Adoption and acceptability of a Fruit and Vegetable Subsidy in Low-Income Households in urban Chile: the Bolsillo Saludable pilot feasibility study

Background Low-quality diets disproportionally affect low-income populations, limiting access to healthy foods. Objective This feasibility study evaluated the adoption and acceptability of Bolsillo Saludable, a smartphone app-based subsidy designed to incentivize Fruit and Vegetable (FV) purchases at Ferias Libres (open markets) in Chile. Methods In an eight-week pilot study, 30 low-income families received monthly benefits to purchase FV at a Feria Libre in Santiago, with outcomes assessed using a multi-method approach. Qualitative data from focus groups with beneficiaries (n=15) and vendors (n=6) explored acceptability and appropriateness. Quantitative data from the subsidy platform were used to assess adoption. Secondary outcomes (FV expenditure, purchases, dietary diversity) were assessed through app data records and pre-post surveys. Thematic and pre-post analyses were conducted. Results The study demonstrated high adoption and acceptability of the program. All beneficiaries utilized their benefits, with at least one use each month. Qualitative results showed high satisfaction among beneficiaries and vendors, who appreciated the program's focus on healthy food and the ease of the payment system. Participants perceived the restriction to FV and delivery through Ferias Libres as consistent with their purchasing practices, suggesting high appropriateness of the intervention. Over half of beneficiaries perceived positive changes in their family diet, including increased FV consumption and vendors noted increased sales of a wider FV variety. Quantitative results suggested a 38% increase in mean FV expenditure, with improvements in dietary diversity indicators. However, qualitative results identified challenges related to variety of products offered, participating vendors, and invoicing difficulties. Conclusions This feasibility pilot demonstrated high adoption, acceptability, and appropriateness of the Bolsillo Saludable program with preliminary evidence of positive dietary changes among vulnerable populations. Addressing operational challenges, particularly limited vendor participation and invoicing barriers will be essential for scale-up. These findings provide key insights for scaling this intervention in Chile and adapting similar programs across similar settings. Clinical Trial Registry number and website where it was obtained ClinicalTrials.gov Identifier NCT06865157; University of Chile Protocol Record 5128637. https://clinicaltrials.gov/study/NCT06865157