A dynamic, multilevel process evaluation of a produce prescription program at a federally qualified health center: 2017–2021 description, implementation, and infrastructure

The "Food as Medicine" (FAM) movement encourages public health and medical professionals to recognize the importance of dietary patterns and food access. The purpose of this work was to describe patient and physician engagement with a produce prescription (PRx) program to improve access to fresh vegetables in a healthcare setting. A Federally Qualified Health Center, regenerative farm, and academic institution partnered for the PRx program (2017-21). During harvest seasons, patients redeemed "prescriptions" for initial and "refill" produce boxes. Baseline food insecurity surveys were embedded in electronic medical records. Refill surveys assessed satisfaction and confidence. Electronic surveys to prescribing physicians assessed program knowledge, expectations, and motivations. Across 8 biannual harvests generating 9986 produce boxes, 8046 patients received prescriptions, 6227 redeemed prescriptions for ≥1 box, and 720 redeemed for ≥2 boxes. Seasonally, initial redemption rates ranged from 64.5% to 82.7%; refill rates ranged from 6.8% to 16.7%. Among participants, 70.8% sometimes/often worried food would run out and 66.7% sometimes/often ran out of food. Among those with refills, there was high satisfaction with food quality (95.8%) and variety (97.2%), and 94.2% were confident preparing meals from produce. Among physicians (n = 22), 100% self-reported adequate knowledge about PRx for patient recommendations, and 100% believed PRx had benefit for patients. Chronic conditions (77%), low socioeconomic status (64%), and food insecurity (59%) were common motivating factors for prescriptions. We demonstrated the feasibility of implementing a cross-sector, seasonal PRx program within a multisite healthcare system. More research is needed to refine implementation toward greater patient refill rates.