A Default Option to Improve Nutrition for Adults With Low Income Using a Prefilled Online Grocery Shopping Cart

• Published in: Journal of nutrition education and behavior 2021-09, Vol.53 (9), p.759-769
• Main Authors: Coffino, Jaime A., Han, Gloria T., Evans, E. Whitney, Luba, Rachel, Hormes, Julia M.
• Format: Article
• Language: English
• ISSN: 1499-4046; 1878-2620
• DOI: 10.1016/j.jneb.2021.06.011

OBJECTIVETo determine whether a prefilled online grocery shopping (default) cart improves the nutritional quality of groceries purchased compared with receiving nutrition education (NE). DESIGNLongitudinal study. SETTINGThree food pantries in the US. PARTICIPANTSThirty-eight adults with low income. INTERVENTIONGroceries were purchased online for 5 consecutive weeks. After a baseline shopping trip, participants were randomized to receive NE or a nutritionally balanced prefilled online grocery shopping cart (ie, default cart) before shopping (from week 1 [T1] to week 4 [T4]). MAIN OUTCOME MEASURESDiet quality (Healthy Eating Index [HEI-2015] scores), energy, and energy density of each online cart (ie, grocery purchases). ANALYSISPiecewise linear mixed-effects models. RESULTSFrom baseline to T1, HEI-2015 scores in the default condition significantly increased (95% confidence interval [CI], 9.79-23.39), whereas total calories (95% CI, -10,942 to -1,663) and energy density (95% CI, -0.70 to -0.45) significantly decreased compared with NE. Improved HEI-2015 scores were maintained through T4. Calories and energy density increased from T1 to T4 in the default condition, but values remained lower (ie, more healthful) than the NE condition. In the NE condition, outcomes did not significantly change during the intervention. CONCLUSIONS AND IMPLICATIONSProviding an online default cart may improve the nutritional quality of grocery purchases. However, future research is warranted to assess whether adding a second nudge later in the intervention or combining the NE and default cart further promotes healthy purchasing behavior.