Kudos to Hailey Miller, postdoctoral associate, and her sponsors for the submission of her Duke Clinical & Translational Science Institute, Post-Doctoral Training Program (TL1) application entitled: "Feasibility of delivering a digital health intervention to improve food access among adults with hypertension." This proposal requests funding with a start date of July 1, 2021.

Specific Aims

More than 100 million US adults have hypertension. Adults with hypertension are at increased risk for several chronic conditions, including cardiovascular and kidney diseases, stroke and premature mortality. Lifestyle management, including consumption of a high-quality diet, is the first line of treatment recommended for adults with hypertension, regardless of prescription medication recommendations. The majority of Americans with hypertension, however, are not consuming high-quality food items, such as fruits, vegetables and whole grains. A major barrier to consuming these foods is poor accessibility to supermarkets and grocery stores. The USDA defines a census tract to have low access to high-quality food (i.e., supermarket, supercenter, or large grocery store) if a certain proportion of the population lives more than 1 mile from a food store in an urban area or more than 10 miles in a rural area. By the USDA’s definition, approximately 38% of census tracts were considered to have low access to high-quality food in 2015. Barriers to access are often compounded by lack of transportation and/or predominance of convenience stores in close proximity. Innovative approaches are necessary to reduce these barriers and improve access to and consumption of high-quality foods. Grocery delivery smartphone applications (apps) offer a timely and novel approach to address a major barrier to accessing and adopting a high-quality diet. Over 81% of the US population owns a smartphone, with high ownership rates among racial/ethnic minorities and individuals with lower incomes. Moreover, grocery delivery smartphone applications such as Instacart, Shipt, and Walmart+ provide access to full-service supermarket selections of high-quality food items. Many of the grocery delivery applications offer high-quality food items for at-home delivery with in-store pricing, making the food items more affordable and accessible. However, we are unaware of any study that has evaluated the feasibility of utilizing commercially-available grocery delivery smartphone applications to increase access to and consumption of high-quality food among adults with hypertension. This represents a promising approach to reach underserved populations with hypertension that are disproportionately affected by barriers related to high-quality food access.

We propose to develop and test a 3-month digital health intervention, Access Nourish, that will leverage the existing infrastructure from a large behavioral intervention trial for hypertension management. This proposed study will test the feasibility and acceptability of adults with hypertension (N=30) and low access to high-quality food receiving tailored grocery lists and grocery delivery options through a commercially-available smartphone app. We hypothesize that leveraging these smartphone applications will overcome barriers to accessing and consuming high-quality food items, which may promote easier adherence to recommended lifestyle management strategies for hypertension. Additionally, we will explore the barriers and facilitators of utilizing a grocery delivery smartphone app to increase access and consumption of high-quality foods among adults with hypertension. This will be accomplished through the following aims:

• Aim 1: Develop intervention content and adapt existing technology platforms to deliver the Access Nourish intervention.
• Aim 2: Assess the feasibility and acceptability of Access Nourish in a 3-month intervention among adults with hypertension (N =30) who reside in low access census tracts.
• Aim 3: Explore the barriers and facilitators of engagement in the Access Nourish intervention among adults with hypertension who reside in low access census tracts through qualitative interviews.