. 2022 Jan 24;80(5):1294–1310. doi: 10.1093/nutrit/nuab122

Table 2.

Description of the studies included in the systematic review by domains of the equity-oriented framework to promote healthy food purchasing and diet in online grocery environments targeted at underserved populations

Reference	Study design	Setting and population	Online retailer business model	Outcomes	Methods	Main findings^a	Policy implications	Quality, %
Increase healthy options
Appelhans et al (2013)³¹	Cross-sectional	Chicago, IL Adults with children in an urban food desert (n = 34)	Home delivery	Psychosocial: acceptability of online grocery services Purchase: items purchased while online grocery shopping (in office)	Psychosocial factors: perceived convenience, ease of use, and satisfaction; planned frequency of future use Online purchasing: receipts from groceries ordered at research center with study-provided voucher Equity: residents of food desert areas	Online grocery and inequities: higher SSB purchase online; food prices perceived to be high Online grocery and food assistance: most purchases composed of protein; F&V and caloric beverages also common OPP and online grocery: Ability to pay with SNAP would influence decision to buy groceries online.	Online grocery needs competitive prices, 1-d delivery, to accept SNAP, and to be available for home delivery	100²⁶
Burrington et al (2020)³⁵	Mixed methods	New York (rural) Low-income families with children at risk of obesity who qualify for free or reduced school meals (n = 10)	Delivery to a community location	Psychosocial: improve knowledge and attitudes toward F&V consumption Purchase: order F&V from online produce market Diet: increase consumption of F&V	Psychosocial factors: self-efficacy for cooking, attitudes toward trying new foods Online purchasing: voucher redemption or online data monitoring Diet: daily servings of F&V consumed by child and parents Equity: rural communities, children’s eligibility for free or reduced school meals; food-insecurity screener	Online grocery and inequities: increased children’s F&V intake, household food security at post-online F&V ordering	Nutrition or cooking classes in combination with a F&V Rx program with online produce delivery increased F&V access and consumption by children.	73²⁷
Lagisetty et al (2017)¹²	Mixed methods	Baltimore, MD Primarily Black women aged ≥60 and stakeholders from Virtual Supermarket Program (n = 93 customers; n = 14 key stakeholders)	Store pickup and delivery to community location	Psychosocial: to evaluate barriers to program implementation Purchase: self-reported change due to the program Diet: perception of eating more healthfully due to the program	Psychosocial factors: satisfaction with program, barriers to healthy food access Online purchasing: self-reported change Equity: participants living in low-income neighborhoods (food deserts)	Online grocery and inequities: Ability to have community drop-off/pick-up locations and pay with cash or EBT was key to participation. Online grocery and food assistance: higher purchases of F&V and fewer snacks and desserts, but more juices and sodas OPP and online grocery: Participants were satisfied with the ability to pay with SNAP at delivery.	Allow payment with SNAP for online grocery delivery (using hand-held devices at delivery).	73²⁷
Reduce deterrents
Brandt et al (2019)¹⁸	Cross-sectional	Rural and urban food deserts in 8 US states (n = 1250; 13 134 census tracts)	Store pickup or home delivery.	Equity in geographic reach of the SNAP OPP	Online purchasing: Nielsen TD-Linx Database to identify SNAP retailers; Google to identify OPP participation and delivery area Equity: rural and urban food desert census tracts	Online grocery and inequities: Online grocery purchasing and delivery were rarely available in rural food deserts.	Ability to use SNAP online may improve food availability for those in urban food deserts, although access is limited in rural areas.	75²⁶
Cohen et al (2019)⁴⁰	Analytic essay	NYC, NY Individuals with low income (eligible but not enrolled in SNAP) living in 3 Public Use Microdata Areas	Not specified	Equity: to examine city and neighborhood characteristics that affect SNAP participation	Equity: measuring SNAP at the community scale: Program Access Index for Public Use Microdata Area	Online grocery and inequities: disparate grocery costs (high costs in gentrifying neighborhoods) OPP and online grocery: Geographic variation in food prices can be reduced through increased use of online grocers.	Consideration of environmental and social barriers to SNAP participation, disparate grocery costs and SNAP benefits not adjusted for higher cost of living	80²⁶
Cohen et al (2020)¹⁹	Mixed methods	NYC, NY Low-income, predominantly Black adults (n = 466 registered in the pilot; survey, n = 206; focus group, n = 6)	Delivery to a community location	Psychosocial: shopping practices, and perceptions of online shopping Purchase: grocery purchases before and after the pilot Equity: uptake of online grocery shopping	Psychosocial factors: barriers to buying healthy and affordable food online, logistics of grocery delivery Online purchasing: grocery receipt analysis (pre- and post-pilot) Equity: price comparison of in-store vs online prices; low-income residents in food desert; pilot design with input from community	Online grocery and inequities: prices online higher than in store Online grocery and food assistance: potential cost savings online; more promotions or discounts in store; positive experiences online OPP and online grocery: Participants wanted online stores to have the same sales and circulars as local stores.	Low-income individuals are unlikely to fully switch to online shopping unless grocers offer deals comparable to those in store. Community input and buy-in were key to identifying and addressing barriers to online shopping.	73²⁷
Hingle et al (2020)³⁹	Case study	Low-income, older adults in rural Alabama (n = 1 grocery store chain) and low-income Hispanic adults in urban California (Double Up SNAP Incentive Program)	Home delivery, delivery to a community location, curbside pickup	Equity: to identify barriers and opportunities to improve equitable online access to nutrition programs	Online purchasing: stakeholder interviews and document review (proportion of purchases online and in store with SNAP/EBT) Equity: proportion of online purchases and program enrollment	Online grocery and food assistance: Majority of online purchases were non-SNAP. Older rural populations were not using SNAP online as frequently as younger customers who lived in town.	Maintain support for EBT online post-COVID and expand online access to other food assistance programs. Work with grocers and local partners to create grocery drop-off/pick-up centers in hard-to-reach rural areas	70²⁸
Zatz et al (2021)³²	Cross-sectional	Maine Low-income families with children, predominantly non-Hispanic White (n = 863) grocery shopping at 2 supermarkets	Store pickup	Equity: sociodemographic differences between families who shopped online vs in-store	Online purchasing: retail scanner data (specific code for online orders) Equity: Sociodemographic determinants of online and in-store purchases at supermarkets serving low-income communities	Online grocery and inequities: Only shoppers were more likely to have higher incomes and less likely to participate in SNAP or WIC.	Expand the SNAP OPP to other regions and retailers; retailers to reduce or waive fees for low-income consumers; marketing campaigns to increase awareness of the SNAP OPP	100²⁶
Build on Community Capacity
Coffino et al (2020)²³	Experimental	New York (urban) Adults with food insecurity who do not receive SNAP benefits (n = 50)	Home delivery	Purchase: feasibility and initial efficacy of default online shopping cart on quality of foods purchased (whole grains; F&V; calories; total fat; saturated fat; sodium; cholesterol; fiber)	Psychosocial factors: nutrition literacy, dietary preferences, impulsiveness Online purchasing: the Thrifty Food Plan Calculator for price, consumption, and nutrition data Equity: 6-item household food security screener	OPP and online shopping: increased healthfulness of food purchases using default cart options for food insecure individuals	Supports the use of “nudges” (ie, changing defaults) to promote healthier food purchases in online shopping	69²⁶
Coffino et al (2021)⁴¹	Experimental	New York Adults with low income (n = 38), food pantry patrons	Not specified	Purchase: effect of a default online shopping cart on quality of foods purchased	Online purchasing: Grocery items were matched with nutrient data and examined as HEI, total energy, and energy density. Equity: self-reported income, education, SNAP participation, food insecurity, and access to kitchen and computer	OPP and online shopping: Prefilled shopping cart arm had greater nutrition quality (HEI score) and fewer total calories and energy density compared with nutrition education arm	Nutrition education by itself may not be enough to support healthy food purchasing by SNAP online purchasers. Use of principles of nudges for healthy prefilled grocery carts may support healthful purchasing behaviors among consumers with low income.	75²⁶
Dunn et al (2021)³³	Cross-sectional	United States: 46 states and Washington, DC, participating in the SNAP OPP 3 state-level information sources about the SNAP OPP	Store pickup or home delivery	Equity: nationwide assessment of official communication about SNAP OPP	Equity: program, retailer, health and nutrition, and communication accessibility about the SNAP OPP	OPP and online grocery: Most states had identified authorized retailers, half informed about pickup and delivery fees, and few included information about health and nutrition.	Need to improve state communication about the SNAP OPP, which mainly focused on basic program and retailer information and limited about nutrition and health.	100²⁶
Martinez et al (2018)²⁴	Mixed methods	NYC, NY Adult SNAP recipients n = 148 individuals (purchase data); n = 35 (focus groups)	Store pickup and home delivery	Psychosocial: perceptions of and intentions toward online grocery shopping Purchase: online shopping and the use of SNAP online	Psychosocial factors: attitudes, behavioral control, barriers, motivators, and intentions toward online grocery shopping. Online purchasing: sales data from online grocery store; purchases from itemized receipts (planned, but were unable to analyze) Equity: SNAP recipients in low-income zip codes	Online grocery and inequities: online SNAP purchases higher in sweets, salty snacks, and lower in fruit than non-SNAP purchases Online grocery and food assistance: lack of control over food selection and sensorial experience; concerns about delivery, food quality, security, return policies OPP and online grocery: SNAP online acceptance was a motivator. Lack of awareness and information about OPP	Online grocers or USDA may need to use motivators (eg, increased transparency and customer control) to facilitate uptake of online shopping among SNAP recipients.	73²⁷
Rogus et al (2020)³⁷	Qualitative	New Mexico (urban) Adult SNAP recipients with children (n = 18)	Store pickup and home delivery	Psychosocial: behaviors, knowledge, and attitudes of SNAP recipients toward online grocery	Psychosocial factors: attitudes, subjective norms, perceived behavioral control Equity: focus on SNAP participants from families with low income	Online grocery and inequities: perception that online shopping could benefit elderly or disabled people and those without a vehicle Online grocery and food assistance: low uptake of online grocery shopping. Barriers: cost, quality control, liking grocery shopping Motivators: online features, discounts, and delivery	Address negative attitudes to make online grocery more appealing to subgroups that could benefit from the service.	90²⁶
	Improve social and economic resources
Jilcott Pitts et al (2020)³⁶	Qualitative	North Carolina Adult, female WIC participants (n = 7)	Store pickup	Psychosocial: advantages and disadvantages of online grocery shopping Purchase: impulse purchases	Psychosocial factors: perceived advantages and disadvantages of in-store vs online purchases; self-reported planned vs impulse buys Online purchasing: online grocery shopping experience (in the office) and annotated receipts from in-store and online purchases Equity: women with children enrolled in WIC	Online grocery and inequities: Inadequate substitutions, fees, lack of control over item selection, and inability to find deals were deterrents to using online grocery shopping. Participants made more impulse purchases online; most were chips and candy but sometimes consisted of fruit.	Ability to use WIC online could help with linkage to nutrition education programs, improve access for disadvantaged groups.	90²⁶
Zimmer et al (2020)³⁸	Qualitative	East Tennessee Adult WIC recipients (n = 23)	Home delivery and store pickup	Psychosocial: WIC participants’ perceptions about ordering groceries online	Psychosocial factors: perceptions about online ordering and WIC Online purchasing: food shopping experience (in-store and online) Equity: focus on WIC participants	Online grocery and inequities: Online shopping would address transportation issues and barriers related to shopping with children.	Pilot tests for WIC online ordering; facilitate WIC food retail operations	90⁶
Zimmer et al (2021)³⁴	Mixed methods	East Tennessee Adult WIC recipients (n = 24)	Store pickup	Psychosocial: acceptability and feasibility of WIC in online grocery service Purchase: online shopping (office) using WIC	Psychosocial factors: experience, barriers, and facilitators of using WIC for online order and pickup. Online purchasing: online order from WIC costumer and transaction receipts from WIC retailer Equity: feasibility trial of WIC as payment for online ordering	Online grocery and inequities: Challenges of locating WIC items and using the F&V cash value may reduce acquisition of produce online. Online grocery and food assistance: All participants placed an order with WIC and 96% picked up the order. Mean order total was $30.60.	WIC online is feasible; need for consistent WIC labeling policies in store and online	73²⁷

Abbreviations: EBT, electronic benefits transfer; F&V, fruits and vegetables; HEI, Healthy Eating Index; NYC, New York City; OPP, Online Purchasing Pilot; SNAP, Supplemental Nutrition Assistance Program; Rx, prescription; WIC, Special Supplemental Nutrition Program for Women, Infants, and Children; USDA, US Department of Agriculture.

Online grocery and inequities refers to the potential of online grocery to promote or hinder equity in healthy food access; online grocery and food assistance refers to psychosocial and behavioral factors associated with online grocery shopping among families enrolled in federal food and nutrition assistance programs such as SNAP or WIC; OPP and online grocery refers to factors associated with the ability to pay for groceries online using nutrition assistance program benefits.