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)

Abstract

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.