Perceived Advantages and Disadvantages of Online Grocery Shopping among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participants in Eastern North Carolina

Feasibility and acceptability of a personalized, pre-filled online grocery cart to improve benefit redemption and diet quality of grocery purchases among participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Most participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) do not fully redeem their benefits due to barriers like transportation, confusing product eligibility, and unclear labeling. Online food shopping enables choice architecture to promote benefit redemption and maximize diet quality. We conducted a mixed-methods pilot randomized-controlled trial to assess the feasibility and acceptability of a pre-filled online grocery shopping cart to improve WIC benefit redemption and diet quality of grocery purchases. Rhode Island WIC participants (n = 24, mean age 29.4 ± 1.1 years, 75% Hispanic, 54% had never grocery shopped online) completed a baseline questionnaire and a simulated shopping episode (SSE), buying WIC and non-WIC items. After a week, we randomized participants into the intervention (personalized, modifiable carts pre-filled with 100% of the 2022 proposed WIC packages) or control (selected their items individually) groups before the second SSE. Both groups had WIC labels. We assessed feasibility using process data and percent agreement to feasibility questions, and acceptability via percent agreement to acceptability questions and post-intervention qualitative interviews. We conducted exploratory analyses to examine differences within and between groups at each timepoint for percent WIC benefit redemption and diet quality of grocery purchases, evaluated using the Grocery Purchase Quality Index-2016 (GPQI-2016) scores. Quantitative study measures suggest that the intervention was feasible and that the personalized, modifiable pre-filled cart was acceptable. These findings were supported during qualitative interviews, where participants highlighted time-savings, flexibility, and WIC labels as facilitators of WIC online shopping. Exploratory results showed significant increases in mean percent redemption of most WIC food categories and non-significant moderate increases in most GPQI-2016 scores. These measures are vital for the future adaptation of a full-scale efficacy trial in real-life settings.

Barriers and Facilitators to Online Grocery Shopping Among Supplemental Nutrition Assistance Program (SNAP) Participants: A Mixed Method Study

This mixed methods study explored online grocery shopping perceptions by surveying individuals who do and do not receive SNAP benefits (n = 129) and by conducting interviews with SNAP recipients (n = 26) who have grocery shopped online. T-tests assessed survey findings, codebook thematic analysis was used to identify qualitative themes, and results were interpreted collectively. Survey results found no differences in perceptions of online grocery shopping between SNAP and non-SNAP recipients (p-values = 0.2-1.0) and that 97% of SNAP recipients felt comfortable using SNAP online. Five qualitative themes were identified and provided context to the survey results. The study findings can inform policy actions within SNAP.

Multi-Method Formative Evaluation of a Digital Online Grocery Shopping Assistant Among Special Supplemental Nutrition Program for Women, Infants, and Children Participants

OBJECTIVE

Assess the acceptability of a digital grocery shopping assistant among rural women with low income.

DESIGN

Simulated shopping experience, semistructured interviews, and a choice experiment.

SETTING

Rural central North Carolina Special Supplemental Nutrition Program for Women, Infants, and Children clinic.

PARTICIPANTS

Thirty adults (aged ≥18 years) recruited from a Special Supplemental Nutrition Program for Women, Infants, and Children clinic.

PHENOMENON OF INTEREST

A simulated grocery shopping experience with the Retail Online Shopping Assistant (ROSA) and mixed-methods feedback on the experience.

ANALYSIS

Deductive and inductive qualitative content analysis to independently code and identify themes and patterns among interview responses and quantitative analysis of simulated shopping experience and choice experiment.

RESULTS

Most participants liked ROSA (28/30, 93%) and found it helpful and likely to change their purchase across various food categories and at checkout. Retail Online Shopping Assistant's reminders and suggestions could reduce less healthy shopping habits and diversify food options. Participants desired dynamic suggestions and help with various health conditions. Participants preferred a racially inclusive, approachable, cartoon-like, and clinically dressed character.

CONCLUSIONS AND IMPLICATIONS

This formative study suggests ROSA could be a beneficial tool for facilitating healthy online grocery shopping among rural shoppers. Future research should investigate the impact of ROSA on dietary behaviors further.

The dynamics of food for special medical purposes (FSMPs) utilization in cancer care: from doctor recommendations to online pharmacy procurement

This cross-sectional study conducted in Romania examines the increasing role of online pharmacies in providing Food for Special Medical Purposes (FSMP) to cancer patients. Key findings indicate patient satisfaction with ease of access, significant challenges related to costs, and the critical role of healthcare professionals in guiding FSMP selection.

INTRODUCTION

As cancer treatments advance, the demand for supportive nutritional care becomes increasingly critical, with FSMPs playing a vital role in patient recovery and quality of life.

METHODS

Employing a cross-sectional study design, we surveyed cancer patients from Romania to assess their experiences purchasing FSMPs through traditional and online pharmacies. We analyzed the factors influencing their choices, the perceived benefits and challenges of online access, and the role of healthcare professional guidance in their decision-making process.

RESULTS

The study reveals that while patients appreciate the ease of access and the broad spectrum of available FSMPs online, they grapple with the financial burden and the need for reliable information to make informed decisions. Through a cross-sectional analysis, we found that the expertise and recommendations of healthcare professionals remain integral to the FSMP selection process, suggesting that digital solutions should enhance, not replace, traditional healthcare interactions. Moreover, our findings highlight a crucial gap in the taste and variety of FSMPs, suggesting that patient adherence could be improved through product innovation. The study found a significant association between the type of medical unit where patients followed their treatment (state-owned clinic) and whether they received recommendations from a specialist oncologist for using FSMPs. Nutritionists' recommendations were also significantly associated with a higher likelihood of purchasing FSMPs online.

DISCUSSIONS

The study reveals that despite the benefits of digital access, a crucial need exists for regulatory measures and professional oversight to ensure the safe and informed use of FSMPs. The trust placed in healthcare professionals' recommendations continues to be instrumental in navigating the digital marketplace.

CONCLUSION

This work paves the way for future strategies to integrate online solutions with established healthcare practices to optimize cancer care in the digital age.

Experiences participating in federal nutrition assistance programs during the early months of the COVID-19 pandemic: an investigation in Vermont

BACKGROUND

Federal nutrition assistance programs serve as safety nets for many American households, and participation has been linked to increased food security and, in some instances, improved diet quality and mental health outcomes. The COVID-19 pandemic brought new and increased economic, social, and psychological challenges, necessitating inquiry into how nutrition assistance programs are functioning and associated with public health outcomes.

METHODS

Using data from a representative statewide survey administered in Vermont (n = 600) between July and September 2020, we examined participant experiences with major federal nutrition assistance programs: the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and school meal programs. We explored quantitative and qualitative responses regarding perceptions of program utility, and used nearest neighbors matching analyses in combination with bivariate statistical tests to assess associations between program participation and food insecurity, perceived stress, and fruit and vegetable intake as indicators of dietary quality.

RESULTS

One in four respondents (27.3%) used at least one federal nutrition assistance program. As compared to non-participants, we found higher rates of food insecurity among program participants (57.5% vs. 18.1%; p < 0.001), an association that persisted even when we compared similar households using matching techniques (p ≤ 0.001). From matched analyses, we found that, compared to low-income non-participants, low-income program participants were less likely to meet fruit intake recommendations (p = 0.048) and that low-income SNAP and WIC participants were less likely to meet vegetable intake recommendations (p = 0.035). We also found lower rates of perceived stress among low-income school meal participant households compared to low-income non-participants (p = 0.039). Despite these mixed outcomes, participants broadly valued federal nutrition assistance programs, characterizing them as helpful or easy to use.

CONCLUSIONS

We found that federal nutrition assistance programs as a group were not sufficient to address food insecurity and stress or increase fruit and vegetable intake in the state of Vermont during the early months of the COVID-19 pandemic. Nonetheless, participants perceived benefits from participation in these programs. Optimizing the utility of nutrition assistance programs depends on critical examination of their functioning under conditions of great stress.

"I Don't Want an App to Do the Work for Me": A Qualitative Study on the Perception of Online Grocery Shopping From Small Food Retailers

BACKGROUND

Small food retailers often stock energy-dense convenience foods, and they are ubiquitous in low-income urban settings. With the rise in e-commerce, little is known about the acceptability of online grocery shopping from small food retailers.

OBJECTIVE

To explore perceptions of the role of small food retailers (bodegas) in food access and the acceptability of online grocery shopping from bodegas among customers and owners in a diverse New York City urban neighborhood with low incomes.

DESIGN

In-depth interviews were conducted with bodega owners and adult customers between May and July 2022.

PARTICIPANTS/SETTING

Bodega owners who either had (n = 4) or had not (n = 2) implemented a locally designed online grocery system. Customers (n = 25) were recruited through purposive sampling and were eligible if they purchased at bodegas (>once per month), had low income (household income ≤130% of the federal poverty level or Supplemental Nutrition Assistance Program [SNAP] participants), and owned smartphones.

ANALYSES PERFORMED

All interviews were transcribed and analyzed in MAXQDA (Verbi Software, Berlin, Germany), using grounded theory.

RESULTS

To owners and customers, bodegas were seen as good neighbors providing culturally appropriate foods and an informal financial safety net. Their perceptions concerning food cost and availability of healthy foods in bodegas diverged. Although most perceived online grocery from bodegas as a positive community resource, they also believed it was not suited to their own community because of the bodega's proximity to customers' homes and the low digital literacy of some community members. Customers reported social norms of pride in not using online grocery shopping. Owners and customers believed the service would more likely be used if government benefits such as SNAP allowed payment for online orders. Both suggested improved outreach to increase program awareness and uptake.

CONCLUSIONS

Online grocery shopping from small food retailers may be acceptable in urban communities with low income and was perceived as a community resource. However, important barriers need to be addressed, such as social norms related to pride in not using online grocery services, digital literacy, program awareness, and allowing SNAP payment for online orders from bodegas.

Use of online food retail platforms throughout the COVID-19 pandemic and associated diet-related chronic disease risk factors: A systematic review of emerging evidence

Food accessibility was considerably impacted by restrictions during the coronavirus disease 2019 (COVID-19) pandemic, leading to growth in the online food retail sector, which offered contact-free delivery. This systematic review aimed to assess the change in use of online food retail platforms during COVID-19. The secondary aim was to identify diet-related chronic disease risk factors including dietary intake, eating behaviors, and/or weight status associated with the use of online food retail platforms during the pandemic. The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42022320498) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Nine electronic databases were searched between January 2020 and October 2023. Studies that reported the frequency or change in use of online groceries, meal delivery applications, and/or meal-kit delivery services before and during the pandemic were included. A total of 53 studies were identified, including 46 cross-sectional studies, 4 qualitative studies, 2 longitudinal cohort studies, and 1 mixed-methods study. Overall, 96% (43/45) of outcomes showed an increase in the use of online groceries during COVID-19, while 55% (22/40) of outcomes showed a decrease in meal delivery applications. Eight of nine outcomes associated the use of online food retail with weight gain and emotional eating. Further research is needed to investigate the links between online food retail and obesity.

The potential influence of the digital food retail environment on health: A systematic scoping review of the literature

INTRODUCTION

The digital food retail environment (defined in this study as a digital platform, app or website where food can be purchased by individuals for personal consumption) is an emerging component of the wider food system. We aimed to systematically search and review the literature to understand the potential influence of the digital food retail environment on population diets and health.

METHODS

Four databases (across health, business, and marketing) and grey literature were searched using terms relating to "food and beverages," "digital," and "purchasing." Identified studies were included if they examined any aspect of the digital food retail environment where outcomes were examined with a health-related focus and were published before September 2023. All study designs were included (quantitative, qualitative, observational, and experimental). Reviews and conference abstracts were excluded.

RESULTS

We identified 21,382 studies, of which 57 articles were eligible for inclusion. Of the 57 included studies, 30 studies examined online grocery retail, 22 examined online food delivery platforms, and five examined meal kit subscription services. Of the 30 studies examining online grocery retail, six studies reported that customers believed they purchased fewer unhealthy food and beverages when shopping online, compared with shopping in-store. Nevertheless, customers also reported that their ability to choose healthy foods and beverages was reduced when shopping online due to difficulty in product comparison. Studies that examined online food delivery platforms primarily found that they promoted unhealthy foods and beverages more often than healthy options, through extensive use of marketing practices such as price discounts and images, and that unhealthy food offerings on these platforms dominate. Meal kit subscription services offered mostly healthy meals, with studies suggesting that these types of services may help individuals alleviate some of their "mental load" and stress related to cooking meals for their families.

CONCLUSIONS

The literature describing the digital food retail environment was found to be diverse, with different aspects having potential to impact health in different ways. Some evidence suggests that online grocery retail and meal kit subscription services may have positive population dietary impacts, whereas online food delivery platforms appear likely to promote unhealthy food purchasing. However, the current evidence base is fragmented, with many knowledge gaps. Further research is required to understand the influence of the digital food retail environment on population diets and how these environments can be designed to support healthy food choices.

Vendors' Perceptions and Experiences with WIC Online Shopping Implementation

Background

Online shopping (OS) holds promise for improving the shopping experience for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). However, little is known about vendors' perspectives on implementing OS in the context of WIC.

Objectives

The present study aimed to understand vendors' experiences, needs, and barriers to WIC OS implementation.

Methods

We recruited vendors at various stages of WIC OS planning and implementation (n = 16). Semistructured interviews were conducted, transcribed, and coded using subconstructs of the i-PARIHS framework domains (e.g., Characteristics of the Innovation, recipient, context, and facilitation) to assess determinants related to adoption and implementation of WIC OS among vendors.

Results

Interviewees represented various organizations, including local (n = 5), regional (n = 4), and national (n = 5) entities, along with enablement platforms (n = 2). The interviews yielded themes related to experiences planning and implementing a WIC OS system (n = 7) and perceived needs and barriers (n = 3). Vendors drew on prior experiences with Supplemental Nutrition Assistance Program (SNAP) OS to inform WIC OS projects, stressing the importance of building relationships and collaborating, particularly in technical partnerships, during WIC OS implementation. They also highlighted the value of leveraging existing OS systems to implement WIC OS projects, discussed WIC OS perceived benefits, emphasized the role of educating staff and participants on its usage, and valued WIC OS implementation guidance provided by WIC agencies. Needs and barriers for vendors contemplating WIC OS implementation included the need for evidence of successful implementation of WIC OS projects, understanding current regulatory implications, and appraising existing priorities and financial considerations for adopting and implementing WIC OS.

Conclusions

WIC OS innovations are integral to modernizing the federal food assistance program. The present study highlights the role of vendor engagement, collaboration, guidance from WIC agencies, and knowledge sharing in ensuring WIC OS success. These insights can inform how WIC State agencies engage vendors to implement WIC OS.

Which variables and determinants influence online food delivery consumption among workers and students? Results from the DELIvery Choice In OUr Society (DELICIOUS) cross-sectional study

Introduction

Online food delivery (OFD) applications provide easy access to food, eliminating the need for cooking and meal planning. However, they predominantly promote processed and calorie-dense foods, potentially impacting diet and health. This study aimed to describe the use of OFD services in a sample of Italian workers and students, to explore potential determinants of OFD usage and to assess possible differences in use between these two categories.

Methods

Data were collected through an online survey (convenience sampling) distributed on social media platforms between July 12, 2022, and February 1, 2023. The sample included individuals aged 18 and above, currently residing in Italy. The sample was stratified according to worker/student status. Descriptive analyses were performed on key variables. A multivariable logistic regression analysis was conducted to assess the effects of variables on OFD usage, treated as a dichotomous variable (usage or non-usage).

Results

This study analyzed 3,502 questionnaires (2,594 from workers and 908 from students) after excluding 323 non-student and non-worker responses. Positive associations with OFD use included higher income, remote working, smoking, elevated BMI, depression risk, and impulsive buying among workers, while being female, frequent screen-watching during meals, daily smoking, higher BMI, and impulsive buying were associated with OFD use among students. Factors negatively associated with OFD use included older age (workers and students), living in suburbs (workers and students) or in an outline town (workers), being single (workers and students), adhering to the Mediterranean diet (students), having low health literacy (students), and job dissatisfaction (workers).

Discussion

OFD consumption was associated with some risky behaviors and conditions, such as high BMI or smoking, suggesting that it might be influenced by individual tendencies. Healthier habits, such as physical activity, did not significantly impact OFD usage, especially among workers. Whereas, among students, factors such as low health literacy and better eating habits were associated with less use of OFD, so that they could be more prone to use OFD in a measured way. Further research is needed to better understand potential associations between OFD and risky habits, as well as its role in promoting access to healthy food in underserved areas.

A Formative Evaluation of an Online Meal Kit and Grocery Platform for Supplemental Nutrition Assistance Program Recipients

OBJECTIVE

To assess the barriers and facilitators to online food purchasing through a meal kit and grocery shopping website titled NY SNAP Express among Supplemental Nutrition Assistance Program (SNAP) beneficiaries.

METHODS

A purposive sample of SNAP-eligible adults residing in New York State participated in interviews guided by the Capabilities, Opportunities, Motivations, and Behaviors Model.

RESULTS

Barriers to online food purchasing among participants (n = 32) include physiological and health conditions, the weight of food, technology, language, the price of foods, transportation challenges, the stigma associated with SNAP, and concerns regarding the quantity and quality of meal kits. Facilitators include health and nutrition improvements, knowledge and skills, saving money, culturally relevant meals, increased efficiency in food purchases and preparation, and customization.

CONCLUSIONS AND IMPLICATIONS

Online platforms such as NY SNAP Express have the potential to increase nutritious food access and resources among SNAP recipients; however, improvements are necessary to meet the needs of its audience.

A machine learning ensemble approach to predicting factors affecting the intention and usage behavior towards online groceries applications in the Philippines

The emergence of e-commerce platforms, especially online grocery shopping, is heightened by the COVID-19 pandemic. Filipino consumers started to adapt online due to the strict quarantine implementations in the country. This study intended to predict and evaluate factors influencing the intention and usage behavior towards online groceries incorporating the integrated Protection Motivation Theory and an extended Unified Theory of Acceptance and Use of Technology applying machine learning ensemble. A total of 373 Filipino consumers of online groceries responded to the survey and evaluated factors under the integrated framework. Artificial Neural Network that is 96.63 % accurate with aligned with the result of the Random Forest Classifier (96 % accuracy with 0.00 standard deviation) having Perceived Benefits as the most significant factor followed by Perceived Vulnerability, Behavioral Intention, Performance Expectancy, and Perceived. These factors will lead to very high usage of online grocery applications. It was established that machine learning algorithms can be used in predicting consumer behavior. These findings may be applied and extended to serve as a framework for government agencies and grocers to market convenient and safe grocery shopping globally.

A Mixed-Methods Study of Perceived Implementation Challenges for WIC Online Ordering and Transactions

BACKGROUND

Federal food assistance programs are working towards online grocery shopping. Online ordering in Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is emerging following successful implementation in Supplemental Nutrition Assistance Program (SNAP).

OBJECTIVE

To identify anticipated challenges, potential solutions, and expected costs of WIC online ordering.

DESIGN

Cross-sectional, mixed-methods, web-based, survey research.

SUBJECTS AND SETTING

Data were collected from December 2020 to January 2021. Purposeful and snowball sampling included WIC stakeholders involved in developing processes and systems required for WIC online ordering. Respondents represented diverse geographic areas, levels of intraorganizational authority, and WIC benefit card types.

STATISTICAL ANALYSES PERFORMED

The research team used a rapid analysis and lean coding approach to identify emergent themes from open-ended survey responses. Descriptive statistics were used to describe the distribution of responses across themes and stakeholder types.

RESULTS

Respondents (n = 145) described 812 anticipated challenges within 20 themes grouped into five topic areas: rules and regulations; shopping experience; security, confidentiality, fraud, and WIC State agency processes; training, assistance, and education; and equitable access and buy-in. Addressing anticipated regulatory issues were among the few concrete potential solutions described. The two most frequent costs reported were increased staff time and start-up and ongoing technology costs.

CONCLUSIONS

This study identified several, critical anticipated challenges and considerations that will help prepare WIC state agencies for opportunities to expand online ordering to WIC participants.

Online Grocery Shopping and the Supplemental Nutrition Assistance Program (SNAP) Electronic Benefit Transfer Card (EBT): Perceptions of Head Start Caregivers

The objective of this study was to explore perceptions of online grocery shopping and the online United States Department of Agriculture's (USDA) Supplemental Nutrition Assistance Program (SNAP) Electronic Benefit Transfer card (EBT) program among Head Start caregivers. Three focus groups were conducted between December 2019 and January 2020. Most participants hadn't tried online grocery shopping. Concerns included others choosing perishables, receiving wrong items, and inappropriate substitutes. Perceived benefits included saving time, preventing impulse buys, and eating healthier. Results have broad applicability in the current COVID-19 pandemic where online grocery shopping and the online SNAP EBT program have rapidly expanded across the United States.

Perspectives From Urban WIC-Eligible Caregivers to Improve Produce Access

OBJECTIVES

The Farmer's Market Nutrition Program (FMNP) provides fresh, locally grown fruits and vegetables (FV) to eligible participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). However, redemption of FMNP benefits remains low. This qualitative study explores facilitators and barriers to produce access and FMNP redemption for caregivers of WIC-eligible children in Philadelphia during the COVID-19 pandemic.

METHODS

We conducted semistructured phone interviews with caregivers between August and December 2020 to understand experiences with produce access and programming preferences to increase benefit redemption and produce consumption. We used content analysis with constant comparison with code interviews inductively and identified emerging themes through an iterative process.

RESULTS

Participants (n = 30) wanted their children to eat more produce but described barriers to produce access, including limited availability, higher cost, and limited time. The Supplemental Nutrition Assistance Program and WIC benefits improved the ability to purchase produce, but difficulties with electronic benefit transfer and pandemic-related office closures limited use of WIC benefits. Similarly, lack of convenient market locations and hours prohibited use of FMNP benefits. Caregivers described that an ideal food program would be delivery based, low cost, offer a variety of FV, and provide recipes and educational activities.

CONCLUSIONS

WIC-eligible caregivers want their children to eat more produce; however, they face multiple barriers in redeeming their benefits to access fresh produce. Delivery-based, low-cost produce programs may lead to increased produce access as well as benefit use. Future study is needed on feasibility and acceptability of produce delivery options among WIC-eligible families.

Evaluation of WIC Online Ordering during the COVID-19 Pandemic: Evidence from an Oklahoma Grocery Store Chain

The COVID-19 pandemic is worsening the disparities in food access in the United States. As consumers have been increasingly using grocery online ordering services to limit their exposure to the COVID-19 virus, participants of federal nutrition assistance programs lack the online benefit redemption option. With the support of the US Department of Agriculture (USDA), retailers are pilot-testing online food benefit ordering in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). By combining the Oklahoma WIC administrative data, the online ordering data from a grocery store chain in Oklahoma, and the COVID-19 data in Oklahoma, this study examines how WIC participants responded to the online food benefit ordering option and how their adoption of online ordering was associated with the COVID-19 incidence. Results show that from July to December 2020, 15,171 WIC households redeemed WIC benefits at an Oklahoma chain store, but only 819 of them adopted online ordering. They together completed 102,227 online orders, which accounted for 2.7% of the store visits and 2.6% of the monetary value of WIC redemptions at these stores. There was no significant relationship between WIC online ordering adoption and COVID-19 incidence in Oklahoma.

Barriers and Facilitators to Implementation of a Child Care Center-Based Produce Delivery Program

BACKGROUND

Regular consumption of produce is a challenge for families with young children in low food access areas.

OBJECTIVE

A community partnership formed to evaluate feasibility of and interest in a child care center-based program for produce delivery from an online grocery vendor.

METHODS

Surveys were collected from caregivers across three child care centers, including produce program participants. Descriptive statistics summarize household characteristics and participants' experience with the program.

RESULTS

Challenges related to online payment and difficulty planning delivery times led to implementation of a modified intervention. Survey results revealed factors related to food access and storage that may impact interest and feasibility of online grocery in some communities.

CONCLUSIONS

Online grocery vendors may increase accessibility to fresh produce for families, but barriers to their use still exist. Trusted community partners such as child care centers may offer some of the resources needed for success.

Prevalence and demographic correlates of online grocery shopping: results from a nationally representative survey during the COVID-19 pandemic

OBJECTIVE

To estimate the prevalence of online grocery shopping in a nationally representative sample and describe demographic correlates with online grocery shopping.

DESIGN

The Nielsen COVID-19 Shopper Behavior Survey was administered to a subset of Nielsen National Consumer Panel participants in July 2020. We used survey weighted-multivariable logistic regression to examine demographic correlates of having ever online grocery shopped.

SETTING

Online survey.

PARTICIPANTS

18 598 Nielsen National Consumer Panel participants in the USA.

RESULTS

Thirty-nine percent of respondents had purchased groceries online, and among prior purchasers, 89 % indicated that they would continue to online grocery shop in the next month. Canned/packaged foods were the most shopped for grocery category online, followed by beverages, fresh foods and lastly frozen foods. In adjusted analyses, younger respondents (39 years or less) were more likely (47 %) to have ever shopped for groceries online than older age groups (40-54 years, 55-64 years and 65+ years) (29 %, 22 % and 23 %, respectively, all P < 0·001). Those with greater than a college degree were more likely to have ever grocery shopped online (45 %) than respondents with some college education (39 %) and with a high school education or less (32 %) (both P < 0·001). Having children, having a higher income and experiencing food insecurity, particularly among higher income food-insecure households, were also associated with a higher probability of prior online grocery shopping.

CONCLUSIONS

The COVID-19 pandemic accelerated the transition to online grocery shopping. Future research should explore the nutrition implications of online grocery shopping.

Equity-Promoting Strategies in Online Grocery Shopping: Recommendations Provided by Households of Low Income

OBJECTIVE

To explore barriers and facilitators of online grocery shopping and identify community-driven strategies to promote equity in online food access.

DESIGN

This qualitative study used a purposive recruitment strategy to conduct 11 focus groups and 5 in-depth interviews between November 2020 and March 2021.

SETTING

Data collection was conducted virtually with participants residing in diverse (majority urban) regions of Maryland.

PARICIPANTS

44 primary household food purchasers with young children (aged < 8 years) eligible for the Supplemental Nutrition Assistance Program (SNAP).

PHENOMENON OF INTEREST

Barriers and facilitators of online grocery shopping and strategies elicited by the community to leverage SNAP and online food retailer services to reduce inequities in healthy food access.

ANALYSIS

We coded and analyzed transcripts on the basis of the Socioecological Model, Theory of Planned Behavior, and an Equity-Oriented Framework.

RESULTS

Overall, we identified 10 themes across all socioecological levels, all of which reflected both barriers and facilitators to online shopping: (1) individual: trust of shoppers, technology, (2) interpersonal: spousal/children needs, (3) community: safety and security, (4) organizational: retail experience and food quality, and (5) policy: SNAP and structural inequities. Participant recommendations included improving food access and communication with hired shoppers, implementing more payment/cost-saving options, and offering educational programming for SNAP participants on using benefits online.

CONCLUSIONS AND IMPLICATIONS

Households of low-income identified barriers and facilitators of online grocery shopping across the socioecological levels, emphasizing the need for a multilevel approach to equity promotion. We recommend future work to explore the suggested actionable pathways, which involve delivery providers, grocery stores, nutrition educators, and policymakers leveraging online grocery features (ie, meal planning support) and policies (ie, expansion of the SNAP Online Purchasing Pilot to more retailers) to reducing deterrents (ie, delivery fees waived) for an equity-promoting online grocery environment.

State Agencies' Perspectives on Planning and Preparing for WIC Online Ordering Implementation

Online ordering for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has the potential to alleviate some of the barriers faced by WIC participants when shopping with their WIC food benefits. WIC State agencies are the leaders in planning, preparing, implementing, maintaining, and expanding WIC online ordering. Cross-sectional web-based survey research was utilized to identify barriers to implementing WIC online ordering, as well as the support needed to overcome those barriers, from a WIC State agency perspective. Web surveys were administered to 81 WIC State agencies from 31 January 2022 to 1 April 2022. Descriptive statistics, independent samples t-test, and one-way analysis of variance were used to analyze the findings. Open-ended responses were analyzed using a qualitative iterative approach. WIC State agencies noted several barriers to implementing WIC online ordering, including limited staff capacity, WIC retailer interest, and technological capabilities.

Giving Families a Voice for Equitable Healthy Food Access in the Wake of Online Grocery Shopping

Understanding the views of families from low-income backgrounds about inequities in healthy food access and grocery purchase is critical to food access policies. This study explored perspectives of families eligible for the Supplemental Nutrition Assistance Program (SNAP) on healthy food access in physical and online grocery environments. The qualitative design used purposive sampling of 44 primary household food purchasers with children (aged ≤ 8), between November 2020-March 2021, through 11 online focus groups and 5 in-depth interviews. Grounded theory was used to identify community-level perceived inequities, including influences of COVID-19 pandemic, SNAP and online grocery services. The most salient perceived causes of inequitable food access were neighborhood resource deficiencies and public transportation limitations. Rural communities, people with disabilities, older adults, racially and ethnically diverse groups were perceived to be disproportionately impacted by food inequities, which were exacerbated by the pandemic. The ability to use SNAP benefits to buy foods online facilitated healthy food access. Delivery fees and lack of control over food selection were barriers. Barriers to healthy food access aggravated by SNAP included social stigma, inability to acquire cooked meals, and inadequate amount of monthly funds. Findings provide a foundation for policy redesign to promote equitable healthy food systems.

Barriers and Facilitators of Online Grocery Services: Perceptions from Rural and Urban Grocery Store Managers

Online grocery shopping has expanded rapidly in the U.S., yet little is known about the retailer’s perceptions of online grocery services, which can aid in the expansion of services. Furthermore, many barriers to online grocery utilization persist across geographic areas, especially among Supplemental Nutrition Assistance Program (SNAP)-authorized retailers. This study captured perceived barriers and facilitators of online grocery shopping for managers of SNAP-authorized retailers. Qualitative semi-structured interviews were conducted with managers (n = 23) of grocery stores/supermarkets in urban and rural areas across four different states: TN, KY, NC, and NY. Grocery store managers offering online ordering (n = 15) and managers from brick-and-mortar stores without online services (n = 8) participated in the interviews. Three primary themes emerged among managers offering online ordering: (1) order fulfillment challenges, (2) perceived customer barriers, and (3) perceived customer benefits. Among managers at brick-and-mortar locations without online services, four major themes emerged: (1) thoughts on implementing online shopping, (2) COVID-19 pandemic impacts, (3) competition with other stores, and (4) benefits of maintaining brick-and-mortar shopping. This study provides a deeper understanding of retailers’ experience and perceptions of online grocery services among stores authorized to accept SNAP benefits. This perspective is necessary to inform policies and enhance the evolving virtual food marketplace for SNAP customers.

Content Analysis of Online Grocery Retail Policies and Practices Affecting Healthy Food Access

OBJECTIVE

To describe policies and practices of online grocery retailers that may affect healthy food access, including retailers participating in the US Department of Agriculture's Supplemental Nutrition Assistance Program Online Purchasing Pilot.

DESIGN

Cross-sectional, quantitative content analysis of 21 online grocery retail websites from November 2019 to January 2020.

MAIN OUTCOME MEASURES

Data collected using a coding instrument capturing the presence of policies and practices related to (1) online purchasing and delivery access; (2) availability of features that allow price comparisons and provide nutrition information; and (3) data privacy.

ANALYSIS

Descriptive statistics for features, practices, and policies across online grocery retail websites.

RESULTS

Most retailers (95%) added fees to online orders. Among pilot retailers, 38% added ≥ 3 fees, and 50% required a minimum order > $15. Few retailers (29%) displayed Nutrition Facts Labels on all products, including 50% of pilot retailers. All retailers collected personal information from shoppers and automatically shared data with affiliated companies.

CONCLUSIONS AND IMPLICATIONS

High fees, limited access to nutrition information on retailer sites, and lack of data privacy are prevalent in online grocery retail settings, including among Online Purchasing Pilot retailers. Online retail practices may perpetuate disparities in healthy food access by discouraging use through fees and making nutritious food choices difficult.

The Online Ordering Behaviors among Participants in the Oklahoma Women, Infants, and Children Program: A Cross-Sectional Analysis

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a nutrition assistance program in the United States (U.S.). Participants in the program redeem their prescribed food benefits in WIC-authorized grocery stores. Online ordering is an innovative method being pilot-tested in some stores to facilitate WIC participants’ food benefit redemption, which has become especially important in the COVID-19 pandemic. The present research aimed to examine the online ordering (OO) behaviors among 726 WIC households who adopted WIC OO in a grocery chain, XYZ (anonymous) store, in Oklahoma (OK). These households represented approximately 5% of WIC households who redeemed WIC benefits in XYZ stores during the study period, which was 1 July to 31 December 2020. This period was during the COVID-19 pandemic but after the temporary lockdown in Oklahoma had been lifted. Descriptive statistics were estimated for WIC OO households’ adoption behaviors and their orders. The Cox proportional hazard model and zero-truncated negative binomial regression were applied to examine the relationship between participants’ socio-demographics and the length of time between 1 July 2020, and their first OO, as well as the number of WIC online orders. About 80% of these online orders were picked up without any changes. Minority households had a significantly longer time before adopting their first OO (hazard ratio (HR) < 1, p < 0.001), while households with a child or a woman participant, or more participants, had a shorter time before adopting OO (HR > 1, p < 0.05). Non-Hispanic black households had a fewer number of OOs than non-Hispanic white households (B = −0.374, p = 0.007). OO adoption varied across socio-demographics. More efforts are needed to ensure equal access and adoption of WIC OO.

Online Pilot Grocery Intervention among Rural and Urban Residents Aimed to Improve Purchasing Habits

Online grocery shopping has the potential to improve access to food, particularly among low-income households located in urban food deserts and rural communities. The primary aim of this pilot intervention was to test whether a three-armed online grocery trial improved fruit and vegetable (F&V) purchases. Rural and urban adults across seven counties in Kentucky, Maryland, and North Carolina were recruited to participate in an 8-week intervention in fall 2021. A total of 184 adults were enrolled into the following groups: (1) brick-and-mortar "BM" (control participants only received reminders to submit weekly grocery shopping receipts); (2) online-only with no support "O" (participants received weekly reminders to grocery shop online and to submit itemized receipts); and (3) online shopping with intervention nudges "O+I" (participants received nudges three times per week to grocery shop online, meal ideas, recipes, Facebook group support, and weekly reminders to shop online and to submit itemized receipts). On average, reported food spending on F/V by the O+I participants was USD 6.84 more compared to the BM arm. Online shopping with behavioral nudges and nutrition information shows great promise for helping customers in diverse locations to navigate the increasing presence of online grocery shopping platforms and to improve F&V purchases.

Increasing Healthy Food Access for Low-Income Communities: Protocol of the Healthy Community Stores Case Study Project

Improving healthy food access in low-income communities continues to be a public health challenge. One strategy for improving healthy food access has been to introduce community food stores, with the mission of increasing healthy food access; however, no study has explored the experiences of different initiatives and models in opening and sustaining healthy food stores. This study used a case study approach to understand the experiences of healthy food stores in low-income communities. The purpose of this paper is to describe the methodology used and protocol followed. A case study approach was used to describe seven healthy food stores across urban settings in the U.S. Each site individually coded their cases, and meetings were held to discuss emerging and cross-cutting themes. A cross-case analysis approach was used to produce a series of papers detailing the results of each theme. Most case studies were on for-profit, full-service grocery stores, with store sizes ranging from 900 to 65,000 square feet. Healthy Food Availability scores across sites ranged from 11.6 (low) to 26.5 (high). The papers resulting from this study will detail the key findings of the case studies and will focus on the challenges, strategies, and experiences of retail food stores attempting to improve healthy food access for disadvantaged communities. The work presented in this special issue will help to advance research in the area of community food stores, and the recommendations can be used by aspiring, new, and current community food store owners.

OUP accepted manuscript

Context

Online grocery services are an emerging component of the food system with the potential to address disparities in access to healthy food.

Objective

We assessed the barriers and facilitators of equitable access to healthy foods in the online grocery environment, and the psychosocial, purchasing, and dietary behaviors related to its use among low-income, diverse populations.

Data Sources

Four electronic databases were searched to identify relevant literature; 16 studies were identified.

Results

Barriers to equitable access to healthy food included cost and limited availability of online grocery services in food deserts and rural areas. The expansion of online grocery services and the ability to use nutrition assistance benefits online were equity-promoting factors. Perceived low control over food selection was a psychosocial factor that discouraged online grocery use, whereas convenience and lower perceived stress were facilitators. Findings were mixed regarding healthfulness of foods purchased online. Although few studies assessed diet, healthy food consumption was associated with online grocery use.

Conclusion

Researchers should assess the impact of online grocery shopping on low-income families’ food purchases and diet.

Systematic Review Registration

PROSPERO registration no. CRD: 42021240277

Food and Nutrition Related Concerns Post Lockdown during COVID-19 Pandemic and Their Association with Dietary Behaviors

This study aimed to explore food and nutrition related concerns during the post-lockdown period and their impacts on food shopping, preparation, and eating behaviors.

DESIGN

A cross-sectional study was conducted through online questionnaire. We collected data on food and nutrition related concerns, socio-demographic characteristics, and changes in dietary behaviors.

PARTICIPANTS

A total of 2267 responses were received from people living in 31 provinces across mainland China and 1994 participants were included in the final analysis.

ANALYSIS

Linear and multinomial logistic regression analyses were performed to evaluate the association among food and nutrition related concerns, socio-demographic factors, and dietary behaviors Results: About 56% of participants reported moderate to high levels of concerns related to food and nutrition. Contracting the virus when dining out or through contaminated foods were the top two concerns, followed by overnutrition. Higher levels of concerns were found among people who were older, overweight, or obese, having lower income and education, and living in urban areas, or whose family contained vulnerable individuals. Compared with the pre-COVID-19 period, people who were more concerned about food and nutrition were more likely to report changes in their food purchases and consumption; they were also more likely to eat from individual plates, using serving chopsticks, and separating plates and utensils for raw and cooked foods during the post COVID-19 lockdown period.

CONCLUSION AND IMPLICATION

Food and nutrition related concerns during the post-lockdown period were prevalent and associated with changes in dietary behaviors. Preventative policies and nutritional guidance should be developed to address these concerns in order to reduce inappropriate dietary behaviors amid public health crises.

Digital Food Retail: Public Health Opportunities

For over two decades, digital food retail services have been emerging alongside advances in mobile technology and improved access to wi-fi. Digitalization has driven changes within the food environment, complicating an already complex system that influences food-related behaviors and eating practices. Digital food retail services support an infrastructure that enhances commercial food systems by extending access to and availability of highly processed foods, further escalating poor dietary intakes. However, digital food retail services are heterogeneous–food delivery apps, online groceries, and meal kits–and can be feasibly adapted to nutrition interventions and personalized to individual needs. Although sparse, new evidence indicates great potential for digital food retail services to address food insecurity in urban areas and to support healthy eating by making it easier to select, plan, and prepare meals. Digital food retail services are a product of the digital transformation that reflect consumers’ constant need for convenience, which must be addressed in future research and interventions. This paper will discuss public health opportunities that are emerging from the global uptake of digital food retail services, with a focus on online groceries, food delivery apps, and meal kits.

Comparing shopper characteristics by online grocery ordering use among households in low-income communities in Maine

OBJECTIVE

Online grocery shopping could improve access to healthy food, but it may not be equally accessible to all populations - especially those at higher risk for food insecurity. The current study aimed to compare the socio-demographic characteristics of families who ordered groceries online v. those who only shopped in-store.

DESIGN

We analysed enrollment survey and 44 weeks of individually linked grocery transaction data. We used univariate χ2 and t-tests and logistic regression to assess differences in socio-demographic characteristics between households that only shopped in-store and those that shopped online with curbside pickup (online only or online and in-store).

SETTING

Two Maine supermarkets.

PARTICIPANTS

863 parents or caregivers of children under 18 years old enrolled in two fruit and vegetable incentive trials.

RESULTS

Participants had a total of 32 757 transactions. In univariate assessments, online shoppers had higher incomes (P < 0 0001), were less likely to participate in Special Supplemental Nutrition Program for Women, Infants, and Children or Supplemental Nutrition Assistance Program (SNAP; P < 0 0001) and were more likely to be female (P = 0·04). Most online shoppers were 30-39 years old, and few were 50 years or older (P = 0·003). After controlling for age, gender, race/ethnicity, number of children, number of adults, income and SNAP participation, female primary shoppers (OR = 2·75, P = 0·003), number of children (OR = 1·27, P = 0·04) and income (OR = 3·91 for 186-300 % federal poverty line (FPL) and OR = 6·92 for >300 % FPL, P < 0·0001) were significantly associated with likelihood of shopping online.

CONCLUSIONS

In the current study of Maine families, low-income shoppers were significantly less likely to utilise online grocery ordering with curbside pickup. Future studies could focus on elucidating barriers and developing strategies to improve access.

The Availability and Quality of Food Labelling Components in the Canadian E-Grocery Retail Environment

Background: Although packaged foods sold in retail stores must follow food labelling regulations, there are no e-grocery food labelling regulations to mandate and standardize the availability and presentation of product information. Therefore, the objective of the study was to evaluate the availability and quality of food labelling components in the Canadian e-grocery retail environment. Methods: A sample of fresh and pre-packaged products was identified on eight leading grocery retail websites in Canada, to assess the availability and quality of food labelling components. Results: Out of 555 product searches, all products were accompanied by product images with front-of-pack images more readily available (96.0%) than back-of-pack (12.4%) and other side panel images (3.1%). The following mandatory nutrition information was available for 61.1% of the products: nutrition facts table (68.8%), ingredient (73.9%), and allergen (53.8%) information. The majority of the nutrition information was available after scrolling down, clicking additionally on the description page, or viewing only as an image. Date markings were not available; packaging material information was available for 2.0% of the products. Conclusions: There was wide variability and inconsistencies in the presentation of food labelling components in the e-grocery retail environment, which can be barriers in enabling Canadians to make informed purchasing decisions.

Feasibility and Acceptability of a "Click & Collect" WIC Online Ordering Pilot

BACKGROUND

Barriers to shopping for foods in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) have been reported. Online ordering options may improve the WIC shopping experience but are understudied.

OBJECTIVE

The objective of this study was to test feasibility and acceptability of a "Click & Collect" model for WIC online ordering from the perspective of WIC participants.

DESIGN

A Click & Collect online ordering model was adapted to the WIC program and implemented at 1 grocery store. In the Click & Collect model, WIC participants placed an online order ("click"), then completed payment and pickup at the store ("collect").

PARTICIPANTS/SETTING

Twenty-five WIC participants in East Tennessee were included.

MAIN OUTCOME MEASURES

Feasibility was assessed by examining online order summaries and store receipts to determine whether WIC transactions were completed successfully. Acceptability was assessed by qualitative semi-structured interviews conducted with WIC participants after participating in the pilot.

ANALYSES PERFORMED

Descriptive statistics were used to analyze sociodemographic and purchase data in SPSS software, version 27. Qualitative interviews were transcribed and analyzed for themes using directed content analysis in NVivo, version 12.0.

RESULTS

All WIC participants in the study placed an online order, and 96% picked up the order, indicating a high degree of feasibility. In follow-up qualitative interviews, WIC participants reported interest in the Click & Collect model, and provided suggestions to improve practicality across the following 4 primary themes: website experience, curbside pickup, online shopping fee, and shopping preferences.

CONCLUSIONS

The pilot was successfully implemented at 1 store. Click & Collect online ordering was feasible and acceptable to WIC participants, although additional work is needed to make it practical. Online shopping options for the WIC program should be further explored to expand access to nutritious WIC foods in families with low income.

WIC Participants' Perspectives About Online Ordering and Technology in the WIC Program

OBJECTIVE

The objective of this study was to assess the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants' perceptions about ordering WIC groceries online.

METHODS

Qualitative semistructured interviews were conducted with 24 WIC participants in East Tennessee from May to October 2019. Interviews were transcribed verbatim and analyzed using a grounded theory approach.

RESULTS

Participants were interested in online ordering and spoke favorably about delivery and pickup options. Participants were willing to pay $2-5 to order online, though they were more willing to pay for a home or curbside delivery than an in-store pickup. Participants suggested additional ways to integrate technology into WIC food retail operations, such as providing benefit balances via text message and developing a mobile phone application for Tennessee WIC.

CONCLUSIONS AND IMPLICATIONS

Findings can inform pilot tests for WIC online ordering.