Project Summary
Food insecurity, having unreliable access to enough affordable and nutritious food, affects 1 in 10 Americans.
Food insecurity leads to a higher risk of cardiovascular disease and its risk factors, including diabetes,
hypertension, and low diet quality. Adopting healthy dietary patterns can substantially decrease cardiovascular
disease risk, but the cost of healthy foods is a barrier. Food pantries are an important and accessible
community resource for people with food insecurity. In recent decades, food pantries have adopted new
technologies to improve client access and choice. In menu-based food pantries, clients shop for foods using an
online menu, creating opportunities to encourage healthy food selection through small changes in the menu to
increase visibility and appeal of certain foods, called “nudges.” Digital nudges have not been designed for or
widely implemented in menu pantries, and lack of client engagement in creating acceptable nudges for
charitable food settings is a critical implementation barrier. In the proposed K23 project, Dr. Jenny Jia uses
systematic engagement of pantry clients, staff, and other stakeholders to codesign digital nudges that are
acceptable, feasible, and increase healthy food selection. In Aim 1, we will engage menu pantry clients and
staff in systematic codesign to adapt digital nudges for an online menu, using serial interviews and focus
groups to obtain formative feedback to adapt and beta test digital nudge prototypes to increase acceptability.
After consolidating digital nudges into one intervention, in Aim 2, we will test and refine implementation of the
digital nudge intervention in one menu pantry. We will use an iterative, mixed methods approach with pantry
staff to integrate the digital nudge intervention into pantry operations. In Aim 3, we will evaluate preliminary
effectiveness of the digital nudge intervention on nutritional quality of client food selection in a pilot type 1
hybrid intervention study. To measure change due to implementation, we will use an interrupted time series on
longitudinal menu orders from all pantry clients in 3 intervention pantries, comparing 6 months of pre-
intervention to 6 months of during-intervention data. In addition, we will identify implementation facilitators and
barriers and determine feasibility of longitudinally measuring diet quality, blood pressure, and weight in pantry
clients, comparing in-person to remote approaches, to inform methods for a future effectiveness trial. To
effectively accomplish the aims, Dr. Jia has created a comprehensive training plan with the collaboration of her
multidisciplinary mentorship team to gain expertise in systematic codesign methods, implementation science,
and pragmatic evaluations. This proposal aligns with NHLBI’s Behavioral Economics in Implementation
Research priority and NHLBI’s Strategic Vision. Completion of the training plan and proposed project will
prepare Dr. Jia to become an independent investigator with expertise in developing, testing, and implementing
innovative and effective community-based strategies to improve food environments, diet quality, and
cardiovascular health in populations facing social inequities.
