RE-AIM evaluation of the first 5 years of a citywide produce prescription program

Food insecurity and poor diet quality increase risk for diet-related chronic disease and contribute to health disparities. Produce prescription programs (PPPs) are designed to promote chronic disease prevention and treatment by lowering barriers to fruit and vegetable (FV) purchases. In collaboration with a network of distribution partners, Vouchers 4 Veggies (V4V) provides eligible participants with vouchers ("prescriptions") to purchase fresh or frozen FV at participating vendors.

To evaluate the implementation and public health impact of the first 5 years of V4V implementation.

Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we analyzed quality improvement data collected from program participants, distribution partners, and vendors between 2015 and 2020. Participant outcomes included program engagement, FV intake, food security, and program satisfaction; other outcomes included ease of participation and implementation. Data were analyzed using descriptive statistics and t-tests.

Between 2015 and 2020, V4V partnered with 135 distribution partners and 29 food vendors to serve 9720 unique participants across San Francisco, representing 10% of the population at high risk for food insecurity. Participants were racially and ethnically diverse. At baseline, 79% reported household food insecurity and 66% reported fair or poor health. At follow-up, food insecurity had decreased by 0.79 points (P = .001) on a six-point scale, and FV intake had increased by 0.77 servings/day (P = .001). Satisfaction was high among participants, distribution partners, and vendors.

V4V demonstrates the potential for PPPs to improve food security and diet quality across diverse populations for primary and secondary prevention. Sustainable funding and infrastructure are critical for scaling.