Optimizing Online Purchasing of Fruits, Vegetables, and Legumes for Low-Income Families
OPT-FRESH
OPT-FRESH: Optimizing Online Purchasing of Fruits, Vegetables, and Legumes for Low-Income Families
1 other identifier
interventional
360
0 countries
N/A
Brief Summary
Food insecurity, that is, the lack of consistent access to nutritious and affordable food, is associated with poor diet, increased cardiovascular disease (CVD) risk, and has a negative long-term impact on the economy through increased health care costs. CVDs and food insecurity disproportionately affect Black and Hispanic families, and most of these racial health disparities can be attributed to social determinants of health, including poor access to healthy foods. A recent policy in the U.S. authorized the Supplemental Nutrition Assistance Program (SNAP) benefits to be used online to increase grocery access and promote healthy eating. Although online grocery shopping has been growing among populations of low-income, the selection of fruits, vegetables, and legumes (FVL), which are protective against CVD, is lower than in-store. Distrust of online hired shoppers' choices, fear of losing money on unsatisfactory purchases, and impulse of unhealthy food purchases have been the major barriers to online healthy food selection. Thus, there is a need for intervention packages that are effective, economical, and easily scalable into policies that address CVD-related outcomes and improve health equity. The proposed work will use a highly efficient methodological approach, the Multiphase Optimization Strategy (MOST), to test three experimental components aimed at barriers to online healthy food selection, called OPT-FRESH. This approach addresses weaknesses in prior studies, which cannot determine which elements of multicomponent interventions meaningfully improve outcomes. 360 families with children living in low-income urban communities of NYC will be randomized to receive some combination of the three experimental components for 12 weeks: 1) weekly text messages to improve the trust in online grocery services (off/on); 2) weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion (off/on); 3) weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases (off/on). Delivery fee waiver and a tutorial video addressing digital literacy will be constant components to promote equity in participant enrollment. Aim 1 will determine the combination(s) of the three experimental components that improve overall household FVL purchase and food insecurity (primary outcomes) and FVL intake of children (secondary outcome). Aim 2 will identify the optimized intervention that balances component(s) that are affordable and scalable (high adoption, implementation, maintenance) that still produce meaningful effects on the outcomes, using decision analysis for intervention value efficiency. Aim 3 will determine the mechanistic effects of the three intervention components on the outcomes using factorial mediation analysis. Working with community-based organizations and nutrition and hunger relief programs in NYC, a grocery delivery service, and a team with unparalleled expertise in experimental trials, policy, and MOST, we will implement optimized, affordable, and scalable intervention strategies to improve neighborhood food access and ultimately CVD outcomes in socially vulnerable families.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Jul 2026
Longer than P75 for not_applicable
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
July 8, 2025
CompletedFirst Posted
Study publicly available on registry
July 17, 2025
CompletedStudy Start
First participant enrolled
July 1, 2026
ExpectedPrimary Completion
Last participant's last visit for primary outcome
March 30, 2028
Study Completion
Last participant's last visit for all outcomes
December 30, 2029
March 2, 2026
November 1, 2025
1.7 years
July 8, 2025
February 26, 2026
Conditions
Keywords
Outcome Measures
Primary Outcomes (2)
Household Food Security
Change in household food security from baseline will be measured using the 18-item validated USDA screening tool mid-intervention (6-week), post-intervention (12-week), and maintenance (12 months)
6 weeks, 12 weeks, and 12 months
Household Purchase of Fruit, Vegetable, and Legumes.
Change in household purchase of fruits, vegetables, and legumes (online and in-store) from baseline will be assessed via itemized grocery receipts obtained via text messages mid-intervention (6-week), post-intervention (12-week), and maintenance (12 months)
6 weeks, 12 weeks, and 12 months
Secondary Outcomes (1)
Consumption of Fruit, Vegetable, and Legumes
12 weeks
Other Outcomes (2)
Consumption of Fruit and Vegetable, and Legumes
12 weeks
Body Mass Index
12 weeks
Study Arms (8)
Texting + Financial Incentive + Shoppable List
EXPERIMENTALOnline grocer delivery fee waiver and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus: 1. weekly text messages to improve the trust in online grocery services; 2. weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion; 3. weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
Texting + Financial Incentive
EXPERIMENTALOnline grocer delivery fee waiver and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus: 1. weekly text messages to improve the trust in online grocery services; 2. weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion;
Texting only
EXPERIMENTALOnline grocer delivery fee waiver and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus: 1\) weekly text messages to improve the trust in online grocery services;
Financial Incentive + Shoppable List
EXPERIMENTALOnline grocer delivery fee waiver and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus: 1. weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion; 2. weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
Texting + Shoppable List
EXPERIMENTALOnline grocer delivery fee waiver and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus: 1. weekly text messages to improve the trust in online grocery services; 2. weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
Shoppable List
EXPERIMENTALOnline grocer delivery fee waiver and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus: 1\) weekly instant shoppable grocery lists of culturally tailored meal suggestions using SNAP recipes targeted at impulse purchases.
Financial Incentive
EXPERIMENTALOnline grocer delivery fee waiver and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study. Plus: 1\) weekly match-up to $10 as a financial incentive for purchasing FVL online targeting loss aversion.
Delivery fee waived only
ACTIVE COMPARATOROnline grocer delivery fee waiver and a tutorial video addressing digital literacy will be constant components, meaning that it will be available to all participants in the study.
Interventions
At the onset of the intervention, all participants will receive tutorial videos via text, covering Instacart account setup, online item selection, and SNAP-eligible stores, aiming to improve digital literacy in grocery shopping. The video was developed by our team, reviewed by SNAP-Ed partners, and available in English and Spanish. Despite being considered helpful during the pilot, nearly half of the participants reported not receiving or watching the tutorial video. To address this, we will call all participants within the trial's first week to provide technical assistance, including step-by-step instructions on redemption of the free delivery membership. Phone follow-ups were well-received during the pilot. Also, an intervention package will be mailed to all participants as material to be referred to in the calls and throughout the intervention. Those receiving the grocery list component will receive shopping lists and recipes printed and via SMS, to aid online grocery ordering in si
All participants will receive a 12-week Instacart+ Membership e-gift card, eliminating the online delivery fee for orders \>$35.
Participants randomized to this component will receive 2 text messages weekly via EZ text to enhance their perception of behavioral control and trust in online grocery services. Text messages, deemed acceptable during our pilot, will be actionable, informed by constructs of the Theory of Planned Behavior, and tailored to assist shoppers using Instacart delivery services. We will deliver 24 short text messages (\<160 characters), on Friday afternoons and Mondays, each with one or more of the purposes rooted in behavior change techniques: increasing salience of the benefits of online grocery, modeling steps in behavior change, giving facts to address mistrust or improve control, asking questions to promote engagement, adding anonymized quotations from the pilot participants to reinforce social norms.
Participants randomized to this component (alone or in combination with another experimental condition) will receive $1 for each dollar spent on fresh, frozen, or canned FVL loaded onto Instacart Fresh Funds, verified based on the submitted online grocery receipt or data from Instacart. The incentive applies to online purchases only and will not be earned for in-store transactions. A maximum weekly matched incentive will be set to $10, following the local FV incentive NYC ("Get the Good Stuff"). Fresh Funds earned, supported by Instacart Health, is an infrastructure integrated with retailer payment systems. Incentives will only be used for purchases of healthier foods (FVL) predetermined by the research team, as it has been used by FV prescription programs.
Participants randomized to this component will receive weekly SNAP-Ed-based meal plans with instant shoppable grocery lists tailored to household size, dietary, and cultural preferences. All recipes will emphasize FVL-based eating patterns with Hispanic cuisine influences that have FVL as primary ingredients. Grocery lists organized by store department and recipe, will reflect the nearest available in-store unit. For example, if one recipe calls for 1 cup of flour, a small flour bag will be added to the list. Weekly meal plans will be shared via text as a photo and mailed as hard copies, with instant shoppable lists generated through Instacart's List feature as a hyperlink. Links to the instant shoppable list will be shared via text. Upon clicking, grocery items will be pre-filled automatically in the participant's online shopping cart. Participants can modify items and quantities before checking out.
Eligibility Criteria
You may qualify if:
- Adult (\> 21 years old)
- Live in a household with a young child(ren) under the age of 10 years and above age 2.
- Primary shopper for the household
- Have access to a smartphone or computer to place online orders
- Participation in the Supplemental Nutrition Assistance Program in the past year or income eligible (annual household income =\< 130% of the federal poverty line)
- Agree to share itemized grocery receipts during the study (12 months)
- Willing to order groceries online
- English or Spanish speaker
- Informed consent
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Officials
- PRINCIPAL INVESTIGATOR
Angela Trude, PhD
New York University
Central Study Contacts
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- DOUBLE
- Who Masked
- INVESTIGATOR, OUTCOMES ASSESSOR
- Purpose
- PREVENTION
- Intervention Model
- FACTORIAL
- Sponsor Type
- OTHER
- Responsible Party
- SPONSOR
Study Record Dates
First Submitted
July 8, 2025
First Posted
July 17, 2025
Study Start (Estimated)
July 1, 2026
Primary Completion (Estimated)
March 30, 2028
Study Completion (Estimated)
December 30, 2029
Last Updated
March 2, 2026
Record last verified: 2025-11
Data Sharing
- IPD Sharing
- Will not share
At this time, there are no plans to share IPD due to limitations related to participant privacy, the sensitive nature of the data collected, and constraints in the informed consent process that do not allow for broad data sharing. While we support data transparency, any future sharing would require additional ethical review and participant re-consent to ensure privacy protections are upheld.