Quantitative Evaluation of Produce Prescription Programs in the United States: A Scoping Review

The aim of this scoping review was to document quantitative measures used to evaluate produce prescription programs (PRxs). Produce prescription programs for fruits and vegetables are aimed to improve nutrition and health outcomes among individuals with or at risk for chronic disease, many of whom also experience food and nutrition insecurity. Little is known about the scope of evaluation measures applied to PRxs. The JBI guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews were followed. Five databases and web searches were used to identify abstracts, reports, grey literature, and peer-reviewed literature evaluating PRxs in the United States. Data from sources that met inclusion criteria were extracted into a standardized spreadsheet categorized by program characteristics (eg, prescription details, nutrition education), source characteristics (eg, study design), and all quantitative evaluation measures used across multiple levels (eg, individual/household, program implementors, process, community). The Gus Schumacher Nutrition Incentive Program Produce Prescription Program Theory of Change framework was used to identify common measures and to highlight measurement gaps along the pathway from program activities to outcomes. A total of 91 sources were included in the scoping review. Demographic and socioeconomic characteristics (n = 68), program process (n = 64), dietary intake (n = 56), health indicators (n = 56), food and financial security (n = 44), and self-efficacy/knowledge/attitudes (n = 36) were the most frequent constructs measured across all sources. Other common measures included physical and emotional well-being (n = 21), food purchasing patterns (n = 17), and other health-related behaviors (n = 16). Measures of healthcare utilization (n = 15), community and food environment (n = 7), and program implementors (n = 5) were the least frequently reported. A wide variety of quantitative measures have been used to evaluate PRxs across the United States. There is a need to standardize PRx evaluation measures to better capture the important impacts that PRxs have on individuals or households, program implementors, and the broader community.