Using a human-centered design framework and behavioral economic interventions to increase fruit and vegetable...

Diet-related chronic conditions are leading causes of death in the U.S. Healthier diets with fruits and vegetables can reduce the risk of developing these diseases. This study tests interventions to increase redemption of produce subsidies and purchases of fruits and vegetables using an online grocery delivery platform among people who have obesity and type 2 diabetes.

Participants drawn from Penn Medicine primary care practices are given access to online grocery shopping and delivery. The intervention tests ways of increasing subsidy use for fruits and vegetables through a salience manipulation with loss-framed text messages, choice architecture on the grocery platform, or a combination of the two. A 10-person pre-pilot was trialed for two weeks. Learnings from qualitative interviews with the pre-pilot participants were used to refine the design prior to the launch of the 3-month randomized controlled trial (RCT) (projected n = 180).

Total dollar expenditures of eligible fruits and vegetables across the 3 months of the study.

1) mean percentage of the monthly subsidy used across 3 months; 2) cumulative percentage of expenditures spent on eligible fruits and vegetables (i.e., total spent on fruits and vegetables/total spent); 3) change in hemoglobin A1c from baseline; and 4) qualitative results including enrollment experience, experience using the study store, communication with the study team, and dietary effects of the study.

The rationale, design, and protocol of this study are described. This study can provide insights on how food is medicine programs can be structured to improve engagement.

gov Registration Number: NCT06283394.