A Multi-Dimensional Digital Food and Nutrition Literacy Model to Enable Supplemental Nutrition Assistance Program Adults to Make Health Purchases in an Online Food Retail Ecosystem: A Scoping Review to Inform U.S. Policies

Abstract

Background: The coronavirus (COVID-19) pandemic disrupted the food supply, distribution and services and led to major changes in the federal government’s safety-net programs. This paper synthesizes evidence for the literacy needs of Supplemental Nutrition Assistance Program (SNAP) eligible adults who receive benefits from the United States Department of Agriculture (USDA) to purchase groceries in an online food retail ecosystem. Methods: We conducted a scoping review of four electronic databases and gray literature sources to synthesize evidence in a narrative review to recommend actions for U.S. institutions. Step 1 identified health, food, nutrition, digital, media and marketing literacy frameworks and models to develop a multi-dimensional literacy model to inform policies for SNAP participants operating in an online food retail ecosystem. Step 2 identified U.S. cross-sectional or intervention studies that evaluated food or nutrition literacy including SNAP-eligible adults, and the multi-dimensional literacy model was used to evaluate these studies. Both steps informed recommended policies and actions to strengthen SNAP participants’ literacy skills for healthy grocery purchases online. Results: We examined 40 literacy frameworks to develop a multi-dimensional, five-step, digital food and nutrition literacy model that included functional, interactive, communicative, critical and translational literacy. We used the model to review and evaluate 18 U.S. food and nutrition literacy studies. While adults with higher food or nutrition literacy scores had better cognitive, behavioral, food security or health status outcomes, there were no consistent findings across the studies. No frameworks examined digital literacy, three studies reported using a conceptual framework, and six studies examined SNAP or SNAP-Education (SNAP-Ed) outcomes. The results are used to recommend policies and actions for the U.S. Congress and federal agencies to strengthen the digital food and nutrition literacy infrastructure; and for USDA, industry, foundations, researchers and civil society organizations to address the digital food and nutrition literacy needs of SNAP adults who order groceries online. Conclusions: The post-COVID food shopping trends underscore the need to enable SNAP participants at risk of food insecurity to develop many types of literacy skills to navigate the in-store “path to purchase” to the online digital food ecosystem in order to make healthy food and beverage product choices that align with the Dietary Guidelines for Americans (DGA) 2020-2025 and USDA’s MyPlate. Future research should test this multi-dimensional food and nutrition literacy model, validate metrics to measure progress to achieve the outcomes, and develop dissemination tools tailored for SNAP participants. Diverse strategies could be implemented by U.S. government agencies, retailers, foundations and non-governmental organizations to strengthen digital literacy and the infrastructure for a healthy online food retail ecosystem.