Community-engaged Design and Implementation of a Behavioral Economics Food Choice Intervention in Food Pantries to Improve Cardiovascular Health - 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.
