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Abstract
Fruit and Vegetable Prescription (FVRx)® Programs® are multi-level interventions combining healthcare generated produce prescription with nutrition education and local food system settings to improve dietary and health outcomes for low-income patients with diet-related conditions. This dissertation describes the development, implementation, and evaluation of preliminary and expanded FVRx models combining produce prescription with culturally tailored direct nutrition and financial literacy education, and health screenings. Mixed methods approaches and non-randomized controlled study design were used to examine the impact of the programs on low-income adults’ food and nutrition behaviors, health outcomes, and experiences in local food settings. The process and outcome evaluations of the Pilot FVRx Program combining produce prescription and nutrition education in a community- and clinic-setting demonstrate the essential role of a unique university-community-clinic partnership established for program development, implementation, and rigorous evaluation. The Pilot FVRx program showed significant improvements in participants’ fruit and vegetable intake, food purchasing practices, food budgets, but limited changes in food security and clinical outcomes. Building upon these findings, the Expanded FVRx Program included augmented nutrition and financial literacy education programs, clinical biomarker assessments, and an ad-hoc comparison group. The produce prescription combined with intensive education showed enhanced financial and food resources, healthy food purchasing practices, as well as improved knowledge, preference, and consumption of locally grown produce over nutrition education alone. In addition, the multi-level components of the Expanded FVRx program model allowed participants to emerge with new local food system values, perceptions, and experiences. These transformations empowered participants to continue to access local foods and purchase and consume fruits and vegetables even after the program participation. The findings of this research suggest that community- and clinic-based multi-level interventions are feasible and effective for addressing barriers to consuming adequate fruits and vegetables in low-income adults disproportionally affected by poverty, unhealthy food environments, and healthcare disparities. The findings of this study underscore the need for multi-level strategies to address health disparities in medically underserved low-income populations and suggest potential models and recommendations for the design and implementation of effective and sustainable FVRx programs applicable in both community and clinical settings.