OPT-FRESH: Optimizing Online Purchasing of Fruits, Vegetables, and Legumes for Low-Income Families
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 360
- 试验地点
- 1
- 主要终点
- Household Food Security
研究概览
简要总结
Food insecurity, that is, the lack of consistent access to nutritious and affordable food, is associated with poor diet, increased cardiovascular disease (CVD) risk, and has a negative long-term impact on the economy through increased health care costs. CVDs and food insecurity disproportionately affect Black and Hispanic families, and most of these racial health disparities can be attributed to social determinants of health, including poor access to healthy foods. A recent policy in the U.S. authorized the Supplemental Nutrition Assistance Program (SNAP) benefits to be used online to increase grocery access and promote healthy eating. Although online grocery shopping has been growing among populations of low-income, the selection of fruits, vegetables, and legumes (FVL), which are protective against CVD, is lower than in-store. Distrust of online hired shoppers' choices, fear of losing money on unsatisfactory purchases, and impulse of unhealthy food purchases have been the major barriers to online healthy food selection. Thus, there is a need for intervention packages that are effective, economical, and easily scalable into policies that address CVD-related outcomes and improve health equity. The proposed work will use a highly efficient methodological approach, the Multiphase Optimization Strategy (MOST), to test three experimental components aimed at barriers to online healthy food selection, called OPT-FRESH. This approach addresses weaknesses in prior studies, which cannot determine which elements of multicomponent interventions meaningfully improve outcomes. 360 families with children living in low-income urban communities of NYC will be randomized to receive some combination of the three experimental components for 12 weeks: 1) weekly text messages to improve the trust in online grocery services (off/on); 2) weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion (off/on); 3) weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases (off/on). A monthly service fee waiver (3 in total), a monthly $5 stipend (3 in total), unlimited delivery fee waiver and a tutorial video addressing digital literacy will be constant components to promote equity in participant enrollment. Aim 1 will determine the combination(s) of the three experimental components that improve overall household FVL purchase and food insecurity (primary outcomes) and FVL intake of children (secondary outcome). Aim 2 will identify the optimized intervention that balances component(s) that are affordable and scalable (high adoption, implementation, maintenance) that still produce meaningful effects on the outcomes, using decision analysis for intervention value efficiency. Aim 3 will determine the mechanistic effects of the three intervention components on the outcomes using factorial mediation analysis. Working with community-based organizations and nutrition and hunger relief programs in NYC, a grocery delivery service, and a team with unparalleled expertise in experimental trials, policy, and MOST, we will implement optimized, affordable, and scalable intervention strategies to improve neighborhood food access and ultimately CVD outcomes in socially vulnerable families.
详细描述
OPT-FRESH will use a highly efficient methodological approach for intervention development, the multiphase optimization strategy (MOST). We will partner with the private sector (Instacart) to leverage strategies from the public sector (SNAP) and test three experimental components aimed at barriers to online healthy food selection. The three experimental components, which were found in our pilot work to be feasible and acceptable, include: 1) weekly text messages to improve trust in online grocery services; 2) weekly match of up to $10 as a financial incentive for purchasing FVL online; and 3) weekly instant shoppable grocery lists of tailored meal suggestions using SNAP-Ed recipes. Moreover, as our pilot demonstrated that waiving delivery fees enabled more equitable participant enrollment and online grocery uptake, all participants will have the online delivery fee waived for the intervention period (12 weeks), along with a tutorial video addressing digital literacy to further promote equity in enrollment, a monthly service fee waiver (3 in total) and a monthly $5 stipend (3 in total). A sample of 360 families with young children living in low-income urban communities of NYC will be randomized to receive some combination of the experimental components for 12 weeks. We will test component effects at 12 weeks and test maintenance in the absence of intervention (no fee waiving, experimental components) 9 months post-intervention.
We will conduct additional formative research before the intervention is implemented to ensure Cultural tailoring of OPT-FRESH. We will hold 2-5 focus group discussions with caregivers of young children with low-income to gather feedback on intervention materials and research procedures informed by key areas of the Ecological Validity Model: i) Language-feedback on intervention materials, including a tutorial on using Instacart; ii) Persons-recruitment and "buy-in" factors; iii) Metaphors-symbols and sayings that resonate with participants; iv) Content-grocery items needed to address food insecurity, including culturally appropriate options; v) Methods-feedback on text messages, online surveys, and intervention delivery; and vi) Context-barriers to participation and adherence. Then, a group of approximately 10 SNAP-eligible adult caregivers of children will be invited to form our community stakeholder team. They will be engaged throughout the intervention to include their voices and lived experiences in the project. The group will meet virtually once or twice a year to provide feedback on key areas of the intervention.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Factorial
- 主要目的
- Prevention
- 盲法
- Double (Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 2 Years 至 —（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adult (> 21 years old)
- •Live in a household with a young child(ren) under the age of 10 years and above age
- •Primary shopper for the household
- •Have access to a smartphone or computer to place online orders
- •Participation in the Supplemental Nutrition Assistance Program in the past year or income eligible (annual household income =< 130% of the federal poverty line)
- •Agree to share itemized grocery receipts during the study (12 months)
- •Willing to order groceries online
- •English or Spanish speaker
- •Informed consent
排除标准
- 未提供
研究组 & 干预措施
Texting + Financial Incentive + Shoppable List
Online grocery delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
- weekly text messages to improve the trust in online grocery services;
- weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion;
- weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
干预措施: Video tutorial (Behavioral)
Texting + Financial Incentive + Shoppable List
Online grocery delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
- weekly text messages to improve the trust in online grocery services;
- weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion;
- weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
干预措施: Delivery fee waiver (Behavioral)
Texting + Financial Incentive + Shoppable List
Online grocery delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
- weekly text messages to improve the trust in online grocery services;
- weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion;
- weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
干预措施: Texting (Behavioral)
Texting + Financial Incentive + Shoppable List
Online grocery delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
- weekly text messages to improve the trust in online grocery services;
- weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion;
- weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
干预措施: Financial incentive (Behavioral)
Texting + Financial Incentive + Shoppable List
Online grocery delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
- weekly text messages to improve the trust in online grocery services;
- weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion;
- weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
干预措施: Grocery list with instant shoppable SNAP-Ed recipes (Behavioral)
Texting + Financial Incentive
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
- weekly text messages to improve the trust in online grocery services;
- weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion;
干预措施: Video tutorial (Behavioral)
Texting + Financial Incentive
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
- weekly text messages to improve the trust in online grocery services;
- weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion;
干预措施: Delivery fee waiver (Behavioral)
Texting + Financial Incentive
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
- weekly text messages to improve the trust in online grocery services;
- weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion;
干预措施: Texting (Behavioral)
Texting + Financial Incentive
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
- weekly text messages to improve the trust in online grocery services;
- weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion;
干预措施: Financial incentive (Behavioral)
Texting only
Online grocer delivery fee waive, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
1) weekly text messages to improve the trust in online grocery services;
干预措施: Video tutorial (Behavioral)
Texting only
Online grocer delivery fee waive, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
1) weekly text messages to improve the trust in online grocery services;
干预措施: Texting (Behavioral)
Financial Incentive + Shoppable List
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
- weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion;
- weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
干预措施: Video tutorial (Behavioral)
Financial Incentive + Shoppable List
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
- weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion;
- weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
干预措施: Delivery fee waiver (Behavioral)
Financial Incentive + Shoppable List
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
- weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion;
- weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
干预措施: Financial incentive (Behavioral)
Financial Incentive + Shoppable List
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
- weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion;
- weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
干预措施: Grocery list with instant shoppable SNAP-Ed recipes (Behavioral)
Texting + Shoppable List
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
- weekly text messages to improve the trust in online grocery services;
- weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
干预措施: Video tutorial (Behavioral)
Texting + Shoppable List
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
- weekly text messages to improve the trust in online grocery services;
- weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
干预措施: Delivery fee waiver (Behavioral)
Texting + Shoppable List
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
- weekly text messages to improve the trust in online grocery services;
- weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
干预措施: Texting (Behavioral)
Texting + Shoppable List
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
- weekly text messages to improve the trust in online grocery services;
- weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
干预措施: Grocery list with instant shoppable SNAP-Ed recipes (Behavioral)
Shoppable List
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
1) weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
干预措施: Video tutorial (Behavioral)
Shoppable List
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
1) weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
干预措施: Delivery fee waiver (Behavioral)
Shoppable List
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
1) weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
干预措施: Grocery list with instant shoppable SNAP-Ed recipes (Behavioral)
Financial Incentive
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
1) weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion.
干预措施: Video tutorial (Behavioral)
Financial Incentive
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
1) weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion.
干预措施: Delivery fee waiver (Behavioral)
Financial Incentive
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus:
1) weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion.
干预措施: Financial incentive (Behavioral)
Delivery fee waived only
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study.
干预措施: Video tutorial (Behavioral)
Delivery fee waived only
Online grocer delivery fee waiver, a monthly one-time use service fee waiver (3 in total), a monthly one-time use $5 stipend (3 in total) and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study.
干预措施: Delivery fee waiver (Behavioral)
结局指标
主要结局
Household Food Security
时间窗: 6 weeks, 12 weeks, and 12 months
Change in household food security from baseline will be measured using the 18-item validated USDA screening tool mid-intervention (6-week), post-intervention (12-week), and maintenance (12 months)
Household Purchase of Fruit, Vegetable, and Legumes.
时间窗: 6 weeks, 12 weeks, and 12 months
Change in household purchase of fruits, vegetables, and legumes (online and in-store) from baseline will be assessed via itemized grocery receipts obtained via text messages mid-intervention (6-week), post-intervention (12-week), and maintenance (12 months)
次要结局
- Consumption of Fruit, Vegetable, and Legumes(12 weeks)