How does fresh food prescribing fit into the social service landscape? A qualitative study in Ontario, Canada

INTRODUCTION: Food prescription programs are part of the broader social prescribing movement as an approach to address food insecurity and suboptimal diet in health care settings. These programs exist amid other social services, including income-based supports and food assistance programs; however, evaluations of the interactions between these programs and pre-existing services and supports are limited. This study was embedded within a larger evaluation of the 52-week Fresh Food Prescription (FFRx) program (April 2021-October 2022); the objective of this study was to examine how program participation influenced individuals' interactions with existing income-based supports and food assistance programs. METHODS: This study was conducted in Guelph, Ontario, Canada. One-to-one (n = 23) and follow-up (n = 10) interviews were conducted to explore participants' experiences with the program. Qualitative data were analyzed thematically using a constant comparative analysis. RESULTS: Participants described their experience with FFRx in relation to existing income-based supports and food assistance programs. FFRx reportedly extended income support further to cover living expenses, allowed participants to divert income to other necessities, and reduced the sacrifices required to meet basic needs. FFRx lessened the frequency of accessing other food assistance programs. Aspects of FFRx's design (e.g. food delivery) shaped participant preferences in favour of FFRx over other food supports. CONCLUSION: As food prescribing and other social prescribing programs continue to expand, there is a need to evaluate how these initiatives interact with pre-existing services and supports and shape the broader social service landscape. This study examined how a food prescription program interacts with pre-existing services. Participants shared experiences with the program as related to other income-based supports and food assistance programs. For income-based supports: the Fresh Food Prescription (FFRx) program enabled participants to extend income further, divert it to other necessities and reduce incomerelated sacrifices. For food assistance programs: FFRx reduced frequency of accessing other food programs and was the preferred choice due to the program’s design (e.g. accessibility, food quality, delivery). As food and social prescribing initiatives expand, evaluations must consider how these programs interact with and influence the broader social service landscape. eng