Feasibility of an Adaptive Food Insecurity Intervention for Patients with Uncontrolled Hypertension: A Pilot SMART

Top Things to Know

The study showed that individuals benefit differently from varying levels of support: CHW engagement helped many, but adding MTM for non‑responders produced the strongest clinical improvements.

CHWs can serve as a core “first‑line” FIM strategy by addressing multiple barriers simultaneously before layering on costlier food‑based interventions.

Successful FIM programs should address nutritional, psychological, and compensatory (trade‑offs between food and medical costs) pathways.

Summary of Conclusion/Findings

This pilot sequential multiple‑assignment randomized trial (SMART) tested the feasibility of an adaptive food insecurity intervention for patients with uncontrolled hypertension. Nearly all eligible patients enrolled (98.3%), 82.1% completed the 3‑month follow‑up needed for re‑randomization, and 71.4% completed the full 6‑month trial, demonstrating strong feasibility. Participants initially received either community resource information or community health worker (CHW) support; those without sufficient blood pressure improvement were assigned to additional CHW support or medically tailored meals (MTM). CHW support in Stage 1 produced greater early blood pressure improvement than information alone, and the greatest 6‑month clinical improvement occurred when CHW support was followed by MTM, with 66.7% achieving ≥10 mmHg systolic blood pressure reduction. Food insecurity and perceived stress improved in both Stage 1 groups, though fruit and vegetable intake did not significantly change. Overall, the study found that adaptive, individualized, interventions are feasible and show promise for improving outcomes in food‑insecure patients with diet‑sensitive chronic disease.