Use of a Produce Prescription Program to Address Chronic Disease and Nutrition Security in Rural Appalachia: Outcomes...

Produce prescription programs (PRx) have shown promise in improving fruit and vegetable consumption, nutrition security and health outcomes among marginalized populations. Implementation and evaluation of PRx programs is more common in urban areas, leaving gaps in understanding how programs can be effectively delivered in rural communities, which are often under-resourced. A 15-week PRx program using Social Cognitive Theory and the National Produce Prescription Collaborative conceptual framework was implemented and evaluated among 1,092 participants across 16 health centers, in 17 counties, in a rural Appalachian state over a 4-year period (2020-2023). The program included vouchers for on-site farmers markets, a series of optional nutrition education and culinary instruction sessions, and used common evaluation measures and a secure data collection and reporting system. A single-group, pre-/post-test design was used to evaluate changes in anthropometric and biometric markers (systolic and diastolic blood pressure, hemoglobin A1c [HbA1c], total cholesterol, high- and low-density lipoprotein, triglycerides, weight, body mass index [BMI], and waist circumference) and self-reported survey measures of nutrition behaviors, food security and program satisfaction. Matched-pairs t-tests were conducted to assess outcome changes. Statistically significant improvements in food security, fruit and vegetable consumption and statistically and clinically significant changes in HbA1c, especially among those with higher levels at baseline, were achieved. Participants expressed high levels of satisfaction with all aspects of the program. Clinical-community-based PRx programs involving multi-sector partnerships were effective in supporting local food economies and improving nutrition-related behaviors and clinical health outcomes among participants in rural Appalachian communities.