RE-AIM evaluation of the first 5 years of a citywide produce prescription program

BACKGROUND: Food insecurity and poor diet quality increase risk for diet-related chronic disease and contribute to health disparities. Produce prescription programs (PPPs) are designed to promote chronic disease prevention and treatment by lowering barriers to fruit and vegetable (FV) purchases. In collaboration with a network of distribution partners, Vouchers 4 Veggies (V4V) provides eligible participants with vouchers ("prescriptions") to purchase fresh or frozen FV at participating vendors. PURPOSE: To evaluate the implementation and public health impact of the first 5 years of V4V implementation. METHODS: Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we analyzed quality improvement data collected from program participants, distribution partners, and vendors between 2015 and 2020. Participant outcomes included program engagement, FV intake, food security, and program satisfaction; other outcomes included ease of participation and implementation. Data were analyzed using descriptive statistics and t-tests. RESULTS: Between 2015 and 2020, V4V partnered with 135 distribution partners and 29 food vendors to serve 9720 unique participants across San Francisco, representing 10% of the population at high risk for food insecurity. Participants were racially and ethnically diverse. At baseline, 79% reported household food insecurity and 66% reported fair or poor health. At follow-up, food insecurity had decreased by 0.79 points (P = .001) on a six-point scale, and FV intake had increased by 0.77 servings/day (P = .001). Satisfaction was high among participants, distribution partners, and vendors. CONCLUSIONS: V4V demonstrates the potential for PPPs to improve food security and diet quality across diverse populations for primary and secondary prevention. Sustainable funding and infrastructure are critical for scaling. Produce prescription programs (PPPs) are gaining traction as a strategy to address food and nutrition security. Vouchers 4 Veggies (V4V) is a PPP that partners with healthcare and social service organizations in San Francisco to provide individuals with $20–$40 per month for 6 months to purchase fruits and vegetables at participating stores. Using the RE-AIM framework, we evaluated the program’s reach, effectiveness, adoption, implementation, and maintenance. We analyzed participant, partner, and vendor data collected between 2015 and 2020. Outcomes of interest included program engagement, fruit and vegetable (FV) intake, food security, program satisfaction, and ease of participation and implementation. V4V served 9720 unique participants, representing 10% of San Francisco’s population at high risk for food insecurity. On average, participants ate 0.77 more servings of FVs per day and experienced less food insecurity after program participation. V4V partnered with 135 clinics and community organizations and 29 vendors. Satisfaction was high among participants, vendors, and partners, with over 88% reporting high or very high satisfaction. PPPs show promise in improving food security and diet quality across diverse communities. Sustainable funding and infrastructure are needed to increase reach to individuals experiencing food insecurity and expand community partnerships. eng