Healthy Food Subsidy Project in Chile

Bolsillo Saludable: Feasibility of a Healthy Food Subsidy on Healthy Eating in Low-Income Households in Chile

Feasibility Study

Objective:

The objective of this feasibility study is to develop and evaluate the feasibility and acceptability of a healthy food subsidy program within the Chilean context. The program, called Healthy Wallet, is a smartphone app-based initiative aimed at incentivizing low-income families to purchase fruits and vegetables at open markets. The findings from this study are intended to inform and potentially accelerate the implementation of similar policies in other countries.

Methods:

This study assessed the feasibility of implementing the Healthy Wallet subsidy program, designed to promote healthy eating habits among low-income families. The program incentivized the purchase of fruits and vegetables at local ferias (open markets) and was delivered through a smartphone application. The research adopted a community-based approach, leveraging existing social support systems to identify eligible beneficiaries and streamline the distribution of benefits. Open markets served as redemption sites for the subsidies.

The study engaged 30 families and 8 vendors in an 8-week pilot program conducted from June to August 2024. Data collection included pre- and post-implementation surveys, as well as focus group discussions: three with participating families and one with vendors. These methods aimed to evaluate the app's effectiveness, user experience, and overall feasibility of the program. Insights from the study will guide recommendations for scaling the initiative to a national level and beyond.

Study Overview

• Status: Completed
• Conditions: Feasibility Studies; Food Security
• Intervention / Treatment: Other: Healthy Wallet

Detailed Description

Study Design:

This study employed an eight-week feasibility approach (Healthy Wallet) utilizing a mixed-methods assessment. The quantitative component consisted of a pre-post single-arm study, while the qualitative component involved focus group discussions with both vendors and participants.

Intervention:

The Healthy Wallet program is a mobile-based initiative aimed at promoting healthy eating habits among low-income families by incentivizing the purchase of fruits and vegetables at open markets. The program provides a monthly electronic transfer of 16,000 CLP (approximately 17 USD) for each eligible household member, including children under 18, students under 25, and individuals with disabilities. The primary food purchaser in each household receives the transfer, which is exclusively redeemable at registered stalls in the open market.

To ensure seamless transactions, registered vendors display a distinctive Healthy Wallet identification sign with a unique code. Beneficiaries use the mobile application to view available funds and complete purchases by entering the vendor's stall code. A separate vendor application tracks sales and maintains transaction records for efficient invoicing.

Sample:

The program engaged 30 families, who received monthly benefits for two consecutive months to use at 6 participating stalls within the Juan Pinto Durán open market.

Eligibility Criteria:

Eligibility aligned with Chile's existing social protection framework, leveraging the Emergency Family Wallet government subsidy established to address rising food prices during the COVID-19 pandemic. Households that participated in the Emergency Family Wallet program (2023-2024) were eligible.

The designated household representative, responsible for receiving and managing the benefit, had to meet the following criteria:

Be at least 18 years old (legal age). Be a parent or guardian of a child aged 0-5 years. Be responsible for household grocery purchases. Vendors operating at the Juan Pinto Durán open market were excluded from household eligibility.

Subsidy Delivery Platform:

A private mobile application, originally developed for university food benefits, was adapted for this pilot program. A private company managed the entire process, including loading benefits into participants' accounts, facilitating their use at the Juan Pinto Durán open market, and ensuring payment to vendors. This company provided its services pro bono, offering technical expertise and logistical support at no cost.

Ethical Considerations:

The study was conducted in accordance with the Declaration of Helsinki. The protocol and informed consent forms were approved by the Ethics Committee of the Faculty of Medicine, University of Chile.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Chile
  • Macul
    • Santiago, Macul, Chile, 7830490
      • Feria Libre Juan Pinto Durán

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

Households that are beneficiaries of the Bolsillo Familiar Electrónico program in 2023-2024 and have children under 5 years of age.

Availability to shop at the local open-air market (feria libre).

Exclusion Criteria:

Individuals who are market vendors (feria vendors).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Healthy Wallet; Each eligible household receives a monthly electronic transfer of 16,000 CLP (approximately USD 17) per eligible member to purchase fruits and vegetables from authorized vendors at the Juan Pinto Durán open market. A dedicated mobile application manages the process by crediting the benefit to participants' accounts, simplifying its use at the market, and ensuring seamless payment to vendors.

Other: Healthy Wallet; The Healthy Wallet program is a mobile-based initiative designed to promote healthy eating among low-income families by incentivizing the purchase of fruits and vegetables at open markets. Over a two-month period, 30 families received monthly benefits to use at a designated open market.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of the monetary subsidy spent daily by each household, based on the records from the subsidy delivery platform.	Percentage of the monetary subsidy spent daily by each household, based on the records from the subsidy delivery platform.	Daily throughout the two months of follow-up
Percentage of households that used the monetary subsidy at least once per month, based on the records from the subsidy delivery platform	Percentage of households that used the monetary subsidy at least once per month, based on the records from the subsidy delivery platform	Weekly throughout the two months of follow-up
Perceived utility of the subsidy program among beneficiaries, evaluated through online surveys	Perceived utility of the subsidy program among beneficiaries, evaluated through online surveys (Likert scale)	At the end of the study, at two months of follow-up
Perceived utility of the subsidy program among vendors, evaluated through online surveys	Perceived utility of the subsidy program among vendors, evaluated through online surveys (Yes/No questionnaire)	At the end of the study, at two months of follow-up
Self-reported satisfaction of the subsidy program among beneficiaries, evaluated through focus groups	Self-reported satisfaction of the subsidy program among beneficiaries, evaluated through focus groups	At the end of the study, at two months of follow-up
Self-reported satisfaction of the subsidy program among vendors, evaluated through focus groups	Self-reported satisfaction of the subsidy program among vendors, evaluated through focus groups	At the end of the study, at two months of follow-up
Perceived utility of the subsidy platform among beneficiaries, evaluated through online surveys	Perceived utility of the subsidy program among beneficiaries, evaluated through online surveys (Likert scale)	At the end of the study, at two months of follow-up
Perceived utility of the subsidy platform among vendors, evaluated through online surveys	Perceived utility of the subsidy program among vendors, evaluated through online surveys (Yes/No questionnaire)	At the end of the study, at two months of follow-up
Self-reported satisfaction of the subsidy platform among beneficiaries, evaluated through focus groups	Self-reported satisfaction of the subsidy platform among beneficiaries, evaluated through focus groups	At the end of the study, at two months of follow-up
Self-reported satisfaction of the subsidy platform among vendors, evaluated through focus groups	Self-reported satisfaction of the subsidy platform among vendors, evaluated through focus groups	At the end of the study, at two months of follow-up

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Self-reported monthly expenditure on all fruits purchased from the open market, based on a questionnaire	Self-reported monthly expenditure on all fruits purchased from the open market, based on a questionnaire	At baseline and at the end of the study (0 and 2 months of follow-up)
Self-reported monthly expenditure on all vegetables purchased at the open market, based on a questionnaire	Self-reported monthly expenditure on all vegetables purchased at the open market based on a questionnaire	At baseline and at the end of the study (0 and 2 months of follow-up)
Self-reported monthly expenditure on all fruits and vegetables combined, purchased from the open market, based on a questionnaire	Self-reported monthly expenditure on all fruits and vegetables combined, purchased from the open market, based on a questionnaire	At baseline and at the end of the study (0 and 2 months of follow-up)
Self-reported monthly combined fruit and vegetable purchases (in kilograms) from the open market, based on a questionnaire	Self-reported monthly combined fruit and vegetable purchases (in kilograms) from the open market, based on a questionnaire	At baseline and at the end of the study (0 and 2 months of follow-up)
Self-reported monthly fruit purchases (in kilograms) at the open market, based on a questionnaire	Self-reported monthly fruit purchases (in kilograms) at the open market, based on a questionnaire	At baseline and at the end of the study (0 and 2 months of follow-up)
Self-reported monthly vegetable purchases (in kilograms) at the open market, based on a questionnaire	Self-reported monthly vegetable purchases (in kilograms) at the open market, based on a questionnaire	At baseline and at the end of the study (0 and 2 months of follow-up)
Self-reported monthly vegetable purchases (in units) at the open market, based on a questionnaire	Self-reported monthly vegetable purchases (in units) at the open market, based on a questionnaire	At baseline and at the end of the study (0 and 2 months of follow-up)
The Global Dietary Recommendations (GDR) score from the Diet Quality Questionnaire (DQQ), range 0-18	The Global Dietary Recommendations (GDR) score is a score with a range from 0 to 18 that indicates adherence to global dietary recommendations, which include dietary factors protective against non-communicable diseases (NCD). The higher the GDR score, the more recommendations are likely to be met. The GDR score is based on food group consumption during the past day and night. The GDR score is calculated as follows: NCD-Protect - NCD-Risk + 9 = GDR score It is expressed as the average score for the population.	At baseline and at the end of the study (0 and 2 months of follow-up)
The Non-Communicable Disease-protect (NCD-protect) score from the Diet Quality Questionnaire (DQQ), range 0-9	An indicator of dietary factors protective against non-communicable diseases (NCD) (articulated by the World Health Organization): At least 400g of fruits and vegetables per day; Whole grains, pulses, and nuts or seeds; At least 25g of fiber per day The NCD-Protect score is a score with a range from 0 to 9. It is a sub-component of theGDR score, and reflects adherence to global dietary recommendations on healthy components of the diet. The NCD-Protect score is based on food consumption from 9 healthy food groups during the past day and night. A higher score indicates inclusion of more health-promoting foods in the diet, and correlates positively with meeting global dietary recommendations. It is expressed as the average score for the population.	At baseline and at the end of the study (0 and 2 months of follow-up)
The Non-Communicable Disease-risk (NCD-risk) score from the Diet Quality Questionnaire (DQQ), range 0-9	An indicator of dietary factors for Non-Communicable Diseases (NCD): Less than 10% (ideally less than 5%) of total energy from free sugars; Less than 10% of total energy from saturated fat, and less than 30% from total fat; Less than 5g of salt per day; Little if any processed meat, and red meat limited to no more than 350-500g per week. It is a score with a range from 0 to 9. It is a sub-component of the GDR score, and reflects adherence to global dietary recommendations on components of the diet to limit or avoid. A higher score indicates higher consumption of foods and drinks to avoid or limit, and correlates negatively with meeting global dietary recommendations. The NCD-Risk score is based on food consumption from 8 food groups to limit or avoid during the past day and night (one food group, processed meat, is double weighted). This is a negative indicator, and is expressed as the average score for the population.	At baseline and at the end of the study (0 and 2 months of follow-up)
The Food Group Diversity Score (FGDS) from the Diet Quality Questionnaire (DQQ), range 0-10	The Food group diversity score (FGDS) is a semicontinuous score ranging from 0 to 10, by summing the scores for each food group (0: not consumed; 1: consumed) using the following 10 food groups: 1) grains, white roots and tubers, and plantains; 2) pulses (beans, peas, and lentils); 3) nuts and seeds; 4) milk and milk products; 5) meat, poultry, and fish; 6) eggs; 7) dark green leafy vegetables; 8) other vitamin A-rich fruits and vegetables; 9) other vegetables; and 10) other fruits. The FGDS is a proxy indicator of micronutrient adequacy for the general population expressed as the mean population score.	At baseline and at the end of the study (0 and 2 months of follow-up)

Collaborators and Investigators

• Sponsor: University of Chile
• Collaborators: Bloomberg Philanthropies
• Investigators: Principal Investigator: Camila Corvalan, PhD, Institute of Nutrition and Food Technology, University of Chile

Publications and helpful links

General Publications

• Huangfu P, Pearson F, Abu-Hijleh FM, Wahlich C, Willis K, Awad SF, Abu-Raddad LJ, Critchley JA. Impact of price reductions, subsidies, or financial incentives on healthy food purchases and consumption: a systematic review and meta-analysis. Lancet Planet Health. 2024 Mar;8(3):e197-e212. doi: 10.1016/S2542-5196(24)00004-4.
• Andreyeva T, Marple K, Moore TE, Powell LM. Evaluation of Economic and Health Outcomes Associated With Food Taxes and Subsidies: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022 Jun 1;5(6):e2214371. doi: 10.1001/jamanetworkopen.2022.14371. Erratum In: JAMA Netw Open. 2022 Jun 1;5(6):e2221711. doi: 10.1001/jamanetworkopen.2022.21711.
• Berkowitz SA, Curran N, Hoeffler S, Henderson R, Price A, Ng SW. Association of a Fruit and Vegetable Subsidy Program With Food Purchases by Individuals With Low Income in the US. JAMA Netw Open. 2021 Aug 2;4(8):e2120377. doi: 10.1001/jamanetworkopen.2021.20377. Erratum In: JAMA Netw Open. 2021 Dec 1;4(12):e2142888. doi: 10.1001/jamanetworkopen.2021.42888.

Study record dates

Study Major Dates

• Study Start (Actual): May 15, 2024
• Primary Completion (Actual): August 19, 2024
• Study Completion (Actual): October 30, 2024

Study Registration Dates

• First Submitted: November 21, 2024
• First Submitted That Met QC Criteria: March 3, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: March 3, 2025
• Last Verified: December 1, 2024

More Information

Terms related to this study

• Keywords: Feasibility study; Chile; Fruit and vegetables subsidy
• Other Study ID Numbers: 5128637 (Other Grant/Funding Number: Bloomberg Philanthropies)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: All IPD data related to study protocol, statistical analysis plan and informed consent form
• IPD Sharing Time Frame: 6 months after publication of primary results
• IPD Sharing Access Criteria: Access to IPD data will be available for qualified researchers for scientific purposes that meet specific criteria: ethical, security and administrative criteria
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No