Sitting in the loft at the Corryville Kroger, shoppers below pick produce, peruse the aisles, swing by the pharmacy and wait at The Little Clinic.
“This is our laboratory,” Dr. Dylan Steen says, peering over the scene with his colleague Dr. Sarah Couch. The two University of Cincinnati researchers are chief investigators on an upcoming clinical trial that will take place in this and 11 other Kroger stores. Together, with a team that includes researchers from the Lindner College of Business, the College of Medicine, the College of Allied Health Sciences, the College of Design, Architecture, Art, and Planning, Cincinnati Children’s Hospital and, of course, Kroger, the team will ask: Can neighborhood supermarkets become the catalyst for improved health in America?
“It’s a perfect, one-stop shop,” says Couch, “The store presents the perfect model for nutrition counseling … you can provide nutrition guidance to your client and then help them select the food that is appropriate for their health condition.”
You see, Steen, a cardiologist, and Couch, a registered dietitian and professor in Nutrition Science, have both long held a goal to make strides in the prevention of heart disease, the cause of death for one in four Americans each year. Until three years ago, when their project, called SuperWIN, began, they both toiled with the idea of using these stores and their new e-commerce technologies for this purpose.
If their model works, it could impact the rates of other chronic diseases, as well. In fact, SuperWIN is part of a research partnership with Kroger that will be dedicated to designing and studying new and scalable models of improving health across the country.
Kroger already had part of the model in place, Steen says. The Little Clinics are already there, and Kroger employs registered dietitians familiar with the store and its products. Kroger’s popular loyalty card program also collects purchase data which can be refined and used to individualize dietary therapy. This is an incredibly innovative company and we’re grateful to have them as our partner in this effort, Steen says. Based on retail sales, Kroger is the largest supermarket chain in America, so the study’s findings could have a nationwide impact– in case SuperWIN is onto something.
Their randomized clinical trial starts enrolling in February and will involve 250 participants who receive care at UC Health. The roughly six-month program will show whether the model has the potential to rewire America’s bad eating habits, the researchers say.
“We’ve spent the last year really formalizing the in-store and online intervention designs,” Couch says. “It is theory-based and includes behavioral strategies.”
This is how it will work: Take theoretical Participant A, for example.
For three months, over six visits, Participant A meets with a dietitian, reviewing his goals, health status, food purchases and nutritive value, dietary intake, food preferences, and shopping habits. The dietitian may find Participant A buys a lot of convenience food, which is high in sodium, and that his exam demonstrates high blood pressure.
During this time, Participant A is then educated about the connection between high sodium diets and high blood pressure, which can increase his chances of heart attack or stroke. Knowing this, he then works with a dietitian at the Kroger store where he generally shops. The dietitian will help him choose healthier options, showing him where to find the items in the store and helping with recipes, meal planning, and managing his food budget. In order to reduce barriers to healthier shopping, online ordering, grocery delivery services, and phone-based applications may be used.
Three months is enough time, Couch says, to potentially see progress. “That’s when you can see changes in lipids and in diet quality.”
Then, they’ll continue to monitor the participants for another three months, without any intervention, to see if they continue to eat healthier. The research team will do some mock runs in January before getting started.
“A clinical trial is like an airline flight,” Steen says. “Before you ever take off an enormous amount of time is spent in preparation, because the risks from having a problem once you’re in the air are enormous.”
That’s why they’ve been listening and collaborating carefully with behavioral scientists, business experts, dietitians and data scientists on the project. It’s the first time everyone has worked together on a research project, so Steen sees this as a foundational study in the research partnership.
He’s excited for the possibilities of looking at differences in study outcomes according to demographic groups, like age, or people with particular food preferences or levels of technological savvy.
“As you can imagine, for the next trial, we can tweak things,” Steen said, “We can emphasize the components that are beneficial and remove those that are not.”
It’s a great example of what universities can achieve when experts from different specialties join forces, Steen said.
“Accelerating the transition to value-based healthcare is a shared problem and working together improves our chances of success,” Steen says, “but more importantly, serves the communities for which we are charged with finding innovative solutions to important public health problems.”
SuperWIN received a Collaborative Team Science award of $100,000 in 2016 from the Office of Research. Learn more about the award, and what research qualifies, here or email Assistant Vice President for Research Philip Taylor at firstname.lastname@example.org.