Optimizing Online Purchasing of Fruits, Vegetables, and Legumes for Low-Income Families

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 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.