Evaluation of a produce prescription (PRx) program with food literacy and culinary medicine education for rural, uninsured patients with type-2 diabetes

Purpose: Produce prescription (PRx) programs improve the nutrition and health of participants; however, best practices to optimize and sustain dietary changes have not been established. This study examined the acceptability and impact of food literacy and culinary education aligned with a PRx.

Design: Single-group pre-post design, process evaluation.

Setting: 4 primary care safety-net clinics.

Subjects: 150 rural, uninsured patients with type-2 diabetes.

Intervention: 20-week PRx intervention with 9 food literacy and culinary-focused group classes.

Measures: Attendance, satisfaction, knowledge, food purchasing and consumption changes, food literacy scores, diet changes.

Analysis: Closed-ended survey responses and sociodemographics were analyzed using descriptive statistics. Open-ended responses were analyzed thematically. Paired Sample t-tests and Wilcoxon signed-rank test compared pre- vs post-food literacy scores and diet changes; multiple linear regression examined the effect of program participation on food literacy scores.

Results: Taste testing had the greatest influence on food behavior changes followed by the PRx and nutrition education. Food literacy significantly increased (89.1 (19.5) to 100.9 (19.5)), (P < .001) and was positively predicted by group class attendance (B = 1.366, P = .044). Diet quality improved (whole grains, P < .001, fruits, P = .03, and vegetables, P < .001).

Conclusion: Food literacy and culinary-focused nutrition education within a PRx amplified healthy food behavior changes and should be examined for long-term effectiveness in promoting and sustaining dietary changes.