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Use of financial incentives and text message feedback to increase healthy food purchases in a grocery store cash back program: a randomized controlled trial.
BMC Public Health. 2019 May 31; 19(1):674.BP

Abstract

BACKGROUND

The HealthyFood (HF) program offers members up to 25% cash back monthly on healthy food purchases. In this randomized controlled trial, we tested the efficacy of financial incentives combined with text messages in increasing healthy food purchases among HF members.

METHODS

Members receiving the lowest (10%) cash back level were randomized to one of six arms: Arm 1 (Usual Care): 10% cash back, no weekly text, standard monthly text; Arm 2: 10% cash back, generic weekly text, standard monthly text; Arm 3: 10% cash back, personalized weekly text, standard monthly text; Arm 4: 25% cash back, personalized weekly text, standard monthly text; Arm 5: 10 + 15%NET cash back, personalized weekly text, standard monthly text; and, Arm 6: 10 + 15%NET cash back, personalized weekly text, unbundled monthly text. In the 10 + 15%NET cash back, the cash back amount was the baseline 10% plus 15% of the net difference between healthy and unhealthy spending. The generic text included information on HF and healthy eating, while the personalized text had individualized feedback on purchases. The standard monthly text contained the cash back amount. The unbundled monthly text included the amount lost due to unhealthy purchases. The primary outcome was the average monthly percent healthy food spending. Secondary outcomes were the percent unhealthy food spending, and the percent healthy and unhealthy food items.

RESULTS

Of the members contacted, 20 opted out, and 2841 met all inclusion criteria. There were no between-arm differences in the examined outcomes. The largest mean (standard deviation) difference in percent healthy spending was between Arm 1 (24.8% [11%]) and Arm 2 (26.8% [13%]), and the largest mean difference in percent unhealthy spending was also between Arm 1 (24.4% [20%]) and Arm 2 (21.7% [17%]), but no differences were statistically significant after correction for multiple comparisons.

CONCLUSIONS

None of the tested financial incentive structures or text strategies differentially affected food purchasing. Notably, more than doubling the cash back amount and introducing a financial disincentive for unhealthy purchases did not affect purchasing. These findings speak to the difficulty of changing shopping habits and to the need for innovative strategies to shift complex health behaviors.

TRIAL REGISTRATION

NCT02486588 Increasing Engagement with a Healthy Food Benefit. The trial was prospectively registered on July 1, 2015.

Authors+Show Affiliations

Division of Research, Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA94612, USA. Anjali.Gopalan@kp.org.Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA. Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.Discovery Vitality, Johannesburg, South Africa.Discovery Vitality, Johannesburg, South Africa.Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA. Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA. Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA. Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

31151390

Citation

Gopalan, Anjali, et al. "Use of Financial Incentives and Text Message Feedback to Increase Healthy Food Purchases in a Grocery Store Cash Back Program: a Randomized Controlled Trial." BMC Public Health, vol. 19, no. 1, 2019, p. 674.
Gopalan A, Shaw PA, Lim R, et al. Use of financial incentives and text message feedback to increase healthy food purchases in a grocery store cash back program: a randomized controlled trial. BMC Public Health. 2019;19(1):674.
Gopalan, A., Shaw, P. A., Lim, R., Paramanund, J., Patel, D., Zhu, J., Volpp, K. G., & Buttenheim, A. M. (2019). Use of financial incentives and text message feedback to increase healthy food purchases in a grocery store cash back program: a randomized controlled trial. BMC Public Health, 19(1), 674. https://doi.org/10.1186/s12889-019-6936-5
Gopalan A, et al. Use of Financial Incentives and Text Message Feedback to Increase Healthy Food Purchases in a Grocery Store Cash Back Program: a Randomized Controlled Trial. BMC Public Health. 2019 May 31;19(1):674. PubMed PMID: 31151390.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of financial incentives and text message feedback to increase healthy food purchases in a grocery store cash back program: a randomized controlled trial. AU - Gopalan,Anjali, AU - Shaw,Pamela A, AU - Lim,Raymond, AU - Paramanund,Jithen, AU - Patel,Deepak, AU - Zhu,Jingsan, AU - Volpp,Kevin G, AU - Buttenheim,Alison M, Y1 - 2019/05/31/ PY - 2018/10/01/received PY - 2019/05/02/accepted PY - 2019/6/2/entrez PY - 2019/6/4/pubmed PY - 2019/8/2/medline KW - Diet KW - Financial incentives KW - Messaging KW - Nutrition SP - 674 EP - 674 JF - BMC public health JO - BMC Public Health VL - 19 IS - 1 N2 - BACKGROUND: The HealthyFood (HF) program offers members up to 25% cash back monthly on healthy food purchases. In this randomized controlled trial, we tested the efficacy of financial incentives combined with text messages in increasing healthy food purchases among HF members. METHODS: Members receiving the lowest (10%) cash back level were randomized to one of six arms: Arm 1 (Usual Care): 10% cash back, no weekly text, standard monthly text; Arm 2: 10% cash back, generic weekly text, standard monthly text; Arm 3: 10% cash back, personalized weekly text, standard monthly text; Arm 4: 25% cash back, personalized weekly text, standard monthly text; Arm 5: 10 + 15%NET cash back, personalized weekly text, standard monthly text; and, Arm 6: 10 + 15%NET cash back, personalized weekly text, unbundled monthly text. In the 10 + 15%NET cash back, the cash back amount was the baseline 10% plus 15% of the net difference between healthy and unhealthy spending. The generic text included information on HF and healthy eating, while the personalized text had individualized feedback on purchases. The standard monthly text contained the cash back amount. The unbundled monthly text included the amount lost due to unhealthy purchases. The primary outcome was the average monthly percent healthy food spending. Secondary outcomes were the percent unhealthy food spending, and the percent healthy and unhealthy food items. RESULTS: Of the members contacted, 20 opted out, and 2841 met all inclusion criteria. There were no between-arm differences in the examined outcomes. The largest mean (standard deviation) difference in percent healthy spending was between Arm 1 (24.8% [11%]) and Arm 2 (26.8% [13%]), and the largest mean difference in percent unhealthy spending was also between Arm 1 (24.4% [20%]) and Arm 2 (21.7% [17%]), but no differences were statistically significant after correction for multiple comparisons. CONCLUSIONS: None of the tested financial incentive structures or text strategies differentially affected food purchasing. Notably, more than doubling the cash back amount and introducing a financial disincentive for unhealthy purchases did not affect purchasing. These findings speak to the difficulty of changing shopping habits and to the need for innovative strategies to shift complex health behaviors. TRIAL REGISTRATION: NCT02486588 Increasing Engagement with a Healthy Food Benefit. The trial was prospectively registered on July 1, 2015. SN - 1471-2458 UR - https://www.unboundmedicine.com/medline/citation/31151390/Use_of_financial_incentives_and_text_message_feedback_to_increase_healthy_food_purchases_in_a_grocery_store_cash_back_program:_a_randomized_controlled_trial_ L2 - https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6936-5 DB - PRIME DP - Unbound Medicine ER -