Developing a Support Application for Food Pantries (SAFPAS) to Improve Client Access to Healthy Foods & Enhance Emergency Preparedness

Overview and Study Design The overall goal of this application is to develop and test a mobile application to improve food pantry services in low-income areas of Baltimore, increase access to healthier foods to clients, and enhance emergency preparedness and response capacity.

The first part of the study will involve meeting with key stakeholders to develop the Support Application for Food Pantries (SAFPAS) and testing the app for usability. This work will take place in Baltimore and Detroit. The second part is a pilot study in which food pantries located in Baltimore will be randomly selected to receive the SAFPAS app (n=10) or serve as comparison pantries (n=10). The investigators will introduce different features of the app to food bank staff, food pantry managers and staff, and food pantry clients to understand challenges related to using the app for day-to-day tasks and to evaluate the healthiness of the foods clients receive as the main outcome. Finally, the investigators will demonstrate the completed app to additional stakeholders in Baltimore and Detroit to learn more about feasibility and how to improve it.

The findings from this R34 application will be used to support a full-scale clinical trial, which will test the SAFPAS app across multiple cities, and will assess its impact on pantries (i.e., change in food stocking, staff capacity, distribution of healthier foods) and pantry clients (i.e., obesity and dietary intake, and food security). Findings from this study will help us to: 1) produce a functional and acceptable mobile app; 2) provide preliminary data needed to plan a full-scale clinical trial, including demonstrating preliminary efficacy; 3) set appropriate standards for implementation and evaluation; 4) demonstrate the investigators ability to recruit and retain large numbers of food pantries and pantry clients; and 5) identify unexpected challenges of introducing a mobile application in a food pantry setting and help determine potential solutions. For details on these future research plans see the Future Clinical Trial Description document.

Study setting and Collaborations The study will primarily take place in low-income neighborhoods of Baltimore, Maryland. Baltimore has 225 food pantries located in churches, schools, etc., all of which receive most of the food supply from the Maryland Food Bank (MFB). The investigators main partner will be the MFB, specifically the Baltimore branch which is the central "hub" for both Western Maryland and Eastern Shore branches. The MFB distributes roughly 40 million meals to food pantries, soup kitchens, shelters, and faith-based organizations throughout Maryland. The research team has worked with the MFB for more than five years on projects involving food pantries, including Fresh Shelves Healthy Pantries.87 The research team will also partner with various city stakeholders including the Food Policy Director, the Baltimore Food Policy Initiative, the Baltimore City Health Department, and the Baltimore City Office of Emergency Management (see Letters of Support). Additional formative and feasibility research will also be conducted in Detroit, including with local food pantries and the Gleaners Food Bank.

The study will take place in 6 phases:

Phase 1: Formative Research As part of the proposed research, the investigators will conduct formative research to refine the SAFPAS app into an effective mobile app. The formative research will include in-depth interviews with multiple types of key stakeholders, including food pantry directors and volunteers (n=12), MFB leadership (n=4), food pantry clients (n=20), and representatives of key Baltimore agencies (n=6). These interviews will focus on understanding reactions to a prototype of the app, including key features, in particular to eChoice, capacity-building (staff/volunteer training), and emergency preparedness information components, on refining these features, adding features as needed, and incorporating the recommendations. In addition, the investigators will assess the potential demand for the app beyond Baltimore by conducting in-depth interviews about the app prototype in low-income areas of Detroit, among approximately 6 food pantry directors, 4 food bank leaders, and 20 food pantry clients.

Interviews will be recorded, transcribed and analyzed using qualitative analysis software (Atlas.ti 22). The research team will develop a coding scheme to apply to interview transcripts (i.e., labeling sections of text with a word or phrase that captures what the interviewee was talking about). The investigators will then use these codes to identify common themes that emerged across multiple interviews. Products of the formative research will center around identifying and refining the most useful components of the SAFPAS app.

Phase 2: SAFPAS App Development Results from the formative research phase will be incorporated into the development of the SAFPAS mobile app. The investigators will develop the app using Bootstrap 4.0, a multi-platform framework for building web-based apps.89 While web-based apps are slightly less user-friendly than "native" iPhone and Android apps, the apps are more versatile in that the app will run on all smartphones and laptops. Moreover, adjustments to the system can be more easily accommodated.

The SAFPAS app will provide food pantry managers a convenient and cost-effective tool to support pantry activities, and for staying connected with food pantry clients, the food bank, and with emergency services in the event of an emergency. SAFPAS will feature an attractive user interface, and have 13 main modules:

Module 1 (Opening the App): Opening the SAFPAS application for the first time will direct the user through a series of onboarding pages that describe the key features of the application and the benefits of using it. The user will then be directed to a main screen to choose whether the user is a food pantry client, food pantry manager/volunteer, or food bank or other city agency representative (e.g., emergency operations center (EOC) representative).

Module 2 (Registration and 'Turn on Notifications'): All users will be directed towards a registration page where the user can enter the user email and a password and general information (depending on role selected in Module 1, this could include: household size, title, contact information, preferred pantry). Once registration is complete, users will receive a pop-up screen to "Turn on Notifications?". This will allow push notifications regarding important communications from, for example, the food pantry managers to all clients regarding a change in pantry hours.

Module 3 (Food Pantry Client Main Screen): If the user selected the "Food Pantry Client" role, the user will be directed to the client main screen. Users will be able to select 'preferred' food pantries from either a list of available pantries or from a map. The main menu will include quick links and visuals to: preferred food pantry information (hours, location, available volunteer shifts), volunteer opportunities, eChoice ordering system, and the option to receive nutrition education messages through push notifications.

Module 4 (eChoice Ordering System): Clients will be able to use the app to create food orders using the eChoice system. While users cannot order specific foods, the user will be able to indicate to the food pantry the types of desired items (i.e., breakfast, lunch, or dinner items), diet preferences (low sodium, low cholesterol, plant-based, vegetarian, Kosher, Halal, etc.), and allergies. This system will also thereby provide data on client preferences and report these statistics to the food bank and other stakeholders.

Module 5 (Communications Center): All users will have access to a communication center where the user can message contacts at different levels (food banks \<-\> food pantries \<-\> clients). This will include direct and group messaging. Users can choose the addressee from a contact list or from a group drop down menu (i.e., all volunteers for a food pantry). Pantry managers will be able to push notifications to groups of people from the communications center. The communications center will also be used for the provision of nutrition education messaging for clients as a means of improving client food choices.

Module 6 (Food Pantry Directors/Staff Main Screen): If the user selected the "Food Pantry Director" role, the user will be directed to the food pantry director main menu. The main menu will include visuals and links to the following modules: Volunteer Management, eChoice Order Management, Communications Center, 'Our Pantry Dashboard' with pantry statistics, and Volunteer/Staff Training.

Module 7 (Volunteer Management): Food pantry directors and staff will be able to recruit and schedule volunteers through the app. The scheduling feature will include a calendar of shifts, open and filled slots, a contact list of active and inactive volunteers, and the status of volunteer training (who has completed, in process, or hasn't started required training). This module is integrated with the communications center, so directors can easily push notifications to all volunteers or individuals.

Module 8 (eChoice Order Management): Directors and volunteers/staff will use the eChoice order management tool to identify client preferences and restrictions, match with foods in stock, and then put together client orders and track distribution. This feature will help pantries better identify food needs within the client network and pantries will be able to use this information to guide choices from the food bank.

Module 9 (Our Pantry Dashboard): Pantry directors will be able to collect information from users through the app. Data will be automatically displayed and visualized via the "Our Pantry Dashboard", which will include client statistics, real-time emergency situation information, and volunteer management (i.e., number of trainings completed). This Dashboard will also collect user feedback on the eChoice system and barriers to success. These data can be exported to the food bank and other stakeholders, including local city agencies, in different report formats.

Module 10 (Training Provision and Tracking): Food pantry staff/volunteers will have access to online training via the SAFPAS app. Directors will be able to efficiently track and manage required and recommended training for volunteers and staff. Training modules include the use of the SAFPAS app, food pantry-specific rules and regulations, nutrition education for meeting client diet preferences, food safety/hygiene, emergency preparedness, and federal food assistance program applications. Users will receive a sharable certificate upon completion of the training.

Module 11 (Food Bank/EOC Main Screen): If the user selected "Food Bank/EOC representative" at the time of registration, the user will be directed to the food bank main menu. The main menu for food bank users will be data-oriented to provide quick access to statistics on all food pantry clients, managers, and staff/volunteers using the app. There will also be a communications center where the food bank can quickly send messages to food pantries (from a specific contact list or to all food pantry-related users).

Module 12 (App Administrator/Usage Statistics): On the backend of the app, the administrator will be able to access the app's overall analytics, including usage, active versus inactive users, time per page, demographics, feedback, number of direct versus group messages, number of push notifications, and number of users per pantry. The administrator will also have access to the app's settings and control features.

Module 13 (Emergency Operations -- Data Exportation and Sharing): Data from the SAFPAS app will be available for sharing with governmental agencies for use in tracking and monitoring emergency situations. During an emergency activation, the National Incident Managemen