82 - Randomized Controlled Trial to Evaluate Effect of Pricing Structure on Participation in a Home-Delivered Produce Box Program among WIC-eligible Families in Philadelphia

Poster Number: 82
Publication Number: 82.210

Priyanka Joshi, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Brittany J. Van Remortel, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Janakiram Rameswaran, University of Pennsylvania, Philadelphia, PA, United States; Danielle Cullen, CHOP, Philadelphia, PA, United States

Background:
Under 15% of the U.S. population consumes the recommended daily amounts of fruits and vegetables. These rates are lower among low-income minority populations such as those served by WIC. Limited availability, higher cost, poor quality, and lack of transportation are all barriers to produce access that were exacerbated by COVID-19. Informed by caregiver preferences for food programs identified in our previous qualitative work, we partnered with community organizations to create a low-cost produce delivery program.

Objective:
This pilot randomized controlled trial evaluates the effect of price on participation in a produce delivery program for WIC-eligible families, as well as the program’s impact on healthy eating.

Design/Methods: We recruited 50 caregivers of WIC-eligible children from an urban, pediatric primary care center to participate in an 8 week produce delivery program. All participants received free produce boxes for the first 4 weeks and were then randomized to a cost of $5 or $10 per box for the remaining 4 weeks which could be paid with SNAP benefits. Delivery was free and each box included recipes and educational activities. Weekly orders were tracked, and pre-, mid-, and post-intervention surveys were conducted to assess the program's impact on healthy eating and participant satisfaction.

Results: Of the 50 families enrolled, 43 (86%) completed the pre-intervention survey and participated in the study. An average of 30.3 (SD 5.74) participants ordered weekly during the free period with a significant drop-off to an average of 18.3 (SD 0.96) participants ordering weekly following the shift to the paid model (P  < 0.001). There was no significant difference in average orders between the $5 and $10 groups (12.25 [SD 4.4] vs 14.5 [SD 5.63], P = 0.19). The majority (74%) of participants paid with SNAP benefits. There was a significant increase in participant-reported produce access (57% vs. 97%, P < 0.001) and ability to eat healthy (51% vs 84%, P = 0.004), from pre-intervention to post-intervention.Conclusion(s): Our study suggests that WIC-eligible families are interested in a delivery-based produce program but that participation is highest when the service is free. There was a decrease in ordering after the transition to a paid model however participation was sustained equally between groups regardless of price. The program was successful in improving the perceived ability of caregivers to access produce and eat healthy. Future study is needed to evaluate the long-term feasibility & health effects of implementing a similar program at no cost or with expanded use of benefits, such as WIC.
Priyanka Joshi CVPriyanka Joshi_CV_Jan 2022.pdf
Figure 2: Number of Produce Boxes Ordered Per Week