Evaluating the impact of the Ripe for Revival mobile market with vouchers on food and nutrition security, fruit and vegetable intake, and blood pressure in rural eastern North Carolina: a quasi-experimental trial design study protocol.

INTRODUCTION: Rural residents are less likely to meet the recommendations for fruit and vegetable intake and disproportionately carry the burden of nutrition-related chronic disease. Nutrition incentive or voucher programmes aim to increase fruit and vegetable intake by reducing the financial burden of purchasing produce. Additionally, mobile markets have emerged as a potential strategy for increasing access to affordable fresh fruits and vegetables, particularly among rural residents. Yet, few studies have assessed the effectiveness of mobile markets to improve fruit and vegetable intake and the food and nutrition security status of rural residents, particularly those provided with vouchers. METHODS AND ANALYSIS: This quasi-experimental, pre-post study examines the impact of vouchers provided to North Carolina (NC) Cooperative Extension programme participants to shop for produce at the Ripe for Revival (RfR) mobile market in eight rural eastern NC counties. The RfR mobile market sells fruits, vegetables, eggs, meat and milk at affordable prices in rural, economically disadvantaged communities. The trial's primary outcome is the change in fruit and vegetable intake (self-reported and objectively measured) among rural Extension participants who use vouchers to shop at the RfR mobile market. The trial's secondary outcomes include food security status, nutrition security status, blood pressure, height, weight (Body Mass Index (BMI) calculated), food utilisation, mobile market satisfaction, voucher redemption, and pounds and dollars of produce distributed. We will recruit participants (n=150) through NC Cooperative Extension programmes in the eight participating counties to receive a $20 monthly voucher each month for 3 months and shop at the RfR mobile market. Data will be collected at 4 time points: baseline (week 0, when a voucher is issued), 4-6 weeks post-baseline (1 month), 8-10 weeks post-baseline (2 months) and 12-16 weeks post-baseline (3 months). One-sided paired t-tests or Wilcoxon signed-rank tests (depending on normality) will evaluate mobile market voucher effectiveness. ETHICS AND DISSEMINATION: The North Carolina State University Institutional Review Board approved the trial procedures. We plan to disseminate the main outcomes at the conclusion of grant funding (year 2) in both scientific and community settings. TRIAL REGISTRATION NUMBER: NCT07218978.