Unintended consequences of a financial incentive scheme for fruit and vegetable purchasing in an unorganised retail setting in rural India

Consumption of fruits and vegetables in rural India is among the lowest in the world. We assessed how a financial incentive scheme influenced purchasing of fruits and vegetables in an unorganised retail setting in rural India and explored any unintended consequences. We used a mixed-methods approach, triangulating between in-depth interviews with community members, vendors, local leaders, and intervention implementors (N = 21) and fruit and vegetable purchasing surveys (N = 1109), vendor sales surveys (N = 36), and routine coupon use data. The intervention led households to use their own budgets to buy fruits and vegetables and receive the cashback. This was used to buy more fruits and vegetables (45 % and 77 % of intervention participants, respectively). Changes in purchasing behaviours unexpectedly increased farmer-to-consumer sales in the village markets. This increased the variety of fruit and vegetables purchased locally (baseline-adjusted mean difference of 2.2 items in intervention versus control villages (95 % CI: −0.7 to 5.1)) but may have negatively impacted the sales of existing vendors (baseline-adjusted mean difference of −150₹ in intervention versus control villages (95 % CI: −296 to −0.1). Financial incentive schemes have the potential to change the food environment in unorganised retail settings, which could have major consequences for diets.