Participant redemption and engagement in produce prescription programs: A qualitative analysis of implementer perspectives

BACKGROUND: Produce prescription programs are a type of Food is Medicine (FIM) strategy to address food and nutrition insecurity and promote health among patients. Although produce prescription programs can be effective at improving health (e.g., reduce hemoglobin A1c), program designs tend to be highly heterogeneous, and the degree to which participants engage with the programs and redeem prescriptions varies widely. 

OBJECTIVES: The purpose of this qualitative study was to explore produce prescription programs design and implementation practices for promoting fruit and vegetable prescription redemption and participant engagement using an implementation science framework. 

METHODS: Interview guide development followed the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework. We conducted 60-min semistructured interviews with Gus Schumacher Nutrition Incentive Program produce prescription program leads (n = 15) from across the United States to understand factors they felt impacted participant redemption and engagement. We used an inductive thematic analysis using a rapid qualitative approach and mapped emergent themes to EPIS constructs to identify themes. 

RESULTS: We identified 16 relevant themes. These themes centered around ensuring programmatic fit to the participants and the setting, especially addressing access barriers, partnerships and staffing, added services provided, and systems for program monitoring and for participant navigation and communication. 

CONCLUSIONS: This study helps elucidate further about produce prescription program characteristics that may influence prescription redemption and engagement. These qualitative findings can help provide evidence to current program implementers and future researchers of the best practices for produce prescription programs and FIM interventions overall.