthly change from baseline across 3 months of participation, in number of calories from healthier foods per shopping trip.
Biomarker Change in Fruit and Vegetable Intake	Assessed at baseline and 3 months.	Change from baseline in carotenoid levels (scores range 0-800) as measured by the VeggieMeter®. The VeggieMeter® is a spectroscopy-based skin carotenoid measurement device, created by Longevity Link Corporation in 2015. It uses pressure-mediated reflection spectroscopy (RS) to detect and quantify skin carotenoids as a proxy for fruit and vegetable intake in humans. Validation studies show VeggieMeter scores to be highly correlated with blood serum measures of carotenoids (R=.81). Higher units represent a higher concentration of carotenoids in the skin.
Change in Body Mass Index (BMI)	Assessed at baseline and 3 months.	Change from baseline in BMI (weight in kg / height in meters\^2)
Change in Systolic Blood Pressure	Assessed at baseline and 3 months.	Change from baseline in systolic blood pressure (indicator of heart health)
Change in Diastolic Blood Pressure	Assessed at baseline and 3 months.	Change from baseline in diastolic blood pressure (indicator of heart health)
Mean Monthly Change in 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.	Average monthly change from baseline across 3 months of participation, in number of calories from less healthy foods per shopping trip.
Self-reported Change in Fruit and Vegetable Intake	Assessed at baseline and 3 months.	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.