Behavioral Economics to Implement a Traffic Light Nutrition Ranking System: Study 2

Not Applicable

Recruiting

• Conditions: Behavioral Economics; Diet, Healthy; Food Insecurity; Implementation Science
• Interventions: Behavioral: Basic SWAP implementation; Behavioral: Behavioral economics-enhanced SWAP implementation

• Registration Number: NCT06298253
• Lead Sponsor: Massachusetts General Hospital

Brief Summary

This is a cluster randomized controlled trial of 30 food pantries affiliated with the Greater Boston Food Bank to test the use of behavioral economics (BE) tools to encourage food pantries to implement the Supporting Wellness at Pantries (SWAP) program, with the goal of fostering accurate use of SWAP traffic light labels on pantry shelves and increasing the healthfulness of foods chosen by pantry clients. Primary outcomes will be assessed at 6 and 12 months to compare the implementation and effectiveness of the SWAP program in the intervention vs. control pantries.

Detailed Description

This study will test the use of behavioral economics (BE) tools to encourage food pantries to implement the Supporting Wellness at Pantries (SWAP) program, with the goal of encouraging pantries to use SWAP traffic light labels on pantry shelves and increase the healthfulness of foods chosen by pantry clients. The study design is a 12-month cluster RCT of 30 Greater Boston Food Bank partner pantries comparing a basic SWAP implementation strategy (control, n=15) with a BE-enhanced SWAP implementation strategy (intervention, n=15). Primary outcomes assessed at 6 and 12 months will be implementation of the SWAP program within pantries and improvement of client food choices and dietary quality. At the end of 12 months, the BE-enhanced SWAP implementation strategy will be adapted, updated, and offered to the 15 pantries assigned to control (waitlist) at baseline. The 15 intervention pantries will be followed without further intervention.

Study Timeline

• Study First Submitted: 2024-03-01
• Study First Submitted QC: 2024-03-01
• Study First Posted: 2024-03-07
• Study Start: 2024-10-01
• Status Verified: 2025-04
• Last Update Submitted: 2025-04-27
• Last Update Posted: 2025-04-30
• Primary Completion: 2027-06-01
• Study Completion: 2028-06

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 3750

Inclusion Criteria

• Food pantries enrolled in the study will be partner agencies of the Greater Boston Food Bank that are maximum client choice, are located within approximately 1 hour driving time of Boston (for logistical feasibility), and are not actively using traffic-light nutrition ranking.
• Food pantry clients that complete assessments must be 18 years or older and speak English or Spanish.

Exclusion Criteria

• Food pantries that are not affiliated with the Greater Boston Food Bank and are not maximum client choice.
• Food pantry clients that do not speak English or Spanish.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Basic SWAP implementation strategy	Basic SWAP implementation	Pantries assigned to the control arm will receive email communication from the food bank dietitian providing them with information about SWAP, online links to SWAP implementation guides, and encouragement to purchase SWAP Toolkits on their own.
Behavioral economics-enhanced SWAP implementation strategy	Behavioral economics-enhanced SWAP implementation	Pantries assigned to the intervention group will receive behavioral nudges for implementing the SWAP nutrition program. These include: 1) invoice labeling with the food labeled as red, yellow, or green; 2) receipt of the SWAP toolkit at no cost; 3) pantry learning communities; 4)incentives to purchase SWAP implementation materials (e.g., shelves); 5) food bank recognition for SWAP implementation.

Primary Outcome Measures

Name	Time	Method
Pantry SWAP implementation	6 months and 12 months	Proportion of pantries in the intervention vs. control group that implement SWAP (e.g., traffic-light labels on shelves)
Percent items (by weight) ordered by pantry that are labeled green or red	6 months and 12 months	Using data collected from the food bank ordering platform, this outcome will be the proportions (by weight) of the overall orders from GBFB that are green-labeled and red-labeled according to SWAP ranking categories
Percent of pantry clients' selected food that is green or red	6 months and 12 months	Using pantry client basket assessments, the total proportion (by weight) of food selected by the client that is labeled green (or red) will be calculated for each participant
Client dietary quality score	6 months and 12 months	Rapid Prime Dietary Quality Score (range 0 to 52, higher is healthier) collected at the time clients are leaving the pantry

Secondary Outcome Measures

Name	Time	Method
Skin carotenoid level	6 months and 12 months	Measured using the Veggie Meter scale at the time clients leave the pantry; range is 0 to 800 units, with higher scores indicating higher carotenoid levels (and therefore higher fruit and vegetable intake)

Trial Locations

Locations (1)

Massachusetts General Hospital; 🇺🇸 Boston, Massachusetts, United States