Abstract MPTU21: Proactive Outreach May Mitigate Disengagement in Electronic Healthy Eating Interventions: A Qualitative Study

Abstract

Background: The US population eats less than recommended amounts of fruit and vegetables (F&V). We conducted a randomized clinical trial to test whether a $160 monthly F&V subsidy, choice architecture (F&V shown first on the online store), and/or text message reminders of the subsidy balance increased F&V purchases in an online grocery store over 3 months. We conducted interviews with high and low spending participants to understand their experiences. Methods: Using data on participants’ subsidy expenditures, we recruited respondents from the top and bottom 30% of average monthly expenditures among those in the intervention arm for the three months they participated. Participants were invited to brief telephone interviews that asked about their experience in the program, benefits, challenges, and program impact. Interviews were conducted March - May 2025, recorded, transcribed, and blinded. Two researchers summarized transcript responses. After all data were summarized, responses were unblinded, analyzed, and compared by group. Results: We conducted 41 interviews with 23 high spenders and 18 low spenders (N=187). Respondents were primarily Black, female, and over 50 years of age. High spenders described the program as easy to use, motivating, and enjoyable. They liked the convenience of selecting eligible items, tracking balances, and having groceries delivered. The program enhanced access to F&V while fitting into existing routines and helping participants save time. They also appreciated features such as reminder texts and the $25 sign-up incentive. Some high spenders reported difficulties using the site but proactively reached out for support and found solutions. Low spenders struggled with adoption, often due to technical or payment barriers. Confusion around the site, digital subsidy, and competing payment methods (e.g., SNAP or debit cards) discouraged participation. These participants frequently expressed frustration and reported abandoning attempts to use the subsidy. They emphasized the need for greater communication and troubleshooting support from the study team. Conclusion: While many high spenders found the program motivating and easy to use, lower spenders were often discouraged by technological barriers such as confusion with payment systems. Interventions that include an electronic component should consider proactive outreach to help mitigate these challenges and support full engagement.