Sisters Together: Lessons Learned from Implementing a Grocery Store Campaign in Michigan Communities at Risk for Neural Tube Defects.

Abstract

Sisters Together intended to develop and disseminate folic acid (FA) educational materials through a point-of-purchase program in low-income predominantly African American communities in Southeastern Michigan counties with high prevalence of neural tube defects (NTDs). Guided by the Theory of Reasoned Action and the Consumer Information Processing Model, 17 supermarkets hosted displays, shelf-signs, and food tastings and tracked purchases of FA sources, alongside customer-intercept and store manager surveys, and observational logs. Stocking and signage were implemented with moderate-to-high fidelity, and food tastings with high reach and dose. Purchases of black beans, spinach, orange juice, and supplements showed increases, although only a third of the women identified them as sources of FA. Only 21/122 women (17%) surveyed reported seeing the shelf-signs. Theory-driven, grocery store-centric interventions are effective strategies to address gaps in FA education, with the key behavior change mechanism appearing to be modeling "procedural knowledge."