A randomized controlled study comparing three food prescription programs for older adults: Program design, implementation, and utilization

OBJECTIVE: Food prescriptions can help address food insecurity, however older adults have unique barriers to food prescription utilization, including transportation, that threaten program effectiveness. This research compares utilization of two delivered food prescription programs with a standard of care control. 

DESIGN: Participants were randomized to be offered one of three 12-week free food prescriptions: (1) Home-Delivered Produce Prescription: a customizable fresh produce box, (2) Home-Delivered Meal Kits: an equivalent amount of produce plus complementary food items to make three recipes, or (3) Mobile Market Produce Prescription (control): a voucher to use at local mobile market. Prescription redemption and produce usage were reported on weekly phone or text surveys. 

SETTING: Mobile market or home delivery. 

PARTICIPANTS: Patients aged 65 and older from hospital-based primary care clinics with difficulty accessing fresh fruits and vegetables (N = 67). 

RESULTS: There were no statistically significant differences in enrollment rates across arms: 84.6% in produce prescription (n = 22), 88.5% in meal kit (n = 23), and 73.3% in mobile market (n = 22). Self-reported redemption across 12 weeks was higher (p < 0.001) in the produce prescription (89.2%) and meal kit (89.2%) arms compared to control (28.3%). Among those who redeemed their prescription, produce usage did not differ, but total possible dosage received was significantly higher (p < 0.001) in the produce prescription (75.7%) and meal kit (77.7%) compared to the control (24.9%). 

CONCLUSION: While redemption rates were higher in both delivery arms, the meal kit did not improve produce usage above control, suggesting that delivery had the most impact on food prescription utilization among older adults.