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Abstract
Produce prescription programs (PPPs), in which healthcare providers “prescribe” subsidies for fruits and vegetables, are a strategy for addressing the increased risk for diet-related diseases, low fruit and vegetable consumption, and food insecurity that individuals with a low socioeconomic status face. PPPs have grown in number across the country in the past decade, yet there is a stark understanding of PPP models and of the PPP participant experience. This dissertation utilized mixed methods to understand how U.S. PPPs are designed and implemented, what strategies help or hinder program success, and the PPP experience of participants and their families from the perspectives of the participants themselves. The dissertation findings highlight the wide variety in PPPs models nationwide, though programs tended to have three main arms: a produce prescription, usually in the form of a voucher redeemable at farmers markets; a healthcare visit, for which programs mainly partnered with a safety net clinic; and nutrition education, largely delivered in the form of one-on-one counseling/advice or a class by a registered dietitian. Programs had clinical and non-clinical positive impacts on participants, though the need in communities was higher than what most programs can currently meet. A lack of funding was the most common barrier to sustaining programming. At the state level, a process evaluation of Georgia PPPs suggested that provider dedication and program accessibility were major facilitators for positive program outcomes, while key barriers included participants’ challenging life circumstances and issues around program sustainability. Finally, at the individual level, participants experienced a unique, interactive shopping experience at the market, though program locations could be more convenient to access. Participants’ access to produce increased, and they experienced physical and mental health benefits. For some, the programs “came at the right time” and catalyzed meaningful change after a hardship. The findings of this dissertation highlight the positive impacts of PPPs on participants and the need to continue supporting programs in their wide variety of models across the country. The findings further suggest various strategies and models for PPP design and implementation to equip nationwide PPP providers to best serve their communities.