Exploring Nudges in Online Food Pantries to Enhance Diet and Lower Cardiovascular Risk

Background: Individuals facing food insecurity have higher cardiovascular risks, partly due to unhealthy diets. Healthy food nudges harness heuristics to increase selection of healthier options and their use in charitable food programs can help reach food insecure families while maximizing resources. In this qualitative study, we explored the decision environment of online food pantries, including decision-making factors of the shoppers, to inform nudge development. Methods: We recruited adults who were shoppers or workers of online food pantries in metro Chicago in a 2:1 distribution, respectively. We conducted semi-structured interviews that covered several topic areas, including the online pantry experience and decision-making factors when shopping the pantry. All interviews were transcribed, translated (for Spanish interviews), and underwent content analysis to describe the decision environment and key determinants of food choices. Results: Interviews were conducted with 32 participants, of which 69% were shoppers. Instead of pre-planned grocery lists, most shoppers described making decisions as they scrolled through the online site, which presented the opportunity for nudges to influence the decision-making moment. Also, most shoppers (77%) ordered as regularly as allowed, demonstrating the potential for repeat exposure to behavioral interventions. Specific characteristics of a food item or social factors influenced decision making about food choices (Figure). Item-specific factors were the item’s market value, ability to combine with other pantry offerings to make a meal, ability to be prepared in multiple ways, healthfulness (both in supporting general good health and chronic disease management), freshness (as opposed to nonperishables), and novelty. Major social factors were taste preferences and dietary restrictions of the household, size of household, and consideration of other shoppers’ needs and waste reduction. Conclusions: We identified decision-making patterns and processes of individuals who utilize online pantries; this information can be used to design and implement healthy food nudges in online food pantries. While health is a major decision-making factor, other food-related and social factors are also involved in the heuristics of choosing groceries in online food pantries. Nudges that bundle healthy pantry offerings may further increase healthy food selection while helping shoppers to meal-plan a variety of dishes for their households.