Impact of Delivering Nutrition Interventions Through Online Grocery Services to Improve Nutrition Security Among the Low-Income Population

An unhealthy diet is a major contributor to the development and progression of type 2 diabetes (T2D). Our recent research estimated that a suboptimal diet accounts for up to 70% of the global incidence of T2D, due to excess intake of refined grains, insufficient whole grains, excess processed meat, and excess sugar-sweetened beverages (SSB), among several other dietary factors. In the U.S., individuals from traditionally marginalized groups suffer disproportionally from poor diet and diabetes, including those with lower incomes, from certain racial and ethnic minority backgrounds, and with food insecurity. SNAP, by far the largest U.S. nutrition program – providing a total of $100 billion/year for grocery food purchases for 33 million Americans in low-income households – is a critical program to reduce hunger and food insecurity.  However, SNAP has been less successful at advancing nutrition security: the consistent access, availability, and affordability of healthy foods that promote well-being and prevent and, if needed, treat disease.

Online grocery shopping is the fastest growing segment in food retail, now 15% of US grocery sales and with rapid projected further growth. Online retail has tremendous potential to help address nutrition security and health equity, by reducing access, transportation, and time barriers while also leveraging the online format to nudge and incentivize healthier food choices. In April 2023, 3.7 million SNAP households shopped online, compared with 35,000 SNAP households in March 2020. These shifts provide an exciting, timely opportunity to identify feasible and effective strategies to leverage online retail to address persistent diet-related health disparities by promoting healthier food choices in SNAP. This project will leverage interdisciplinary methods in behavioral, implementation, and qualitative and quantitative science to translate innovative interventions to promote healthy eating among SNAP recipients with diabetes in the real-world online retail setting.

Aim One

To use mixed-method research to understand the needs and preferences of multiple key stakeholders, co-creating intervention components for healthier purchases in online retail, with pilot testing and adapting the intervention components among SNAP recipients with diabetes.

Aim Two

Formally test the interventions in a 3-month randomized controlled trial (with additional follow-up to 6 months) among 400 SNAP recipients with diabetes who utilize an online food shopping platform, randomized equally to: 1) control (online shopping as usual); 2) digital healthy shopping nudges within the online platform; 3) direct financial incentives for purchasing healthy foods within the online platform; or 4) the combination of digital nudges and financial incentives.

Aim Three

To assess usability of the intervention, and barriers and facilitators for implementation among key stakeholders by qualitative interviews.