Evaluation of the 2021-2024 Implementation of the Fresh Start Enhanced Food Is Medicine Intervention Among Rural,...

We aimed to evaluate the feasibility, acceptability, and impact of the Fresh Start produce prescription (FSPRx) intervention among rural, underinsured people with type 2 diabetes.

The 20-week FSPRx intervention was implemented in 15 counties in eastern North Carolina to provide 5 to 7 pounds of produce at 9 group classes and individual, telephone-based health coaching.

We evaluated feasibility by reviewing program records, acceptability by reviewing surveys and interviews, and impact by reviewing validated pre-post questionnaires on knowledge, skills, and behavior and retrospective medical record review (glycated hemoglobin A_1c [HbA_1c]). Quantitative data were analyzed by using descriptive statistics, the Wilcoxon signed-rank test, paired sample t tests, repeated-measures analysis of variance (ANOVA), and multiple linear regression. We analyzed interview transcripts by inductive content analysis for themes.

Approximately half of enrolled participants (N = 414) completed pre-post measures (n = 225) and actively participated (n = 170). Participants were majority female (65.4%) and were White (36.5%) or Black (34.3%). Program satisfaction was 96.5%. Participation was moderate for coaching encounters and class attendance (mean [SD], 3.1 [4.5] encounters; 2.0 [2.9] classes, respectively). Food literacy and consumption of fruits, vegetables, and whole grains increased significantly. Glycemic control (mean HbA_1c) improved significantly, with the greatest decreases among participants with 4 or more classes and 4 or more health coaching encounters (0.44% in the full analytic sample). Group classes were the strongest predictor of improved HbA_1c (B = -0.07, P = .06). Interest was high for flexible remote education (program notebook, 97.1%).

Strengths of the FSPRx intervention were acceptability and impact, while feasibility was moderate. Although participation in group classes was the strongest predictor of improved HbA_1c, attendance was limited. Research is warranted to identify optimal integration of educational and behavioral support in Food Is Medicine programs, especially for rural populations.