The Baltimore Urban Food Distribution (BUD) App: Study Protocol to Assess the Feasibility of a Food Systems Intervention

Abstract

Low-income urban communities in the United States commonly lack ready access to healthy foods. This is due in part to a food distribution system that favors the provision of high-fat, high-sugar, high-sodium processed foods to small retail food stores, and impedes their healthier alternatives, such as fresh produce. The Baltimore Urban food Distribution (BUD) study is a multilevel, multicomponent systems intervention that aims to improve healthy food access in low-income neighborhoods of Baltimore, Maryland. The primary intervention is the BUD application (app), which uses the power of collective purchasing and delivery to affordably move foods from local producers and wholesalers to the city’s many corner stores. We will implement the BUD app in a sample of 38 corner stores, randomized to intervention and comparison. Extensive evaluation will be conducted at each level of the intervention to assess overall feasibility and effectiveness via mixed methods, including app usage data, and process and impact measures on suppliers, corner stores, and consumers. BUD represents one of the first attempts to implement an intervention that engages multiple levels of a local food system. We anticipate that the app will provide a financially viable alternative for Baltimore corner stores to increase their stocking and sales of healthier foods, subsequently increasing healthy food access and improving diet-related health outcomes for under-resourced consumers. The design of the intervention and the evaluation plan of the BUD project are documented here, including future steps for scale-up. Trial registration #: NCT05010018.

Design of an innovative digital application to facilitate access to healthy foods in low-income urban settings

“…Once we were confident that the design was passing these initial user performance tests, we then generated and tested high-fidelity wireframes (mockups that include all design elements and branding) with target users ( Figures 1,2 ) ( 16 ). The sitemap, branding, and low- and high-fidelity mockups were designed via Adobe Photoshop, Illustrator, and XD.…”

“…Baltimore corner stores typically stock few affordable healthy foods and beverages, instead stocking higher-priced nutrient-poor foods and beverages. The stocking of affordable healthy foods and beverages in these stores is impeded largely in part by lack of an adequate distribution network for healthier foods ( 16 ). While high-sugar and high-fat foods and beverages are commonly delivered directly to these stores by manufacturers and distributors, healthier foods such as fresh produce, milk, and 100% whole wheat bread typically must be obtained by the corner store owners themselves at local wholesalers or at grocery stores where availability, selection, and quality are often poor, and pricing may be high.…”

“…Inclusion and exclusion criteria for retailers (corner stores) and suppliers (wholesalers, producers) to participate in the study is detailed in Gittelsohn et al [2022] ( 16 ).…”

“…In order to provide a scalable and sustainable solution to address the problem of healthy food sourcing and distribution to small food retail stores in Baltimore, we received funding to implement the Baltimore Urban Food Distribution (BUD) Study ( 16 ). The overall goal of the BUD study is to develop a user-friendly digital application (app) to improve access to healthier foods and beverages in small corner stores located in under-resourced urban settings and to generate preliminary findings in support of a full-scale clinical trial.…”

Fresh Shelves, Healthy Pantries: A Pilot Intervention Trial in Baltimore City Food Pantries

“…Since the conclusion of this pilot trial, Baltimore City food pantries and the MFB shifted their operational strategies to increase the number of clients they served during the COVID-19 pandemic, while maintaining social distance. With the client choice food distribution method becoming less favorable, digital technologies at the food pantry setting may improve the sustainability and the scalability of environmental, educational and policy strategies found to be feasible in this pilot trial, while making emergency response safer and swifter [ 32 , 33 ]. Digital strategies such as videos, discussion forums, blog posts, recipes, and online flyers might be more sustainable and scalable for this setting, as most food pantry managers are technologically savvy, and submit orders and reports through the MFB website.…”