Barriers and facilitators to implementing a pilot produce prescription program in a community health setting in Toronto, Canada

BACKGROUND: Produce prescription programs (PRx) are gaining traction in Canada and globally as an approach to promote food security and healthy diets. Unison Health and Community Services (Unison), a community health centre in Toronto, Canada, piloted a PRx program to promote food access and healthy eating for adults with experiences of food insecurity and chronic disease risk factors. In this study, we explored the barriers and facilitators to implementing a pilot PRx program in a community health setting to inform program improvements, including opportunities to better meet participant health needs and preferences. 

METHODS: Participant follow-up calls, focus group discussions, and semi-structured key informant interviews were conducted in person and online. Detailed call logs and interview transcripts were analyzed thematically using a hybrid inductive-deductive approach guided by the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to program implementation. 

RESULTS: Key themes were identified across the five domains of the CFIR: (i) Innovation, (ii) Outer Setting, (iii) Inner Setting, (iv) Individuals, and (v) Implementation Process. In total, 19 themes were selected across 14 CFIR constructs, including six inductive sub-themes. The main barriers included the outdoor and public designs of the market, reduced staffing on the clinical team, and a lack of communication infrastructure between primary care providers, program providers, and program participants. Key facilitators included the integration of the PRx pilot into existing Unison programs, the inclusion of nutrition education workshops, and the person-centered and adaptable approach adopted by program providers. These facilitators supported participant referrals and program satisfaction, contributing to participants' desire to continue engaging in the program. 

CONCLUSIONS: This study, guided by the CFIR, revealed valuable insights into the barriers and facilitators that may influence the implementation of a PRx program in community health settings. Study findings emphasize the importance of team-based care to ensure program adaptability and support a person-centered approach. Identifying key champions within primary care teams is needed to strengthen referral pathways and communication with program providers. Future PRx programs may consider incorporating opportunities for knowledge sharing with participants and community-building activities to address important needs related to social connection, community belonging, and mental health.