The Veggie Vouchers intervention to promote SNAP fruit and vegetable incentive program use for families with food insecurity: A single arm feasibility study

Background: The Supplemental Nutrition Assistance Program (SNAP) has financial incentive programs where recipients can purchase fruits and vegetables (F&V) at select sites for half price or less, leading to increased F&V consumption and projected savings in healthcare costs. Yet, limited awareness and uptake of these programs present barriers to widespread utilization, thus limiting potential impact. 

Objective: The Veggie Vouchers intervention was designed to increase awareness and uptake of a SNAP F&V incentive program in South Carolina among families with children 2–17 years of age. The primary aim of this study was to determine intervention feasibility and acceptability among caregivers and pediatricians. Patterns of preliminary efficacy were secondarily examined for changes in diet-related outcomes. 

Methods: This single-arm feasibility study leveraged social determinants of health screenings in a pediatric clinic to identify families who were eligible for a SNAP F&V incentive program. Eligible caregivers received brief education about this program from their pediatrician and an initial free trial to incentivize uptake. Free trial redemption rates were tracked, along with subsequent SNAP F&V incentive program use after the free trial ended. Surveys assessed intervention acceptability and changes in household food security, nutrition security, and children’s dietary intake. 

Results: Caregivers (n = 91; 100% female; 77% Black) and pediatricians (n = 37) were enrolled within 10 months. Most caregivers (70.3%) used their free trial (redeemers), with 58% of “non-redeemers” reporting transportation challenges as reasons for non-redemption. Over 91% of “redeemers” were satisfied with the amount, variety, and quality of F&V; 90.5% reported the free trial made it easier for them and their child to eat more F&V; and 18.8% utilized the SNAP F&V incentive program after the free trial ended. Most assessment time points achieved ≥ 70% survey completion rates. Pediatricians (88.9%) felt the intervention was easy to implement, and 100% reported minimal-to-no disruptions in clinic flow. Initial patterns indicated potential improvements in household food security and nutrition security throughout the intervention for “redeemers,” compared to “non-redeemers”. 

Conclusions: Findings support the feasibility and acceptability of the Veggie Vouchers intervention, yet additional strategies should be explored in a larger randomized controlled trial to enhance sustained SNAP F&V program use. Trial registration: ClinicalTrials.gov, NCT06593028. Retrospectively registered on September 11, 2024, https://clinicaltrials.gov/study/NCT06593028.