“The coupons and stuff just made it possible”: economic constraints and patient experiences of a produce prescription program

Schlosser, Allison V.; Joshi, Kakul; Smith, Samantha; Thornton, Alex; Bolen, Shari; Trapl, Erika S.

doi:10.1093/tbm/ibz086

Cited by 26 publications

(68 citation statements)

References 32 publications

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“…Due to the simplicity of this program and the prevalence of diabetes in the U.S., integration of this program into the clinical setting and scaling up across the country could help reduce the burden of diabetes on the population and healthcare system. The PRx programs [ 32 , 34 , 35 , 42 , 59 ] shared a theoretical framework for behavior change that included economic incentives (vouchers), social incentives (provider’s recommendation), repeated behaviors (prescriptions at monthly clinic visits), and individualized counseling [ 35 ]. Repeated behaviors, such as multiple clinic visits or multiple nutrition counseling sessions, are more effective than single visits, with the magnitude of benefit increasing with more frequent opportunities for reinforcement [ 44 , 56 ].…”

Section: Review Of the Necessity Utilization And Future Of Food Pharmacymentioning

confidence: 99%

“…Sustainability is necessary for participants to maintain healthy behaviors that have been achieved in programs. A recurrent theme across studies is that participants struggled to maintain the habits of buying and eating more produce as a consequence of economic hardship [ 36 , 59 ]. Some participants of farmers’ market programs with financial incentives reported that, without the financial assistance, they were not able to purchase produce as much as when they received financial assistance [ 59 ].…”

Section: Review Of the Necessity Utilization And Future Of Food Pharmacymentioning

confidence: 99%

“…A recurrent theme across studies is that participants struggled to maintain the habits of buying and eating more produce as a consequence of economic hardship [ 36 , 59 ]. Some participants of farmers’ market programs with financial incentives reported that, without the financial assistance, they were not able to purchase produce as much as when they received financial assistance [ 59 ]. Sustainable funding mechanisms are imperative to provide continued support for food-insecure individuals to maintain healthy food choices.…”

Section: Review Of the Necessity Utilization And Future Of Food Pharmacymentioning

confidence: 99%

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The food pharmacy: Theory, implementation, and opportunities

Donohue¹,

Severson

Martin

2021

American Journal of Preventive Cardiology

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The food pharmacy is an emerging program model designed to increase the access to and consumption of healthful foods, particularly fruits and vegetables. Existing research on the efficacy of the food pharmacy model shows that these programs have been effective in improving patient understanding of nutrition and removing barriers to healthy eating, and in turn may have a significant impact on diet-related health outcomes. However, efforts to date aiming to evaluate program effectiveness have been small and lack rigorous research methods. More research is needed to adequately assess the longitudinal effects of food pharmacy programs on healthful food intake and diet-related health outcomes. In this review, we outline the strengths and limitations of previous programs and explore possible options to improve the scalability and sustainability of food pharmacy programs.

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Section: Review Of the Necessity Utilization And Future Of Food Pharmacymentioning

confidence: 99%

Section: Review Of the Necessity Utilization And Future Of Food Pharmacymentioning

confidence: 99%

Section: Review Of the Necessity Utilization And Future Of Food Pharmacymentioning

confidence: 99%

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The food pharmacy: Theory, implementation, and opportunities

Donohue¹,

Severson

Martin

2021

American Journal of Preventive Cardiology

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“…The programme provides participants with 16 weeks' worth of coupons valued at $21/week to purchase fruits, vegetables, dairy, meats, fish, eggs, nuts and fresh herbs in participating BC FMs from June to November (55) . As most previous qualitative studies of FM food subsidy programmes in the USA have investigated fruit and vegetable subsidies exclusively (47,(49)(50)(51)(52) , the current study is unique by examining experiences and outcomes associated with subsidies that can be used to purchase a variety of healthy foods in FMs. The FMNCP also includes nutrition skill-building activities (e.g., pre-natal nutrition programmes, cooking classes).…”

Section: Programme Overview and Objectivesmentioning

confidence: 99%

“…Participants were purposively recruited by community partner organisations via face-to-face discussions, emails and social media platforms, with the goal of recruiting a total of 25-30 participants. Based on sample sizes reported in qualitative descriptive studies (62) and previous qualitative studies of FM food subsidy programmes (47)(48)(49)(50)(51)(52) , we anticipated that we would reach data saturation after twenty interviews. To be eligible, individuals had to be ≥ 18 years of age, from low-income households participating in the FMNCP during the 2019 FM season (June-November) and the primary food shopper for their household.…”

Section: Participant Recruitment and Data Generationmentioning

confidence: 99%

“My coupons are like gold”: experiences and perceived outcomes of low-income adults participating in the British Columbia Farmers’ Market Nutrition Coupon Program

Caron-Roy

Sayed

Milaney

et al. 2021

Public Health Nutr.

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Objective: The British Columbia Farmers’ Market Nutrition Coupon Program (FMNCP) provides low-income households with coupons valued at $21/week for 16 weeks to purchase healthy foods in farmers’ markets. Our objective was to explore FMNCP participants’ experiences of accessing nutritious foods, and perceived program outcomes. Design: This study used qualitative description methodology. Semi-structured interviews were conducted with FMNCP participants during the 2019 farmers’ market season. Directed content analysis was used to analyse the data whereby the five domains of Freedman et al’s framework of nutritious food access provided the basis for an initial coding scheme. Data that did not fit within the framework’s domains were coded inductively. Setting: One urban and two rural communities in British Columbia, Canada. Participants: 28 adults who were participating in the FMNCP. Results: Three themes emerged: Autonomy and Dignity; Social Connections and Community Building; and Environmental and Programmatic Constraints. Firstly, the program promoted a sense of autonomy and dignity through financial support, increased access to high-quality produce, food-related education and skill development, and mitigating stigma and shame. Secondly, shopping in farmers’ markets increased social connections and fostered a sense of community. Finally, participants experienced limited food variety in rural farmers’ markets, lack of transportation, and challenges with redeeming coupons. Conclusions: Participation in the FMNCP facilitated access to nutritious foods and enhanced participants’ diet quality, well-being and health. Strategies such as increasing the amount and duration of subsidies, and expanding programs may help improve participants’ experiences and outcomes of farmers’ market food subsidy programs.

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Effect of Brief Produce Exposure and Unconstrained Grocery Gift Cards on Caregiver Influence on Diet of Elementary Age Children

et al. 2022

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IMPORTANCEChildren's diets affect health trajectories but are difficult to influence, especially for resource-constrained families.OBJECTIVE To assess the effectiveness of providing 4 weeks of grocery gift cards and small produce boxes to caregivers on their ability to support healthy shifts in children's diets. DESIGN, SETTING, AND PARTICIPANTSThis 2-group randomized clinical trial was conducted from May to July 2021, with 4 weeks of intervention and follow-up at 8 weeks. Resources were provided curbside at 3 schools, 3 housing sites, and 1 after-school site for use at home. Participants consisted of 1 index child ages 5 to 11 years with 1 index caregiver from 68 low-income families. Data were analyzed from July 2021 through March 2022.INTERVENTIONS During each week for 4 weeks, caregivers were offered 10-lb (4.5 kg) boxes of fruits and vegetables, $10.00 grocery gift cards, an additional $10.00 gift card over the last 3 weeks triggered by a task completion, and a 1-time choice of a $25.00 food preparation tool.MAIN OUTCOMES AND MEASURES Index child and caregiver diets were measured together over the phone at baseline, 4 weeks, and 8 weeks using the 2019 to 2020 Texas School Physical Activity and Nutrition (SPAN) tool, which measures the number of times food items were eaten over the prior day to report a SPAN Healthy Eating Index (SHEI) score and subscores for specific categories of foods (range, 0-57, with higher scores indicating a more healthful diet). RESULTSAmong 68 children (mean [SD] age, 8.2 [1.7] years; 35 [51.5%] girls) and caregivers (mean [SD] age, 37.9 [7.9] years; 63 mothers [92.6%]) from primarily low-income families, 26 caregivers were Hispanic or Latino (38.2%), while 18 caregivers were Black (26.4%), 25 caregivers were White (36.7%), and 24 caregivers had more than 1 race (35.3%). Most families were below the federal poverty level (41 of 60 families that reported income [68.3%]). Per participating caregiver, a mean (SD) 2.7 [1.4] fruit and vegetable boxes and $42.35 ($25.46) worth of gift cards were picked up over 4 weeks. Mean (SE) child SPAN SHEI increased from 32.03 (0.62) times/d to 33.75 (0.69) times/d at 4 weeks (ie, postintervention) and 34.03 (0.69) times/d 4 weeks later (ie, at 8 weeks of follow-up). Mean (SE) child fruit and vegetable intake increased from 5.31 (0.47) times/d to 5.78 (0.51) times/d postintervention and 6.03 (0.51) times/d at follow-up. Children in the control group did not have improved diet (overall mean [SE] SHEI: 31.48 [0.58] times/d at baseline, 31.68 [0.54] times/d postintervention, and 31.81 [0.52] times/d at follow-up; mean [SE] fruit and vegetable intake: 5.21 [0.45] times/d at baseline, 4.77 [0.45] times/d postintervention, and 4.68 [0.41] times/d at followup). Compared with children in the control group, mean SHEI was increased for children in the (continued)

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“The coupons and stuff just made it possible”: economic constraints and patient experiences of a produce prescription program

Abstract: Patients with hypertension who also experience food insecurity experience economic barriers to participating in a produce prescription program even after vouchers for produce were provided.

Cited by 26 publications

References 32 publications

The food pharmacy: Theory, implementation, and opportunities

The food pharmacy: Theory, implementation, and opportunities

“My coupons are like gold”: experiences and perceived outcomes of low-income adults participating in the British Columbia Farmers’ Market Nutrition Coupon Program

Effect of Brief Produce Exposure and Unconstrained Grocery Gift Cards on Caregiver Influence on Diet of Elementary Age Children

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