Financial Incentives Drive Healthy Behavior Change in Online Grocery Retail

With online grocery retail becoming increasingly popular, a new study has shown that financial incentives and default options can drive healthy behavior change and boost access to fresh foods, particularly among low-income individuals who rely on SNAP benefits.

Food insecurity—linked to lower nutrient intake and reduced consumption of fruits and vegetables—is a critical social determinant of health (SDOH) that can directly impact patient outcomes, such as the risk of cardiovascular disease. Moreover, food insecurity links to other major SDOH, such as educational attainment, job performance, and financial stress.

While SNAP is the largest federally funded program in the United States to reduce food insecurity, experts have revealed that low-income patients and SNAP participants have poorer dietary behaviors than those with higher incomes. Said otherwise, the problem isn’t just food security; it’s access to nutritious foods, too.

Therefore, there is a need for interventions that improve the affordability of healthy foods, researchers stated.

Over 2,700 participants were instructed to shop for a week's worth of groceries within a budget tailored to their household size during an intervention conducted from October 7 to December 2, 2021.

Participants were randomly assigned to one of four conditions: no intervention, a 50 percent discount on eligible fruits and vegetables, prefilled shopping carts with tailored fruit and vegetable items (default options), or a combination of the discount and default options.

Participants in the discount group received a 50-percent discount on qualifying fruits and vegetables, up to $20 off, while those in the default group had their cart prefilled with one fruit and one vegetable product based on expenditure data from SNAP-participating households.

The study found that financial incentives for fruits and vegetables, combined with default options, led to a significant increase in online fruit and vegetable purchases among low-income adults.

Of the 2744 participants, 93.1 percent purchased fruit or vegetables. On average, participants spent 21 percent of their total dollars on fruits and vegetables.

The study also revealed that participants in the discount condition spent 4.7 percent more on fruits and vegetables than those in the control condition.

Additionally, the researchers found that combining discounts and default options had a collaborative effect, suggesting that implementing multiple healthy eating strategies online could be effective.

The study found that using a behavioral nudge to prefill shopping carts with default fruit and vegetable items based on participants’ past purchase history had a positive impact on healthy patient behavior, with over 90 percent of participants in the default group buying food in the prefilled shopping cart, compared to approximately 50 percent of participants in the other groups.

Specifically, 93.4 percent purchased default cart items in the default condition, while 95.5 percent bought default items in the combination conditions.

"The results of this randomized clinical trial support the use of financial incentives to meaningfully increase fruit and vegetable purchases for those shopping with SNAP benefits online," the research team, lead by Pasquale E. Rummo, wrote. "We also found evidence that prefilling shopping carts with fruits and vegetables motivated individuals to purchase default products, with a synergistic effect with discounts."

"Future research should explore the effectiveness of strategies designed to mitigate lack of trust and other noneconomic barriers on purchases of fresh products online," the research team continued. "Evaluating other interventions in online settings, such as restrictions on targeted marketing, is also a valuable next step."

As the trend of online retail continues to grow, healthcare experts must consider SDOH interventions, particularly those related to food security. It is imperative to study these interventions in an online context, given the recent surge in online grocery sales, the researchers wrote.

In 2021, online sales accounted for 10 percent of all US grocery sales, triple that of 2017. Moreover, the SNAP Online Purchasing Pilot program has rapidly expanded, allowing retailers to accept SNAP benefits in online transactions. Although shoppers with low income are less likely to shop online, the pandemic started to change that trend. Online redemption of SNAP benefits increased from 0.1 percent to 3.0 percent of total sales from February 2020 to December 2020.

As more people turn to online retail groceries, it is vital to consider the importance of cultural competence when addressing food security issues in a digital setting. In the past, researchers have implemented various healthy behavior change interventions to promote food security while focusing on fresh produce aligned with their cultural and taste preferences.