Feasibility of an Online-supported Delivery Program Bringing Nutritious Groceries to Households with Children at Risk for Food Insecurity (FOODBOX): A Study Protocol

Background : In 2023, one in five U.S. households with children experienced food insecurity, with Black and Hispanic households disproportionally affected. While programs like the Supplemental Nutrition Assistance Program (SNAP) provide grocery funds, many families still lack consistent access to nutritious foods due to structural barriers. To address these inequities, FOODBOX proposes an intervention informed by Food Is Medicine (FIM) to improve food and nutrition security among households of low-income with children. Leveraging existing online grocery technology (Instacart), the project will pilot a medically tailored grocery box delivery program in diverse New York City (NYC) neighborhoods. This paper describes the study protocol to assess the feasibility of delivering grocery boxes via community-based Federally Qualified Health Center Network (FQHCN) and Women, Infants, and Children (WIC) clinic. Methods : Formative research will be guided by the Ecological Validity Model to ensure culturally appropriate intervention design. Implementation science approaches will inform the evaluation of intervention fidelity and acceptability (primary feasibility outcomes), and preliminary effectiveness (secondary feasibility outcome) will be assessed though changes in household food security (USDA module) and fruit and vegetable intake (measured by skin carotenoid via Veggie Meter). Fidelity will be assessed by adherence to the intervention protocol in terms of recruitment, retention and compared to benchmarks set a priori. Acceptability will be evaluated through a post-intervention survey assessing satisfaction using Likert-scale and multiple-choice questions. We will enroll 30 households with young children at risk for food insecurity, collaborating with a FQHCN and a WIC clinic. Eligibility includes primary household shoppers with low income (i.e., Medicaid recipients, uninsured, SNAP participants, or those living below 130% of the federal poverty level), living with at least one child < age 10, screened positive for food insecurity, and with access to smartphones or computers for online orders. Discussion : This project, timely in its alignment with the current policy momentum, seeks to decentralize FIM approaches from healthcare systems and incorporate existing technology like Instacart to improve access to nutritious foods. By piloting innovative FIM interventions in community settings, the project seeks to inform evidence-based approaches and pave the way for a subsequent larger-scale intervention. Trial Registration : clinicaltrials.gov ID: NCT06870526. Registered 11 March 2025, https://clinicaltrials.gov/study/NCT06870526