Barriers and facilitators to implementing food is medicine programs: Evidence from 21 food bank-healthcare partnerships

BACKGROUND: Food is Medicine (FIM) programs identify people experiencing food insecurity and diet-related chronic disease and connect them with nutritious foods. Food banks and healthcare partners are well positioned to deliver FIM programs; however, there is limited knowledge about factors that influence FIM program implementation in this context. 

PURPOSE: The goal of this study was to understand barriers and facilitators to FIM program implementation within food bank-healthcare partnerships in diverse US settings. METHODS: A phenomenological study using semi-structured interviews was conducted with 21 programmatically and contextually diverse Food as Medicine 3.0 (FAM3) grantees, including food bank leads and some healthcare partners. The Consolidated Framework for Implementation Research (CFIR) 2.0 informed interview guide development, coding, and interpretation. Interviews and the analysis were completed by a team of trained researchers following best practices. Data was analyzed using Dedoose (version 9.2.12). 

RESULTS: Fifty participants across 21 FAM3 grantees engaged in an interview. Most grantees shared challenges related to initiating and maintaining the healthcare partnerships needed for FIM programs. The tracking, gathering, and/or sharing of FIM program implementation and evaluation data was another primary challenge. Furthermore, limited healthcare and food bank staff capacity to carry out FIM programs was another prominent barrier. Despite these challenges, FIM programs were considered adaptable, testable, and to meet a core need among neighbors, all of which were implementation facilitators. 

CONCLUSIONS: Results of this study inform the need to design and test implementation strategies to overcome barriers to the implementation of a promising food bank-healthcare partnership model for FIM. Food is Medicine (FIM) programs identify people experiencing food insecurity and diet-related chronic disease and connect them with nutritious foods to improve their health. Healthcare organizations and food banks have the potential to create strong partnerships to deliver FIM programs nationwide. This study examined challenges and opportunities to FIM program implementation among food banks and their healthcare partners. The research team conducted and analyzed interviews with 21 diverse grantees of a Food as Medicine 3.0 initiative. The results of this research identified that, across diverse FIM programs, the main challenges to food bank–healthcare FIM programs were starting and maintaining healthcare partnerships, tracking accurate information on how the program was being implemented or generating impact, and limited food bank and healthcare staff capacity to dedicate to program implementation. The results also found that several factors facilitated food bank–healthcare partnership FIM programs, including that FIM programs were adaptable, easy to test prior to rolling out, and designed to meet important needs of food bank neighbors. This study highlighted several important considerations for building successful FIM partnerships, including the need to design and test strategies to improve implementation by overcoming challenges to a promising food bank–healthcare FIM program model. eng