Impact of text message reminders on attendance at a health center-based produce market: A quasi-experimental study

BACKGROUND: Food insecurity is associated with adverse health outcomes and disproportionately affects low-income and minoritized communities. Mobile produce markets co-located within healthcare settings have emerged as a promising strategy to reduce food insecurity, but sustained program engagement remains a challenge. 

OBJECTIVE: To evaluate the impact of bilingual text message reminders on attendance at a health center-based produce market. 

DESIGN: A quasi-experimental study using interrupted time series analysis of aggregate attendance data from March 2021 to 2024. 

PARTICIPANTS: Patients of a federally qualified health center with access to an on-site mobile produce market. 

INTERVENTION: Monthly bilingual text message reminders about the produce market, initiated in April 2024. 

MAIN MEASURES: Change in monthly market attendance and predictors of delayed reattendance (≥ 3 months). Logistic regression models adjusted for time-in-sample were used to estimate associations. 

KEY RESULTS: Text message reminders were associated with a sustained increase in attendance (+ 80.7 individuals/month; 95% CI, 42.5-119.0). Among 2597 individuals with a ≥ 3-month gap or no return, reattendance was less likely among men (adjusted odds ratio [aOR] 0.74; 95% CI, 0.59-0.92), Medicaid enrollees (aOR 0.67; 95% CI, 0.51-0.88), and uninsured individuals (aOR 0.53; 95% CI, 0.40-0.70). 

CONCLUSIONS: Text message outreach was associated with increased participation in a health center-based food access program. However, disparities in reattendance by insurance status suggest that text-based interventions may reinforce existing inequities, highlighting the need for multimodal outreach strategies or options for home delivery.