Elsevier

Appetite

Volume 160, 1 May 2021, 105087
Appetite

The East Side Table Make-at-Home Meal-Kit Program is feasible and acceptable: A pilot study

https://doi.org/10.1016/j.appet.2020.105087Get rights and content

Abstract

Drawing from marketing literature, shopper solutions and food bundles (that group items to be used together) can promote purchase intention, efficacy, and related outcomes. Similarly, meal kits boxes (food bundles with step-by-step instructions to prepare home-cooked meals) have potential to be an accessible intervention to facilitate healthy, at-home food preparation and intake. This manuscript describes the feasibility, acceptability, and preliminary outcomes of a community-designed and -led program promoting healthy food skills, accessibility, and intake through meal kits. This pilot study was designed using community-based participatory research principles and 60 participants enrolled in the study. Participating families received a free meal kit weekly during the 10-week program. Meal-kit boxes also included language-appropriate recipe cards, step-by-step instructions, and supplemental educational material including links to videos with related food preparation tips and fact sheets about the meal. Data were collected at baseline, post-program, and follow-up (3 months post-program). Specifically, validated measures were used to assess food insecurity, food availability, cooking preparation techniques, self-efficacy, and fruit/vegetable intake. Process data were also collected. Descriptive statistics, paired t-tests, and Wilcoxon sign-ranked tests were used to describe data and evaluate outcomes. Content analysis was used to code open-ended survey responses into categories. Study findings indicated retention rates were high (≥90%); 83% made eight or more meal kits. At post-program, significant increases were observed in cooking/meal preparation self-efficacy, cooking techniques, and healthy food availability. At follow-up, only healthy food availability remained significantly higher. Findings suggest that meal-kit programs are feasible and acceptable, and there is a potential for these programs to influence factors important to increasing healthy home-cooked meals and dietary intake. Future research should use more rigorous designs and explore meal-kit dosage.

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)

  • A.J. Moran et al.

    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

    (2019)
  • M. Reicks et al.

    Impact of cooking and home food preparation interventions among adults: Outcomes and implications for future programs

    Journal of Nutrition Education and Behavior

    (2014)
  • A. Storfer-Isser et al.

    Measuring parent time scarcity and fatigue as barriers to meal planning and preparation: Quantitative scale development

    Journal of Nutrition Education and Behavior

    (2013)
  • L.S. Taillie et al.

    Associations of cooking with dietary intake and obesity among supplemental nutrition assistance program participants

    American Journal of Preventive Medicine

    (2017)
  • J. Utter et al.

    Feasibility of a family meal intervention to address nutrition, emotional wellbeing, and food insecurity of families with adolescents

    Journal of Nutrition Education and Behavior

    (2019)
  • J. Utter et al.

    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

    (2018)
  • M. Arain et al.

    What is a pilot or feasibility study? A review of current practice and editorial policy

    BMC Medical Research Methodology

    (2010)
  • A. Bandura

    self-efficacy

  • D. Chen et al.

    Food environments and obesity: Household diet expenditure versus food deserts

  • East Side Table

    East Side Table Meal kits

    (2019)
  • S.A. Flocke et al.

    Developing multidimensional measures of healthy food access among low-income adults in Cleveland, Ohio, USA

    Public Health Nutrition

    (2017)
  • Cited by (15)

    • Participant Insights From a Family-based Meal Kit Delivery Intervention

      2024, Journal of Nutrition Education and Behavior
    • Supporting family meal frequency: Screening Phase results from the Simply Dinner Study

      2022, Appetite
      Citation Excerpt :

      This is an interesting finding because we might have expected to only see these results with the Ingredient Delivery intervention component, in which families received ingredients and recipes to facilitate cooking. Ingredient delivery has been shown to increase cooking self-efficacy in adults (Horning et al., 2021) and has been shown to reduce some (but not all) barriers to home cooking among families with children (Oberle et al., 2020). An Australian study found that parents who participate in commercially available meal kits report less food-related decision making, enhanced opportunities for food literacy, and less food consumed away-from-home (Fraser et al., 2022), suggesting that ingredient delivery may increase cooking behaviors among those families who have access to commercial meal kit delivery services.

    View all citing articles on Scopus
    View full text