Frequency of attendance to a behavioral intervention on health-related outcomes in a multicomponent Food as medicine intervention

OBJECTIVE: Determine whether the frequency of attendance to Recipe4Health was associated with improvements in health-related outcomes. 

DESIGN: Secondary analysis of the Recipe4Health quasi-experimental study. 

SETTING: Federally Qualified Health Centers in Alameda County, California. 

PARTICIPANTS: Patients with nutrition-related chronic conditions and/or food insecurity. INTERVENTION: Sixteen weekly produce deliveries and behavioral intervention sessions. 

MAIN OUTCOME MEASURES: Attendance was categorized by percentage: low (< 50%), moderate (50% to < 75%), and high (≥ 75%), and outcomes included vegetable/fruit intake, physical activity (PA), mental health, and clinical biomarkers. 

ANALYSIS: Prepost changes were assessed using repeated measures linear mixed-effects models, adjusting for baseline values. 

RESULTS: Of the 199 patients, approximately one-third had low (36%), moderate (30%), and high (34%) attendance. Patients with high attendance had greater improvements in vegetable/fruit intake (0.3 cups/d; P = 0.03), PA (24.4 min/wk; P < 0.01), and depression symptoms (Patient Health Questionnaire score: -1.1; P < 0.01) compared with patients with low attendance. Patients with moderate attendance had greater improvements in PA compared with low attendance (15.1 min/wk; P = 0.03). Patients with high attendance had greater improvements in physically unhealthy days compared with moderate attendance (-2.4 d/mo; P < 0.01). Patients with high attendance had significant improvements in hemoglobin A1c from baseline (-0.7%; P = 0.02). 

CONCLUSIONS: Strategies to improve attendance should be prioritized in food as medicine interventions.