Impact and Cost-Effectiveness of a Home Food Environment Intervention on Healthy Eating

Introduction

Multiple aspects of the home food environment shape dietary patterns. The purpose of this study was to test a more scalable version of an intervention designed to promote healthy eating by improving home food environments, and to determine its cost-effectiveness.

Methods

Healthy Homes/Healthy Families (HH/HF) is a 3-month program alternating weekly coaching calls and text messages to encourage healthy eating by creating healthier home food environment through 8 healthy actions. Healthy Homes/Healthy Families was evaluated in a randomized controlled trial with follow-up at 4 and 9 months post-baseline (2020–2023). Participants were clients of four United Way 2-1-1 information and referral organizations in Georgia. The primary outcome was the Healthy Eating Index (HEI-2015), calculated from two 24-hour dietary food recalls. Data were analyzed in 2023–2024..

Results

The majority of participants (n=510) were women (91.6%) and identified as African American or Black (82.7%). The HEI-2015 improved more (3.26 units, p=0.005) for the intervention than control group at 9 months in intent-to-treat analyses. Both total fruits (0.53, p=0.009) and added sugar (0.81, p=0.004) HEI-2015 domain scores also improved significantly. Multiple aspects of the home food environment improved in a desired direction, including inventories of unhealthy snacks/foods, food preparation and food serving practices, family meals from non-home food sources, and frequency of family meals and snacks while watching TV. Costs averaged $85 per participant ($95 for full program delivery); costs per unit HEI increase were $26. The intervention is cost-effective, with a cost per quality-adjusted life year of $28,762. The intervention is cost-saving as long as the benefits last 3 years or longer.

Conclusions

The intervention was effective in promoting modest changes in diet quality by improving home food environments.