Participant Experiences With the Healthy Food First Clinical Trial to Reduce Food Insecurity and Blood Pressure

Objectives: To better understand the participant experience with the interventions during the Healthy Food First (HFF) clinical trial. Methods: The HFF trial is designed to evaluate the effect of 8 different study conditions (factorial design) on blood pressure and food insecurity. Patients enrolled in Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and/or North Carolina Medicaid were eligible to participate if they reported being food insecure and had elevated blood pressure. Enrolled participants were randomized to receive a home delivered food box or a 40/month subsidy to purchase WIC eligible foods in a local grocery store chain. The intervention was 6 or 12-months in length, and with or without lifestyle support from Community Health Workers using an evidence-based culturally tailored counseling program. Study staff purposely recruited a diverse sample of participants who had completed the HFF intervention for semi-structured telephone interviews. Interviews lasted 20-30 minutes and focused on three key topics (1) program experience, (2) intervention components, and (3) perceived program effects. All interviews were audio-recorded, transcribed, and analyzed with ATLAS. ti 23. Results: A total of 19 individual interviews were conducted. Participants were predominantly female (68%) and 53% identified as Black or African American. Four key findings were identified. First, both the food box and subsidies were considered helpful to participants. Second, participants felt both interventions improved dietary quality. Third, participants suggested improvements in the guidance and resources on how to use the food box and subsidy. Fourth, although the food subsidy was appreciated, participants felt it may not have been enough to make a major difference in individual health outcomes. Conclusions: These summative evaluation interviews provided a deeper understanding of positive intervention attributes and highlighted opportunities for improvement. Participants found both food subsidies and food box delivery to be helpful and acceptable. Regardless of intervention, many individuals noted improvements in diet quality and healthy lifestyle behaviors. These findings provide valuable information to interpret trial results and design future food insecurity interventions. Funding Sources: Blue Cross and Blue Shield of North Carolina (Blue Cross NC).