How Does the Gus Schumacher Nutrition Incentive Program Work? A Theory of Change

Abstract

Increased fruit and vegetable (FV) intake is associated with decreased risk of nutrition-related chronic diseases. Sociodemographic disparities in FV intake indicate the need for strategies that promote equitable access to FVs. The United States Department of Agriculture’s Gus Schumacher Nutrition Incentive Program (GusNIP) supports state and local programs that offer nutrition incentives (NIs) that subsidize purchase of FVs for people participating in the Supplemental Nutrition Assistance Program (SNAP). While a growing body of research indicates NIs are effective, the pathways through which GusNIP achieves its results have not been adequately described. We used an equity-focused, participatory process to develop a retrospective Theory of Change (TOC) to address this gap. We reviewed key program documents; conducted a targeted NI literature review; and engaged GusNIP partners, practitioners, and participants through interviews, workshops, and focus groups in TOC development. The resulting TOC describes how GusNIP achieves its long-term outcomes of increased participant FV purchases and intake and food security and community economic benefits. GusNIP provides NIs and promotes their use, helps local food retailers develop the capacity to sell FVs and accept NIs in accessible and welcoming venues, and supports local farmers to supply FVs to food retailers. The TOC is a framework for understanding how GusNIP works and a tool for improving and expanding the program.

Improving Fruit and Vegetable Accessibility, Purchasing, and Consumption to Advance Nutrition Security and Health Equity in the United States

“…The Gus Schumacher Nutrition Incentive Program (GusNIP), formerly called the Food Insecurity Nutrition Incentive Program (FINI), was operationalized in the 2018 Farm Bill and provides competitive grant dollars to organizations administering nutrition incentive or produce prescription programs [ 65 ]. Both programs aim to improve FV affordability and thus consumption [ 66 ] among Americans with lower income through the provision of a financial incentive or a healthcare prescription used at the point-of-purchase (e.g., farmers markets, retail stores). To evaluate the impact of these efforts on outcomes such as food security and dietary quality (i.e., nutrition security), the GusNIP mechanism also established the Nutrition Incentive Program Training, Technical Assistance, Evaluation, and Information Center (NTAE) [ 65 , 67 ] to help build program capacity at local sites and to evaluate the combined impact of funded projects.…”

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“…Healthy food financial incentive projects, including nutrition incentive (NI) and produce prescription (PPR) projects, can help address disparities in diet quality among populations with low income by increasing their purchasing power and access to fruits and vegetables (FV) (Engel & Ruder, 2020;Leng et al, 2022). Throughout this paper, both NI and PPR projects will be collectively referred to as "healthy food financial incentive projects."…”

Client experience of food assistance programs among adults in the United States: a qualitative evidence synthesis protocol

“…Evidence shows that many food assistance programs have a positive impact on a wide range of metrics assessing food behaviors (e.g., fruit and vegetable intake, dietary quality), food security, health (e.g., disease self-management, mental well-being), and healthcare utilization (e.g., emergency department visits) and cost ( 4 , 5 ). Expanding effective food assistance programs is a major focus among policymakers, funders, and implementers, especially during times of economic crisis or public health emergencies like the COVID-19 pandemic ( 6 , 7 ). Simultaneously, there is widespread recognition that it is important to promote positive experience of food assistance programs among individuals participating in these programs, hereafter referred to as clients ( 6 , 8 ).…”

“…Expanding effective food assistance programs is a major focus among policymakers, funders, and implementers, especially during times of economic crisis or public health emergencies like the COVID-19 pandemic ( 6 , 7 ). Simultaneously, there is widespread recognition that it is important to promote positive experience of food assistance programs among individuals participating in these programs, hereafter referred to as clients ( 6 , 8 ).…”