The East Side Table Make-at-Home Meal-Kit Program is feasible and acceptable: A pilot study
Introduction
Especially for those from underserved backgrounds, lack of time, access to affordable foods, and cooking/food skills may make low-cost, energy-dense, low-nutrient foods appealing (Dinour et al., 2007; Drewnowski, 2004; Horning et al., 2017; Seligman & Schillinger, 2010; Taillie & Poti, 2017) and lead to increased consumption of foods with less healthy nutrient profiles (e.g., prepackaged processed meals; away from home meals; Brunner et al., 2010; Hartmann et al., 2013; Horning et al., 2017; Mills et al., 2017; Wolfson & Bleich, 2015). Because research has linked these barriers to poor dietary and health outcomes (Caspi et al., 2012; Chen et al., 2016; Monsivais et al., 2014; Reicks et al., 2014; Storfer-Isser & Musher-Eizenman, 2013; Utter et al., 2018), working to increase food access and skills to prepare home-cooked meals within the time constraints of busy at-risk families may be an important intervention target (Garcia et al., 2016; Reicks et al., 2014, 2018).
Within marketing, shopper solutions and food bundles aim to meet customers’ needs and time constraints with convenience through the display of related items together (Thomas et al., 2020). Within a grocery store, for example, a shopper solution is a display of all the food items necessary to make a particular recipe to facilitate quick and easy purchases (Thomas et al., 2020). Research findings suggest these shopper solutions positively impact both customer convenience and purchase intent (Thomas et al., 2020). While food purchasing research has not found significant increases in healthy food bundle sales as part of a grocery store intervention (Moran et al., 2019), other food purchasing research suggests that food bundling influences customer convenience and may facilitate healthy purchases and outcomes (Carroll et al., 2018). Thus, aligned with marketing and purchasing research, using a well-designed shopper solution and food bundling strategy within a public health intervention may enhance efforts to improve healthy food access, skills, and intake.
The Social Cognitive Theory (Bandura, 1986) posits a dynamic interplay between personal, behavioral, and environmental factors that lead to outcomes. One construct within these factors, self-efficacy (confidence) in performing a skill or task, is highlighted as particularly influential in impacting subsequent health behaviors and outcomes. Drawing from this theory, meal kits – a shopper solution and food bundle that contain step-by-step instructions, pre-measured ingredients, and foods necessary to easily create home-cooked meals – may facilitate increased convenience, access, and cooking self-efficacy. Meal-kits would increase self-efficacy by providing individuals the opportunity to prepare a healthy meal, follow of a recipe, as well as work with and become familiar with ingredients and new cooking techniques. Additionally, because even temporary meal kit use has the potential to increase self-efficacy, meal kits have long-term potential to impact subsequent behavior and outcomes.
Currently, meal-kit interest is high: a recent Nielson survey found nearly one in ten American consumers had reported recently buying a meal kit and one in four was contemplating a future meal-kit purchase (Neilson, 2018). Moreover, meal kits are becoming more widely available and have become Supplemental Nutrition Assistance Program (SNAP) eligible in some states like Minnesota. Given theorized impact on self-efficacy, public interest, increased availability, and SNAP eligibility, meal kits have potential to facilitate healthy at-home food preparation, self-efficacy, and intake for many. Currently, meal kits, a shopper solution and food bundle, are most often available for purchase within an online or grocery store environment and are widely marketed; however, meal kits can also be used within intervention programs. To date, two studies have used meal kits as an intervention with families. The two studies engaged nine (Utter et al., 2019) and ten (Utter & Denny, 2016) New Zealand families with low incomes. Qualitative interview findings indicated participants enjoyed the free meal-kit program and improved their cooking skills and eating habits as a result of the intensive intervention (Utter & Denny, 2016). Survey findings indicated increased vegetable intake and decreased food insecurity (Utter et al., 2019). These findings, while limited to small homogenous samples, indicate further research is needed to better understand (a) if meal kits impact food preparation techniques, self-efficacy, access, and intake in larger more heterogeneous populations at risk for poor outcomes and (b) if outcomes may be sustained after the completion of the intervention.
If meal-kit interventions are found to be effective, they could be particularly advantageous as a scalable intervention for two main reasons. First, meal-kits are widely available for purchase in many physical and online retail locations and have piqued public interest (e.g., which increases interest in participation), important factors in building up an intervention. Second, outside of the already growing retail presence, meal-kit interventions can be implemented with groups (e.g., within a community organization that serves individuals who may be a higher risk for poorer outcomes or in need of food skills); meal kits can also be added as a complement to existing programming (e.g., within Extension's Expanded Food and Nutrition Education Program [EFNEP] or Women, Infants, and Children [WIC] programming) or used with at-risk individuals (e.g., within a clinic setting as a prescription for individuals with uncontrolled chronic health conditions like hypertension). Because the intervention is contained within the meal kit itself, meal-kit interventions can be self-paced. Meal-kit interventions also would not necessarily require a cohort, instructor, class schedule, or transportation, which pose barriers to more traditional cooking classes that have been found to increase cooking skills and self-efficacy, which are linked to healthier dietary behaviors (Hasan et al., 2019; Reicks et al., 2014; Wolfson et al., 2020). Additionally, unlike traditional cooking classes or programming targeting improved food access, skills, and intake outcomes, meal kits remain accessible to participants after intervention programs end, because meal-kits are available for purchase by retailers should organizations or participants need or want additional reinforcement of program messages.
This pilot study, designed with community-based participatory research (CBPR) principles, aimed to assess research feasibility, acceptability, and preliminary outcomes (i.e., food preparation techniques, confidence, accessibility, and intake) of the community-designed and -led Meal-Kit intervention program.
Section snippets
Meal-kit program
In Saint Paul, Minnesota, disparities in food quality, affordability, access, and skills are prevalent (Ramsey County, 2014; United States Department of Agriculture, 2017). These disparities are even more pronounced in the East Side neighborhoods. For example, using a measure of income as social determinant of health, on the East Side, 47% experience poverty at 200% of federal poverty guidelines (Wilder Research, 2020b) compared to 41% in Saint Paul, MN (Wilder Research, 2020a) and 25% in the
Results
Full demographic data for the research participants are available in Table 2 and are similar to the demographic characteristics of the overall Meal-Kit program participant data (see Table 2). Retention was 54/60 (90%) at post-program and 55/60 (92%) at follow-up. Over the course of the program, weekly meals were provided to feed 230 individuals (60 research participants and their 170 household members). Program participation was high; at post-program, 48/54 (89%) reported picking up eight or
Discussion
Our pilot research study showed high retention and meal-kit program participation rates, suggesting feasibility of recruitment and retention of participants. Process data indicated acceptability with high levels of program participation and satisfaction. Change in outcomes is not a key goal of pilot studies because limited statistical power can lead to inaccurate conclusions or misconstrue findings (Arain et al., 2010; Kistin & Silverstein, 2015; Lancaster et al., 2004; Leon et al., 2011).
Ethical statement
The research protocols used for the study described in this manuscript were reviewed and approved by the Institutional Review Board at the University of Minnesota. The research was conducted in accordance with the Declaration of Helsinki.
Author contributions
Horning: Designed the study in partnership with community partner Hill, led all aspects of the study, completed quantitative data analysis and independent qualitative analysis coding, drafted manuscript, revised manuscript.
Hill: Designed the study in partnership with Horning, reviewed manuscript for accuracy and substantially contributed to manuscript revision.
Martin: Assisted with data collection, manuscript drafting, reviewed manuscript for accuracy and substantially contributed to manuscript
Funding
This research study was funded by a Building Healthier Communities Award from Stratis Health. This research used REDCap data collection software supported by the National Institutes of Health’s National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health’s National Center for Advancing Translational Sciences.
Acknowledgements
We would like to thank the members of the Working Council for their support of this research to go alongside the East Side Table Make-at-Home Meal-Kit Program. We would like to thank Brittany Gregorich for her integral assistance with the project.
References (43)
- et al.
Convenience food products. Drivers for consumption
Appetite
(2010) - et al.
Food bundling as a health nudge: Investigating consumer fruit and vegetable selection using behavioral economics
Appetite
(2018) - et al.
The relationship between diet and perceived and objective access to supermarkets among low-income housing residents
Social Science & Medicine
(2012) - et al.
Development of psychosocial scales for evaluating the impact of a culinary nutrition education program on cooking and healthful eating
Journal of Nutrition Education and Behavior
(2011) - et al.
The food insecurity-obesity paradox: A review of the literature and the role food stamps may play
Journal of the American Dietetic Association
(2007) Obesity and the food environment: Dietary energy density and diet costs
American Journal of Preventive Medicine
(2004)- et al.
Importance of cooking skills for balanced food choices q
Appetite
(2013) - et al.
Development of the cooking and food provisioning action scale (CAFPAS): A new measurement tool for individual cooking practice
Food Quality and Preference
(2017) - et al.
The role and interpretation of pilot studies in clinical research
Journal of Psychiatric Research
(2011) - et al.
Time spent on home food preparation and indicators of healthy eating
American Journal of Preventive Medicine
(2014)
Make it fresh , for Less! A supermarket meal bundling and electronic reminder intervention to promote healthy purchases among families with children
Journal of Nutrition Education and Behavior
Impact of cooking and home food preparation interventions among adults: Outcomes and implications for future programs
Journal of Nutrition Education and Behavior
Measuring parent time scarcity and fatigue as barriers to meal planning and preparation: Quantitative scale development
Journal of Nutrition Education and Behavior
Associations of cooking with dietary intake and obesity among supplemental nutrition assistance program participants
American Journal of Preventive Medicine
Feasibility of a family meal intervention to address nutrition, emotional wellbeing, and food insecurity of families with adolescents
Journal of Nutrition Education and Behavior
Self-perceived cooking skills in emerging adulthood predict better dietary behaviors and intake 10 years later: A longitudinal study
Journal of Nutrition Education and Behavior
What is a pilot or feasibility study? A review of current practice and editorial policy
BMC Medical Research Methodology
self-efficacy
Food environments and obesity: Household diet expenditure versus food deserts
East Side Table Meal kits
Developing multidimensional measures of healthy food access among low-income adults in Cleveland, Ohio, USA
Public Health Nutrition
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