Produce prescription projects: Challenges, solutions, and emerging best practices – Perspectives from health care providers

Stotz, Sarah; Nugent, Nadine Budd; Ridberg, Ronit; Byker-Shanks, Carmen; Her, Ka; Yaroch, Amy L.; Seligman, Hilary K.

doi:10.1016/j.pmedr.2022.101951

Cited by 13 publications

(42 citation statements)

References 45 publications

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“…Primary care providers have expressed satisfaction prescribing food [18,20], but how patients feel about receiving fruit and vegetable prescriptions (FVRx) from their health provider versus other means of food provision has not been well explored, particularly in Canada. A recent systematic review of food prescription programs in primary care found very few studies that explored the patient perspective.…”

Section: Introductionmentioning

confidence: 99%

Patients’ experiences with a community fruit and vegetable box program prescribed by their health provider

2023

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Background Food insecurity is “the state of being without reliable access to a sufficient quantity of affordable, nutritious food”. Observational studies have associated food insecurity with many negative health effects including the development and exacerbations of chronic diseases, higher health care use and increased mortality. Health care providers prescribing food is a growing area of interest and research, however it is not known how patients feel about receiving fruit and vegetable prescriptions (FVRx) from their health provider versus other means of food provision. This pilot study was conducted to explore the experiences and opinions of Canadian adults with food insecurity who were recipients of a FVRx box program prescribed by their health provider. Methods Potential participants were recruited to 3 focus groups using flyers included in their monthly food box. Questions were kept open to encourage participation of all group members. The focus groups were audiotaped, transcribed verbatim, and analyzed by the research team using descriptive qualitative research methodology. Results Participants described shame and frustration trying to obtain enough food through local food banks. In comparison, they perceived their team dietitian, family physician or addictions physician as directly helping them with their health by prescribing food. The boxed fruit and vegetables were prepared in many ways and often shared to reduce waste and to reduce the food insecurity of extended family members. Positive effects of the FVRx on physical and mental health were reported. Participants believed that follow up with their health provider helped support them and their behavioural changes towards better nutrition. Limitations of the program included lack of choice, non-flexible pick-up times and the program being limited to 6 months. Being able to choose their own fruit and vegetables, instead of receiving a set box, was suggested by most to help meal planning and to increase autonomy. Conclusions Health providers prescribing FVRx boxes to adult patients with food insecurity was positively received in this study. Evaluation of similar programs in other regions in Canada and internationally, and comparison of food prescriptions to basic income guarantee programs is recommended.

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Section: Introductionmentioning

confidence: 99%

Patients’ experiences with a community fruit and vegetable box program prescribed by their health provider

2023

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“…Healthcare providers have also expressed that education and assistance with logistics would facilitate implementation of food insecurity alleviation programmes. (27) As a result of United States Department of Agriculture (USDA) funding, there is a small, but growing, evidence base of evaluations of produce prescription programmes, (28) a type of food insecurity intervention located at healthcare institutions in which a provider writes a 'prescription' for fruits and vegetables. (29) However, produce prescription programmes may not be the right intervention for every healthcare institution and its patient population.…”

Section: Introductionmentioning

confidence: 99%

Healthcare-based food assistance programmes in the United States: a scoping review and typology

Rudel,

Byhoff,

Strombotne

et al. 2023

J Nutr Sci

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This scoping review aimed to identify the breadth of healthcare-based food assistance programmes in the United States and organize them into a typology of programmes to provide implementation guidance to aspiring food assistance programmers in healthcare settings. We searched PubMed, Cochrane, and CINAHL databases for peer-reviewed articles published between 1 January 2010 and 31 December 2021, and mined reference lists. We used content analysis to extract programmatic details from each intervention and to qualitatively analyse intervention components to develop a typology for healthcare institutions in the United States. Eligible articles included descriptions of patient populations served and programmatic details. Articles were not required to include formal evaluations for inclusion in this scoping review. Our search resulted in 8706 abstracts, which yielded forty-three articles from thirty-five interventions. We identified three distinct programme types: direct food provision, referral, and voucher programmes. Programme type was influenced by programme goals, logistical considerations, such as staffing, food storage or refrigeration space, and existence of willing partner CBOs. Food provision programmes (n 13) were frequently permanent and leveraged partnerships with community-based organisations (CBOs) that provide food. Referral programmes (n 8) connected patients to CBOs for federal or local food assistance enrollment. Voucher programmes (n 14) prioritised provision of fruits and vegetables (n 10) and relied on a variety of clinic staff to refer patients to months-long programmes. Healthcare-based implementers can use this typology to design and maintain programmes that align with the needs of their sites and patient populations.

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“…Although the evidence for PPR's health impact is growing, much remains unknown about its logistics and the ways in which the program can be implemented in a standardized, culturally relevant way [8]. For instance, recent research suggests that both traditional and nontraditional facilitators and barriers can play critical roles in determining how well a PPR fits within a given system/setting [9][10][11][12]. Findings from the literature point to multisector partnerships as a key step to running a successful PPR [11].…”

Section: Introductionmentioning

confidence: 99%

“…Findings from the literature point to multisector partnerships as a key step to running a successful PPR [11]. Clinic staff buy-in and consistent communications among all parties involved in services delivery also represent crucial steps in implementation, as are considerations of transportation barriers and the use of Electronic Health Record (EHR) data to monitor and demonstrate program outcomes [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…Research findings have also provided key insights into how several multi-sector, mutually reinforcing, strategies can work together to facilitate higher quality PPR [1,9]. These promising strategies have included the following: enhancing clinic staff's experiences or satisfaction with program delivery [9]; encouraging flexibility when working with state Medicaid plans (which often have rigid reimbursement requirements); troubleshooting issues with incentive distribution early and often during the start-up phase [10][11][12]; and capitalizing on technology-e.g., the use of electronic benefit cards-to streamline and fast-track the distribution of incentive benefits [10,12].…”

Section: Introductionmentioning

confidence: 99%

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Implementing a Produce Prescription Program at Three Federally Qualified Health Centers to Help Patients Manage Their Diabetes or Prediabetes: A Qualitative Assessment of Clinic Staff Experiences in Los Angeles County, California, USA

Ayala,

Caldwell,

Darwish-Elsherbiny

et al. 2023

Diabetology

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Through a partnership with three Federally Qualified Health Centers (FQHCs), the local health department in Los Angeles County implemented a produce prescription program (PPR) to increase fresh fruit and vegetable purchases among patients with diabetes or prediabetes. The PPR, which began in 2020, provided eligible patients with a USD 40 voucher every month for 6 months to promote the purchase of fresh produce at large-chain grocery stores. To address gaps in current practice and program delivery, this qualitative assessment describes staff experiences with the PPR, documenting the facilitators and barriers they encountered while implementing the program. Fifteen clinic staff (i.e., PPR implementers) were interviewed for this assessment. Thematic analysis and coding were conducted using the ATLAS.ti software; the coding was carried out by two separate coders. Interviewees discussed the importance of having preexisting partnerships and programs to support the PPR at their clinic site. Hidden costs related to implementing the program included a large and unexpected amount of staff time devoted to enrolling patients into the program. Collecting quality data and having limited expertise to rigorously evaluate the program were other challenges. Because patients often share their food with their family, the monthly USD 40 incentive was generally not enough to support their needs; interviewees suggested giving a higher inventive amount to those with a larger household. Future PPR efforts and similar food incentive programs should consider these and other facilitators and barriers to implementation and sustainability, especially when making adjustments to these programs to improve services and access to food resources.

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Produce prescription projects: Challenges, solutions, and emerging best practices – Perspectives from health care providers

Cited by 13 publications

References 45 publications

Patients’ experiences with a community fruit and vegetable box program prescribed by their health provider

Patients’ experiences with a community fruit and vegetable box program prescribed by their health provider

Healthcare-based food assistance programmes in the United States: a scoping review and typology

Implementing a Produce Prescription Program at Three Federally Qualified Health Centers to Help Patients Manage Their Diabetes or Prediabetes: A Qualitative Assessment of Clinic Staff Experiences in Los Angeles County, California, USA

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