Fresh Food RX: Evaluating the impact of a produce prescription program on engagement and well-being using the RE-AIM framework

INTRODUCTION: Food insecurity (FI) affects 13.8% of the USA, disproportionately afflicts low-income and minority populations, and is associated with increased risks of chronic health conditions. Produce prescription (PRx) programs, a Food Is Medicine intervention, have emerged as a promising way to address FI and improve the health of participants with limited access to healthy foods and chronic metabolic conditions, yet PRx implementation in practice remains poorly understood. 

METHODS: We used the Reach, Effectiveness, Adoption, Implementation, Maintenance framework to inform semi-structured interviews with 15 participants enrolled in a 12-month PRx intervention that provided weekly produce deliveries, personalized nutrition coaching, and community-based education sessions to alleviate food insecurity and support dietary behavior change. Interviews explored the intervention's implementation and impacts. We analyzed interview data using a reflexive thematic analysis approach. 

SETTING: Academic health system in North Carolina. 

RESULTS: Participants expressed a variety of motivations for participation (reach). Improved dietary knowledge, community engagement, improvements in health, and motivations to prioritize self-care were viewed as benefits of participation (effectiveness). Engagement was facilitated by social connection as well as the financial benefit and consistency of receiving weekly produce boxes. Barriers to full engagement in PRx (implementation) included logistical, transportation, and financial constraints. Participants expressed a strong commitment to maintaining healthy eating habits, but many were unsure how they would do so because of systemic barriers to healthy food (maintenance). 

CONCLUSIONS: Our study generated novel evidence regarding PRx implementation. We found that PRx implementation was limited by logistical and financial constraints and facilitated by consistent produce access, relationships with the staff and fellow peers, and community-based education. Our findings suggest that flexible produce delivery options, individual-level dietary counseling, and community-located educational sessions enhanced PRx implementation. Future studies should examine strategies to support engagement and sustained behavior change and evaluate mechanisms for stable program implementation.