RESUMO
OBJECTIVE: To determine the contexts under which a fresh food market program is cost-effective in improving dignified access to nutritious food for food-insecure individuals. METHODS: A realist economic evaluation was employed. Purported cost related theories about how the program may function, known as context-mechanism-outcome configurations were developed. In-depth interviews with key stakeholders (program developers, funder, local food relief agencies, volunteers) involved in the program (n=19) as well Photovoice with focus groups with market attendees (n=8) were conducted and coded for contexts, mechanisms and outcomes. A cost-effectiveness analysis of the program was calculated whereby the cost inputs associated with operating the program were compared to the quantity and value of produce distributed. Alternative cost scenarios were evaluated in a sensitivity analysis. The cost-effectiveness analysis was used together with qualitative data to refine theory. RESULTS: Food insecure individuals attending a partnership fresh food market with a small fee, experienced improved, yet infrequent access to nutritious food through community connections and support a more dignified, viable access to fresh nutritious food. CONCLUSIONS: Food relief should consider alternative models. IMPLICATIONS FOR PUBLIC HEALTH: More dignified food relief programs that support local connections may be part of the solution to addressing food insecurity.