A pilot randomized controlled trial of a fruit and vegetable prescription program at a federally qualified health center in low income uncontrolled diabetics

Bryce, Richard; WolfsonBryce, Julia A; CohenBryce, Alicia; Milgrom, Nicki; García, Danny E.; Steele, Alicia; Yaphe, Sean; Pike, Denise; Valbuena, Felix; Miller-Matero, Lisa R

doi:10.1016/j.pmedr.2021.101410

Cited by 25 publications

(89 citation statements)

References 20 publications

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“…The use of an ad hoc comparison group made the recruitment of a comparable sample possible, but the collection of serum measures less feasible and implications of our findings less generalizable. Given prior produce prescription interventions with diabetic patients demonstrated statistically significant changes with a −0.5 reduction in HbA1c% compared with a control group (Bryce et al, 2021), it is likely our sampling strategy and attrition reduced our ability to find substantial changes in this measure. The ad hoc group received only one of the two SNAP-Ed programs the FVRx Intervention group received (Nutrition Education group) or no SNAP-Ed program (Control group), which limits our ability to make direct comparisons between groups.…”

Section: Discussionmentioning

confidence: 99%

“…Conflicting evidence continues to emerge related to the effects of produce prescription programs on clinical outcomes (e.g., HbA1c, blood pressure, BMI) among safetynet clinic and Federally Qualified Health Center (FQHC) patient populations (Bryce et al, 2017(Bryce et al, , 2021Cook et al, 2021;Veldheer et al, 2020;Xie et al, 2021). The majority of produce prescription interventions range from 13 weeks to 1 year with varying amounts of produce prescription redeemed by participants (US$40-US$295) and varying modalities and durations of education provided.…”

Section: Implications For Practice and Researchmentioning

confidence: 99%

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Effects of a Fruit and Vegetable Prescription Program With Expanded Education for Low-Income Adults

et al. 2022

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Fruit and Vegetable Prescription (FVRx) Programs combine produce prescriptions and nutrition education to reduce fruit and vegetable consumption barriers and promote health among low-income patient populations. This study examined whether a multi-level FVRx intervention model with intensive education improves dietary behaviors, food security, and health outcomes over single-level interventions alone. A 6-month nonrandomized, parallel, controlled trial was conducted with one intervention, FVRx ( n = 31) and two comparison groups, Ad hoc Nutrition Education ( n = 13) and Control ( n = 16). The FVRx group received produce prescriptions (US$1/day/household member) redeemable at a farmer’s market, two SNAP-Ed programs, one financial literacy program, and monthly health screenings. The Nutrition Education (NE) group participated in one SNAP-Ed program, and the Control group received safety-net clinic care only. Surveys assessed dietary intake, food security, food purchasing practices, and financial and food resource management. Pre–post clinical biomarkers (blood lipid and hemoglobin A1c) and monthly biometrics (anthropometrics and blood pressure) were measured. Descriptive analysis and one-way analysis of variance (ANOVA) were conducted. Compared with comparison groups, FVRx participants significantly increased the frequency of consuming dark green vegetables, FVRx (0.36 ± 0.72); NE (0.14 ± 0.33); Control (−0.09 ± 0.19) cups/day ( p < .05). FVRx participants significantly improved multiple healthful food purchasing practices, and the ability to afford more utilities (FVRx (33%); NE (0%); Control (10%); p < .05). Limited changes were observed in food security and clinical biomarker outcomes between groups. Combining expanded nutrition and financial literacy education with produce prescriptions improves low-income adults’ financial and food resources, preference, knowledge, purchase, and consumption of locally grown vegetables over single-level interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Implications For Practice and Researchmentioning

confidence: 99%

Effects of a Fruit and Vegetable Prescription Program With Expanded Education for Low-Income Adults

et al. 2022

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“…The most common F&V prescription intervention model was F&V vouchers (n 19), which provide vouchers to participants to be redeemed for fresh fruit and vegetables. (27,(31)(32)(33)(35)(36)(37)(38)(39)(40)(41)(42)44,47,(50)(51)(52)(53)(54) The second most frequent model was delivery and/or collection (n 8), with fresh F&V delivered to participants or made available for collection. (26,28,29,34,43,45,46,55) Lastly, two studies used a cashback rebate on F&V purchases, via EBT card and associated with enhancement to SNAP benefits.…”

Section: Program Methodologymentioning

confidence: 99%

Community-based fruit and vegetable prescription programs: a scoping review

Greatorex Brooks,

McInerney

2023

J Nutr Sci

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Identify and categorise different models of community-based fruit and vegetable prescription programs, to determine variation in terms of methodology, target population characteristics, and outcomes measured. Applying the scoping review methodology, ten electronic databases were utilised to identify community-based fruit and vegetable incentive programs. Results were evaluated by two independent reviewers, using Covidence software. All full-text reviews were completed and documented using the PRISMA-ScR guidelines. Search results were stored and reviewed within the Covidence software. Thirty full-text articles were utilised from the 40 206 identified in the search. Target populations were predominantly female, non-white, and low-income. Considerable heterogeneity was found in both study design and quality. Fruit and vegetable vouchers were utilised in 63 % (n 19) of the studies. Prescriptions were primarily provided by community health centres (47 %; n 14) or NGOs (307 %; n 9) and could be redeemed at farmers’ markets (40 %; n 12) or grocery stores (27 %; n 8). When measured, diet quality significantly improved in 94 % (n 16), health outcomes significantly improved in 83 % (n 10), and food security status improved in 82 % (n 10) of studies. Providing financial incentives to offset the cost of fresh fruits and vegetables can increase consumption, improve health outcomes, and improve food security status. The majority of studies showed significant improvements in at least one outcome, demonstrating the effectiveness of community-based fruit and vegetable prescription programs. However, the diversity of measurement techniques and heterogeneity of design, dosage, and duration impeded meaningful comparisons. Further well-designed studies are warranted to compare the magnitude of effects among different program methodologies.

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“…Across the United States nearly 100 new programs were established between 2010 and 2020 [ 4 ]. Evidence from US and international bodies of research suggest that these programs have a positive effect on household food insecurity [ 5 , 6 ], improve fresh FV consumption [ 7 ], and improve chronic disease management among adults [ 8 , 9 , 10 , 11 ]. For example, an intervention at a safety-net clinic that provided food insecure, hypertension patients with a Produce Rx, yielded significant increases (47 to 50%) in daily FV consumption [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

A Qualitative Study on the Motivators, Barriers and Supports to Participation in a Pediatric Produce Prescription Program in Hawai‘i

Esquivel

Higa²,

Guidry

et al. 2022

IJERPH

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Produce prescriptions that provide vouchers to individuals to purchase fresh FVs at a specified retail outlet have the potential to positively impact food security status, diet, and chronic disease risk. However, maximizing program participation is vital to ensuring program success. This research describes motivators, barriers, and support for participation in a child produce prescription program among a population of Native Hawaiian and Other Pacific Islanders, who are underrepresented in this field of research. This qualitative grounded theory study was nestled within a quasi-experimental pilot intervention trial and included semi-structured interviews with pediatric program participants. Twenty-five interviews were conducted, which represented one-third of program participants. The top support factors for program participation included: ease of voucher use, program convenience, health center/pediatrician endorsement and positive communications with farmers’ market vendors. Key motivators for program participation were produce enjoyment, child support, financial support, and positive impacts on family. Three themes emerged consistently as barriers to participation amongst participants, (1) difficult use of vouchers, (2) conflicting schedules, and (3) online market concerns. (4) Conclusions: This research offers insight into policy implications as the number of produce prescription programs has grown. These findings suggest that key program design characteristics can enhance and support program participation.

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A pilot randomized controlled trial of a fruit and vegetable prescription program at a federally qualified health center in low income uncontrolled diabetics

Cited by 25 publications

References 20 publications

Effects of a Fruit and Vegetable Prescription Program With Expanded Education for Low-Income Adults

Effects of a Fruit and Vegetable Prescription Program With Expanded Education for Low-Income Adults

Community-based fruit and vegetable prescription programs: a scoping review

A Qualitative Study on the Motivators, Barriers and Supports to Participation in a Pediatric Produce Prescription Program in Hawai‘i

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