September 11, 2019 – Incentive programs could encourage more patients to purchase healthy foods for themselves and their families, ultimately addressing nutrition and food security as key social determinants of health (SDOH), according to a new study published in Health Affairs.
Food security and access to nutritious foods is a considerable challenge for families across the US. Individuals need to maintain a healthy diet to remain healthy and stave off potential chronic illness, but the high cost of groceries, and fresh foods especially, can get in the way.
“Although there have been small improvements over the past decade, the average US diet is poor, and it is worse among people of lower income,” the researchers said. “This socioeconomic gap has only widened over time, in part because consuming a healthful diet rich in fruit and vegetables is cost prohibitive for many low-income households.”
Making sure young children have access to nutritious diets adds another layer to the challenge for low-income families, the researchers pointed out. Parents need to model this behavior, but when money is tight they might choose to go without healthy meals for themselves.
Children may also need to be exposed to a certain fruit or vegetable up to 15 times before they actually eat it regularly, the team said, and the risk of food waste may not be financially viable for some families.
The researchers sought to understand how a purchasing program might influence a family’s consumption of fresh produce. The team established a baseline of patient behavior by offering all patient participants access to an in-store loyalty program, complete with a 5 percent discount on total grocery purchases.
Once that baseline was established, the team introduced a discount intervention to a randomly selected group of families. Intervention patients received access to same-day coupons that provided 50 percent off of certain canned and frozen fruits and vegetables as well as all fresh produce.
The intervention worked, producing a spike in the amount of fresh produce families purchased using the 50 percent off coupon. At baseline, the intervention group and control group both spent about $10 on fresh produce. With the 50 percent off coupon, the intervention group spent about $14 on fresh fruits and vegetables.
These findings were prevalent among all households, regardless of whether they receive SNAP or other food assistance.
That said, the researchers found little change in the amount of fruit and vegetable consumption among intervention groups.
“There are several reasons why we might have seen changes in recorded purchases of fruit and vegetables but not in reported consumption,” the research team said. “There may have been small changes in consumption that were not detectable because of the limitations of our dietary assessment tool.”
Additionally, it may be possible that there was indeed no change in fruit and vegetable intake. The researchers were studying a purchasing program at one store. Patients may have increased the amount of produce purchased at the study store while simultaneously decreasing the amount of fruits and vegetables bought at another store. Food may have also gone to waste or have fed other members in a household who were no included in the study’s analysis, the team posited.
Similarly, the researchers saw low participation in Cooking Matters educational sessions, with only 12 percent of intervention and 4 percent of control group members attending.
“The low attendance was disappointing, particularly given the number of opportunities to attend, frequent reminders from the research team, and the opportunity to earn an additional $10 incentive,” the researchers remarked.
That said, attendance was about on par with similar patient education sessions, like the nutrition sessions held by SNAP.
Attendance to a Cooking Matters class did predict higher consumption of fruits and vegetables, the researchers pointed out. However, because participants opted into Cooking Matters classes, it is difficult to determine whether the education prompted them to change eating habits, or they attended the classes because of their own innate curiosity and motivation.
These findings suggest a new path forward for researchers that would consider the return on investment for purchasing programs. Specifically, researchers should assess whether the high cost of discounts are worth the limited produce consumption that follows.
Additionally, healthcare policymakers should look into how these programs might fit into different value-based care models and integrate with other food assistance programs like SNAP.
“Given the urgency of the obesity epidemic, approval of a pilot program implemented as part of a comprehensive strategy to improve nutrition is warranted,” the researchers concluded.
These findings come somewhat contrary to previous research. A 2019 study from the Friedman School of Nutrition Science and Policy at Tufts University found that food insurance programs can be an excellent healthcare investment.
Food insurance programs in which payers cover some of the cost for members’ groceries do create an added cost, the researchers said, but considering the public health benefits they are a worthwhile investment. For about $20,000 each year, a payer could improve the quality of life for all of its beneficiaries, a number that most health experts call a healthcare best buy.
Nonetheless, the Health Affairs study does shine a spotlight on an important consideration. Although investments in food purchasing programs may be seen as a best buy, the money still needs to come from somewhere. Medical researchers should consider the different value-based purchasing programs that could cover these investments.