Investigator will test an intervention to increase use of a fruit and vegetable incentive program in South Carolina for families in the Supplemental Nutrition Assistance Program (SNAP) experiencing food insecurity. Caregivers are randomized to an intervention or an education-only, wait-list control group. The investigators hypothesize the intervention will improve diet-related outcomes, above and beyond the education-only wait-list control.
This study will test an intervention to increase use of a fruit and vegetable incentive program for families in the Supplemental Nutrition Assistance Program (SNAP) using a randomized controlled trial design. Caregivers are randomized to the intervention or an education-only wait-list control group. All caregivers are given brief education about a SNAP fruit and vegetable incentive program. Caregivers in the intervention are also given an initial "free trial" of this program and free home delivery. The primary aim is to examine intervention efficacy on diet-related outcomes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
296
Caregivers will receive brief education about a SNAP fruit and vegetable incentive program in South Carolina during their child's pediatrician visit. Following the visit, caregivers will receive a "free trial" of this SNAP program to encourage first-time use. After the free trial, caregivers can continue purchasing the same fruit and vegetable boxes at a steeply discounted price using their SNAP card. Free home delivery during the "free trial" and for all subsequent boxes purchased at a discounted rate will be offered during the full study duration.
University of South Carolina
Columbia, South Carolina, United States
RECRUITINGChild diet quality
Caregivers will complete a 3-day food record for their child's dietary intake. Child diet quality will then be assessed using the Healthy Eating Index.
Time frame: Baseline, 6, 18, and 30 weeks
Caregiver diet quality
Caregivers will complete a 3-day food record for their dietary intake. Caregiver diet quality will then be assessed using the Healthy Eating Index.
Time frame: Baseline, 6, 18, and 30 weeks
Child Eating Behaviors
The Children's Eating Behavior Questionnaire will be used to assess children's food fussiness. The food fussiness sub-scale consists of 5-pt Likert scale items ranging from Never (1) to Always (5). The mean of the response values is calculated. Higher score indicating a greater degree of food fussiness.
Time frame: Baseline, 6, 18, and 30 weeks
Process metrics
Process metrics will examine the reach of families who received brief education during clinic visits at each site, utilization of the free trial, use of home delivery, and families who cycled off SNAP within the study duration (%, #, timing).
Time frame: Through study completion, an average of 3 years
Intervention utilization
Semi-structured phone interviews and surveys will be administered to caregivers to elicit perceptions on intervention components, barriers/facilitators to intervention use, and suggestions for future dissemination.
Time frame: Through study completion, an average of 3 years
Perspectives of the intervention
Focus groups and online surveys will be administered to key informants to assess barriers and facilitators to intervention implementation and sustainability.
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Time frame: Through study completion, an average of 3 years
Food security
The United States Department of Agriculture Household Food Security Module (18-item) will be administered. Higher scores indicate less food security.
Time frame: Baseline, 6, 18, and 30 weeks
Availability Pillar of Food Security
The Perceived Limited Availability scale will be administered (6-items). Items are summed to create a total score for food stores (3-items) and food pantries (3 items). Each total score ranges 0-3. Higher scores are considered less desirable.
Time frame: Baseline, 6, 18, and 30 weeks
Utilization Pillar of Food Security
The Utilization Barriers scale (8-items) will be administered. Items are summed to create a score ranging 0-8. Higher scores are considered less desirable.
Time frame: Baseline, 6, 18, and 30 weeks
Stability Pillar of Food Security
The Food Insecurity Stability scale (12-items) will be administered. Participants receive 4 scores, each ranging from 0-3 for chronic, seasonal, monthly, and intermittent food insecurity. Higher scores indicate a greater degree of chronic, seasonal, monthly, and intermittent food insecurity.
Time frame: Baseline, 6, 18, and 30 weeks
Nutrition Security
Nutrition security will be measured using the Household Nutrition Security scale (4-items). Item scores range 0 ("Always") to 4 ("Never"). The mean of item scores is calculated. Higher scores indicate a greater degree of nutrition security.
Time frame: Baseline, 6, 18, and 30 weeks
Household Healthfulness Choice
The Household Healthfulness Choice (3-items) survey will be administered. Items are scored from 4 ("Always") to 0 ("Never"). The mean of the item scores is calculated. Higher scores indicate a greater degree healthfulness choice.
Time frame: Baseline, 6, 18, and 30 weeks
Dietary Choice
The Dietary Choice (3-items) survey will be administered. Item scores range from 0 ("Always") to 4 ("Never"). The mean of the item scores is calculated. Higher scores indicate a greater degree of dietary choice.
Time frame: Baseline, 6, 18, and 30 weeks
SNAP fruit and vegetable incentive program utilization
Purchasing data will be used to quantify the number and type of produce boxes purchased as part of the Supplemental Nutrition Assistance Program (SNAP) fruit and vegetable incentive program in South Carolina.
Time frame: Through study completion, an average of 3 years