Process evaluation of a financial incentive scheme to increase fruit and vegetable purchasing from unorganised retailers in rural Telangana, India

Objective: To evaluate a randomised controlled trial of a financial incentive scheme (coupon providing ∼20% cashback on purchase of fruits and vegetables from village vendors) aimed at increasing the purchase of fruits and vegetables from unorganised retailers in rural India.Design: The process evaluation used a mixed-methods approach, incorporating semi-structured interviews, routine coupon use data, repeat fruit and vegetable purchase and sales surveys, an end-line survey, and examination of study documentation.Setting: Six rural villages, Telangana, India.Participants: Intervention village residents (maximum N=1,719), fruit and vegetable vendors (N=36), local stakeholders (N=5), intervention implementors (N=3).Results: Share of households reaching the fruit and vegetable purchase target (and receiving the cashback) increased steadily from 13% to 42% across the 12-week trial period. Fruit and vegetable purchasing data suggest that households increased fruit and vegetable purchasing to receive the cashback, and households reported using the cash to purchase additional fruits and vegetables (42% and 73%, respectively). Unexpected consequences included community members’ efforts to receive the cashback without purchasing the target amount of fruits and vegetables, changes in shopping patterns, entry of new vendors into the local market, and potential reductions in vendor sales. Lower socioeconomic position (SEP) households reported using the intervention more and participants felt the intervention was most useful for lower SEP households. Conclusion: Our findings demonstrate the potential of even small financial incentives for changing healthy dietary-related behaviours. However, in unorganised retail settings, care should be taken to ensure that such interventions benefit both consumers and sellers.