Purchasing BehaviorsNCT02486588
Increasing Engagement With a Healthy Food Benefit
A study testing Messaging and Financial incentives in people with Purchasing Behaviors and Nutrition, run by University of Pennsylvania.
Trial summary
In collaboration with Vitality/Discovery in South Africa, an RCT amongst adult enrolled in the lowest tier of Vitality's HealthyFood benefit will be conducted. We will compare the effect of various messaging, and financial incentive strategies on healthy food purchasing behaviors in this population. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Purchasing Behaviors, Nutrition
- What is being tested?
- Messaging and Financial incentives
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 7,314 participants
- Where
- No sites listed yet
- Study dates
- Oct 2015to 30 Apr 2017
- Phase
- Interventional
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- For this study, we will focus on the following individuals:
- Adult members of Vitality Health who have activated their HealthyFood benefit in 2014 but have not completed the Vitality Age calculation or Vitality Healthy Check, and therefore are on a 10% cash- back reward level on healthy food purchases.
- Members who have chosen Woolworths as their preferred HealthyFood partner.
- Members with an available email address and SMS-capable telephone
- Members with meeting specified spending cutoff (R1000 total spend in the previous month, at least 90% of which was spent at Woolworth's.)
Who cannot join
- Anyone who does not meet all of the above inclusion criteria
About this study
Official title: Increasing Engagement With the Vitality HealthyFood Benefit: A Randomized Field Trial Proposal
In collaboration with Vitality/Discovery in South Africa, an RCT amongst adult enrolled in the lowest tier of Vitality's HealthyFood benefit will be conducted. We will compare the effect of various messaging, and financial incentive strategies on healthy food purchasing behaviors in this population.
Read the detailed description
The Vitality HealthyFood benefit is a three-tiered incentive program designed to encourage healthier food choices amongst members of Discovery Health's Vitality program. Once enrolled in the benefit, participating members can receive 10%, 15%, or 25% cash-back on the healthy foods they purchase at selected grocers. And, while overall enrolment in the program is high, there was been difficulty documenting change in purchasing behaviors; healthy foods have remained a consistent 25-30% of food spend, and unhealthy foods at around 15%. In the current study we would like to test whether differing types of messages and financial incentive structures may be more salient and motivating and have a greater impact on food-purchasing decisions. The proposed study will be a collaboration between Discovery Health/Vitality and researchers at the Perelman School of Medicine at the University of Pennsylvania. In the proposed RCT, Vitality members currently enrolled in the lowest tier (10% level) of the HealthyFood will be randomized to various messaging and financial incentive structures. We will then compare the effectiveness of these different interventions at increasing healthy food purchases among enrolled members.
This study will be a randomized field trial of the combination of several theoretically-motivated interventions: varying weekly messaging, financial incentives, and monthly messaging.
Messaging and financial incentives
Weekly Messaging strategies There are three weekly messaging strategies we want to test. The goal of the messages is to increase the salience of the HealthyFood programme for enrolled members. The three strategies were chosen to enable us to compare the impact of no weekly message vs. a general weekly message vs. a tailored weekly message. The messages will be sent via SMS to all subjects and will be delivered on the same day of the week.
No weekly message-A subset of study subjects will receive no weekly SMS message. This is consistent with the current benefit structure.
General weekly message-A subset of study subjects will receive a weekly SMS that provides general information on the HealthyFood programme and on eating a healthier diet.
Personalized (tailored) weekly message-A subset of study subjects will receive a weekly SMS that includes details about their individual purchasing behavior over the past week. This message will highlight both the percentage and item breakdown of their purchases that were healthy vs. unhealthy.
Financial Incentive Structures
There are three different incentive structures we will test in this study. The goal of the financial incentives is to increase members' motivation to purchase healthy foods. Two of the strategies are currently part of the HealthyFood programme, the third is a new structure which introduces a economic disincentive on the purchase of unhealthy foods.
10% cash-back: This is the current cash-back level for all subjects at the start of on the study. This group is included as a comparison for the other incentive structures.
25% cash back: A subset of study subjects will experience an increase in their cash-back percentage from 10% to 25% of healthy food purchases. The purpose of this group is to assess whether the increase from a 10% level to a 25% level of cash-back is sufficiently large to influence purchasing behaviors.
10% + 15% (healthy-unhealthy): A subset of study subjects will become eligible for additional 15% cash-back above their current 10% level. This additional 15% cash-back will be based on the net monetary amount between their healthy and unhealthy purchases. With this structure, an individual will only receive additional cash-back (above the 10%) if they spend more on healthy foods than on unhealthy foods, and will be able to maximize their cash-back rewards by purchasing only healthy foods.
Monthly Messaging Strategies
Currently all Vitality members enrolled in the HealthyFood programme receive a monthly SMS message informing them of their cash-back deposit.
Bundled deposit SMS (standard)-This message will be the same message that Vitality currently sends to members enrolled in the program me.
Unbundled deposit SMS-Given the introduction of a new incentive structure which includes a penalty for unhealthy purchases, we wanted to test a message strategy which increases the salience of these potential financial losses.
By combining these different weekly messages, incentive structures, and monthly message, the study team determined the aforementioned 6 study arms of interest.
- Conditions
- Purchasing Behaviors, Nutrition
- Being tested
- Messaging, Financial incentives
- Keywords
- Financial incentives, Messaging
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
MessagingOther
See detailed study description for overview of the different messaging interventions in this study
Financial incentivesOther
See detailed study description for overview of the different financial incentive-based interventions in this study
| Study group | Role | What they receive |
|---|---|---|
| Control--no weekly message | No intervention | 10% cash back level, no weekly message, and the standard monthly message |
| General Weekly Message | Experimental | 10% cash back, general weekly message, standard monthly message Receives: Other: Messaging; Other: Financial incentives |
| Personalized Weekly Message | Experimental | 10 % cash back, personalized weekly message, standard monthly message Receives: Other: Messaging; Other: Financial incentives |
| 25 percent cash back | Experimental | 25% cash back, personal weekly message, standard monthly message Receives: Other: Messaging; Other: Financial incentives |
| Standard monthly message | Experimental | 10%+15% cash back, personal weekly message, standard monthly message Receives: Other: Messaging; Other: Financial incentives |
| Unbundled monthly message | Experimental | 10%+15% cash back, personal weekly message, unbundled monthly message Receives: Other: Messaging; Other: Financial incentives |
What is being measured
The primary outcome is the main question the study is designed to answer.
Monthly % Healthy Food Expenditure
The difference in monthly healthy food expenditures between arms. This measure is defined as the monthly amount spent on healthy foods divided by the total monthly amount spent on food, multiplied by 100.
For those individuals who had no recorded expenditure in a given month, they will be assigned 0% healthy food expenditure that month; in this way, this outcome can be considered a composite score of being engaged in the healthy food program (0%=not engaged) and the level of engagement (if monthly expenditure >0). Each individual's data will be averaged across the intervention period.
Measured: Monthly over 6 month intervention period
Secondary outcomes (7)
Monthly % Unhealthy Food Expenditure
The difference in monthly unhealthy food expenditures between arms. This measure is defined as the monthly amount spent on unhealthy foods divided by the total monthly amount spent on food, multiplied by 100.
The average over the full intervention months will be calculated within an individual and compared between arms. To be complementary with the primary endpoint analysis, in a month where an individual is not engaged in the program (0 total monthly expenditure) the worst-score (100) is imputed for that month. A similar MI approach will also be conducted as a sensitivity analysis.
Measured: Monthly over 6 month intervention period
Monthly % Healthy Items
The difference in monthly healthy food items purchased between arms. This measure is defined as the monthly number of healthy food items divided by the total monthly number of food items.
The average over the full intervention months will be calculated within an individual and compared between arms. To be complementary with the primary endpoint analysis, in a month where an individual is not engaged in the program (0 total monthly expenditure) the worst-score (0) is imputed for that month. A similar MI approach will also be conducted as a sensitivity analysis.
Measured: Monthly over 6 month intervention period
Monthly % Unhealthy Items
The difference in monthly unhealthy food items purchased between arms. This measure is defined as the monthly number of unhealthy food items divided by the total monthly number of food items.
The average over the full intervention months will be calculated within an individual and compared between arms. To be complementary with the primary endpoint analysis, in a month where an individual is not engaged in the program (0 total monthly expenditure) the worst-score (100) is imputed for that month. A similar MI approach will also be conducted as a sensitivity analysis.
Measured: Monthly over 6 month intervention period
Percentage Change in Monthly % Healthy Food Expenditures Between Arms
Examining the difference in healthy food expenditure trends between arms where the % health food expenditure is defined as describe for outcome 1 (above)
Measured: During the 6 month intervention period
Percent Change in Monthly %Unhealthy Food Expenditures Between Arms
Examining the difference in unhealthy food expenditure trends between arms where %unhealthy food expenditure is defined as described for Outcome 2 (above).
Measured: During the 6 month intervention period
Percent Change for Monthly % Healthy Food Items Between Arms
Examining the difference in proportion healthy food item trends between arms where % healthy food items is defined as described for Outcome 3 (above)
Measured: During the 6 month intervention period
Percent Change in Monthly %Unhealthy Food Items Between Arms
Examining the difference in proportion unhealthy food item trends between arms where % unhealthy food items is defined as described for Outcome 5 (above).
Measured: During the 6 month intervention period
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted1 Jul 2015 (estimated)
- Study startOct 2015
- Primary completionDec 2016
- Study completion30 Apr 2017
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Purchasing BehaviorsStudies of the same condition, open and under way.
- More trials run by University of PennsylvaniaThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 7,314 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Pennsylvania
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Alison Buttenheim, Phd, Principal investigator, University of Pennsylvania
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02486588
- Sponsor's protocol ID
- 822607
- Status last verified
- Jul 2020
- First submitted
- 29 Jun 2015
- Last updated
- 10 Jul 2020
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- No
- Individual data sharing
- No
Publications
Gopalan A, Shaw PA, Lim R, Paramanund J, Patel D, Zhu J, Volpp KG, Buttenheim AM. Use of financial incentives and text message feedback to increase healthy food purchases in a grocery store cash back program: a randomized controlled trial. BMC Public Health. 2019 May 31;19(1):674. doi: 10.1186/s12889-019-6936-5.
PubMed 31151390
Study at a glance
From the registry record, last updated by the sponsor on 10 Jul 2020. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Increasing Engagement With the Vitality HealthyFood Benefit: A Randomized Field Trial Proposal
- ClinicalTrials.gov ID
- NCT02486588
- Acronym / sponsor ID
- 822607
- Conditions
- Purchasing Behaviors, Nutrition
- Keywords
- Financial incentives, Messaging
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 7,314 participants (actual)
- Lead sponsor
- University of PennsylvaniaUniversity, hospital or other
- Study start
- Oct 2015
- Primary completion
- Dec 2016 (actual)
- Study completion
- 30 Apr 2017 (actual)
- First posted
- 1 Jul 2015 (estimated)
- Results
- Posted 10 Jul 2020
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
In collaboration with Vitality/Discovery in South Africa, an RCT amongst adult enrolled in the lowest tier of Vitality's HealthyFood benefit will be conducted. We will compare the effect of various messaging, and financial incentive strategies on healthy food purchasing behaviors in this population.
Detailed description
The Vitality HealthyFood benefit is a three-tiered incentive program designed to encourage healthier food choices amongst members of Discovery Health's Vitality program. Once enrolled in the benefit, participating members can receive 10%, 15%, or 25% cash-back on the healthy foods they purchase at selected grocers. And, while overall enrolment in the program is high, there was been difficulty documenting change in purchasing behaviors; healthy foods have remained a consistent 25-30% of food spend, and unhealthy foods at around 15%. In the current study we would like to test whether differing types of messages and financial incentive structures may be more salient and motivating and have a greater impact on food-purchasing decisions. The proposed study will be a collaboration between Discovery Health/Vitality and researchers at the Perelman School of Medicine at the University of Pennsylvania. In the proposed RCT, Vitality members currently enrolled in the lowest tier (10% level) of the HealthyFood will be randomized to various messaging and financial incentive structures. We will then compare the effectiveness of these different interventions at increasing healthy food purchases among enrolled members.
This study will be a randomized field trial of the combination of several theoretically-motivated interventions: varying weekly messaging, financial incentives, and monthly messaging.
Messaging and financial incentives
Weekly Messaging strategies There are three weekly messaging strategies we want to test. The goal of the messages is to increase the salience of the HealthyFood programme for enrolled members. The three strategies were chosen to enable us to compare the impact of no weekly message vs. a general weekly message vs. a tailored weekly message. The messages will be sent via SMS to all subjects and will be delivered on the same day of the week.
No weekly message-A subset of study subjects will receive no weekly SMS message. This is consistent with the current benefit structure.
General weekly message-A subset of study subjects will receive a weekly SMS that provides general information on the HealthyFood programme and on eating a healthier diet.
Personalized (tailored) weekly message-A subset of study subjects will receive a weekly SMS that includes details about their individual purchasing behavior over the past week. This message will highlight both the percentage and item breakdown of their purchases that were healthy vs. unhealthy.
Financial Incentive Structures
There are three different incentive structures we will test in this study. The goal of the financial incentives is to increase members' motivation to purchase healthy foods. Two of the strategies are currently part of the HealthyFood programme, the third is a new structure which introduces a economic disincentive on the purchase of unhealthy foods.
10% cash-back: This is the current cash-back level for all subjects at the start of on the study. This group is included as a comparison for the other incentive structures.
25% cash back: A subset of study subjects will experience an increase in their cash-back percentage from 10% to 25% of healthy food purchases. The purpose of this group is to assess whether the increase from a 10% level to a 25% level of cash-back is sufficiently large to influence purchasing behaviors.
10% + 15% (healthy-unhealthy): A subset of study subjects will become eligible for additional 15% cash-back above their current 10% level. This additional 15% cash-back will be based on the net monetary amount between their healthy and unhealthy purchases. With this structure, an individual will only receive additional cash-back (above the 10%) if they spend more on healthy foods than on unhealthy foods, and will be able to maximize their cash-back rewards by purchasing only healthy foods.
Monthly Messaging Strategies
Currently all Vitality members enrolled in the HealthyFood programme receive a monthly SMS message informing them of their cash-back deposit.
Bundled deposit SMS (standard)-This message will be the same message that Vitality currently sends to members enrolled in the program me.
Unbundled deposit SMS-Given the introduction of a new incentive structure which includes a penalty for unhealthy purchases, we wanted to test a message strategy which increases the salience of these potential financial losses.
By combining these different weekly messages, incentive structures, and monthly message, the study team determined the aforementioned 6 study arms of interest.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 6
| Arm | Type | Receives |
|---|---|---|
| Control--no weekly message | No intervention | –10% cash back level, no weekly message, and the standard monthly message |
| General Weekly Message | Experimental | Other: Messaging, Other: Financial incentives10% cash back, general weekly message, standard monthly message |
| Personalized Weekly Message | Experimental | Other: Messaging, Other: Financial incentives10 % cash back, personalized weekly message, standard monthly message |
| 25 percent cash back | Experimental | Other: Messaging, Other: Financial incentives25% cash back, personal weekly message, standard monthly message |
| Standard monthly message | Experimental | Other: Messaging, Other: Financial incentives10%+15% cash back, personal weekly message, standard monthly message |
| Unbundled monthly message | Experimental | Other: Messaging, Other: Financial incentives10%+15% cash back, personal weekly message, unbundled monthly message |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- For this study, we will focus on the following individuals:
Key exclusion criteria (1 listed)
- Anyone who does not meet all of the above inclusion criteria
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| MessagingSee detailed study description for overview of the different messaging interventions in this study | Other | 25 percent cash back, General Weekly Message, Personalized Weekly Message, Standard monthly message, Unbundled monthly message |
| Financial incentivesSee detailed study description for overview of the different financial incentive-based interventions in this study | Other | 25 percent cash back, General Weekly Message, Personalized Weekly Message, Standard monthly message, Unbundled monthly message |
Primary outcome
Monthly % Healthy Food Expenditure
Time frame: Monthly over 6 month intervention period
The difference in monthly healthy food expenditures between arms. This measure is defined as the monthly amount spent on healthy foods divided by the total monthly amount spent on food, multiplied by 100. For those individuals who had no recorded expenditure in a given month, they will be assigned 0% healthy food expenditure that month; in this way, this outcome can be considered a composite score of being engaged in the healthy food program (0%=not engaged) and the level of engagement (if monthly expenditure >0). Each individual's data will be averaged across the intervention period.
7 secondary outcomes
Monthly % Unhealthy Food Expenditure
Time frame: Monthly over 6 month intervention period
Monthly % Healthy Items
Time frame: Monthly over 6 month intervention period
Monthly % Unhealthy Items
Time frame: Monthly over 6 month intervention period
Percentage Change in Monthly % Healthy Food Expenditures Between Arms
Time frame: During the 6 month intervention period
Percent Change in Monthly %Unhealthy Food Expenditures Between Arms
Time frame: During the 6 month intervention period
Percent Change for Monthly % Healthy Food Items Between Arms
Time frame: During the 6 month intervention period
Percent Change in Monthly %Unhealthy Food Items Between Arms
Time frame: During the 6 month intervention period
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Jul 2020.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Derived from this study: PubMed 31151390Gopalan A, Shaw PA, Lim R, Paramanund J, Patel D, Zhu J, Volpp KG, Buttenheim AM. Use of financial incentives and text message feedback to increase healthy food purchases in a grocery store cash back program: a randomized controlled trial. BMC Public Health. 2019 May 31;19(1):674. doi: 10.1186/s12889-019-6936-5.
- Individual participant dataSharing planned: No
Related trials for Purchasing Behaviors
Not yet recruitingObservational study
Assistive Device Rental/Purchase, LTC Service Use, and Caregiver Burden in Taiwan
Self-Help Devices, Long-Term Care
Active, not recruiting
Evaluating the Impact of Psychotherapeutic Advertising Claims on Cannabis Purchasing
Anxiety, Depression
Recruiting
Effects of Tax Proposals and Cigarette Availability on Tobacco Purchasing
Cigarette Smoking
Recruiting
Effects of a Low Nicotine Standard and Tobacco Prices on Illegal Cigarette Purchasing
Cigarette Smoking, E-cigarette Use
RecruitingObservational study
A Prospective Clinical Study of a Cohort of Patients Seeking Treatment for a Behavioral Addiction
Behavioral Addictions
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Alison Buttenheim, Phd principal investigator
University of Pennsylvania
Questions about this trial
What is this clinical trial studying?
A study testing Messaging and Financial incentives in people with Purchasing Behaviors and Nutrition, run by University of Pennsylvania.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 10 Jul 2020. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Yes. Results are posted in the registry (first posted 10 Jul 2020). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Monthly % Healthy Food Expenditure (time frame: Monthly over 6 month intervention period). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02486588, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Jul 2020.