Development and Evaluation of the Delivery-Based HEALED Produce Rx Program for Uninsured Patients With Diabetes in Rural Eastern North Carolina.

Produce prescription (PRx) programs have emerged as a preventive treatment to subsidize the cost of fruits and vegetables for people with lower income and have shown promise in improving diet quality and diabetes-related health outcomes (eg, glycated hemoglobin A1c). Researchers from the Department of Nutrition Science at East Carolina University worked with the Wayne Action Teams for Community Health (WATCH) Clinic, a safety-net clinic in rural Eastern North Carolina, and a local research farm to develop a PRx program for rural patients with type 2 diabetes and no health insurance. Preliminary patient surveys identified high levels of interest in a PRx program and a desire for recipes to accompany the produce. Formative evaluation results via telephone interviews with eligible patients identified transportation barriers to participation and the desire for complementary nutrition education and culinary resources. These results led to a delivery-based PRx program implemented from June through November 2021. Patients received weekly home delivery of an average of 4.7 pounds of fruits and vegetables and complementary nutrition and health education materials and culinary resources (cookbook, recipes). The level of patient satisfaction with the program was high; the reported level of consumption of produce, including unfamiliar produce, was high; educational resources were associated with increased knowledge and motivation to make healthful lifestyle changes, and glycemic control significantly improved. Ensuring that patients have a voice in the design and implementation of PRx programs is crucial to success. Ongoing use of rigorous formative and process evaluations can ensure appropriateness, use, and a positive effect of PRx programs, and they are needed to establish best practices for implementation.

From the Field to the Patient: A Rural Food Recovery-Based Produce Rx Program.

Poor nutrition is a major risk factor for chronic diseases, and emerging produce prescription (PRx) programs are a growing approach to addressing gaps in diet quality to promote health. This article describes a food recovery-based PRx framework called Farm to Clinic (F2C). The F2C program includes a partnership between the North Carolina Association of Free and Charitable Clinics (NCAFCC), Society of Saint Andrews (SoSA), and a local food bank. Patients (n = 4,691) were rural, uninsured, and received care at one of three NCAFCC clinics in Eastern North Carolina. Student volunteers gathered gleaned and/or salvaged produce and delivered it to clinics and/or patients directly. Successes of the current model include complementing chronic disease management and health promotion in a cost-effective way that also assists with reducing food waste. In addition, the patients who participate in the program are connected with produce at their primary care clinic and do not have to drive to an additional community site for produce. Some challenges have included consistency with gleaning; therefore, the program has switched to primarily salvaged produce. Areas for expansion and improvement on the F2C model are also outlined and include incorporating a more prioritized eligibility criteria, provision of additional complimentary resources such as nutrition education and culinary support, as well as improved formal evaluation (e.g., use of food and clinical impact). Finally, the F2C model utilizes community partners that have been established nationwide which allows for replication of a framework in other geographic areas.

A Rural Delivery-Based Produce Prescription Intervention Improves Glycemic Control and Stress.

OBJECTIVE: We examined the impact of a pilot 24-week delivery-based produce prescription (PRx) intervention with tailored education and culinary resources for rural patients (n = 40) with type-2 diabetes in underresourced communities on behavioral and clinical outcomes. METHODS: We used a single group pretest-posttest design that included a home-delivered PRx, culturally tailored recipes, and health/nutrition education handouts. Measures included hemoglobin A1c (HbA1c), self-reported fruit/vegetable consumption, and stress. Descriptive statistics, t-tests, and Wilcoxon signed rank tests were conducted. RESULTS: Mean HbA1c decreased from 7.6 ± 1.6% to 7.1% ± 1.4% (P = 0.001). Self-reported consumption of fruit/vegetables improved, including frequency and serving size of beans (P = 0.01 and P = 0.01), serving size of lettuce salad (P = 0.02), and serving size of vegetable soup (P = 0.001). Perceived stress decreased (P = 0.01). CONCLUSION AND IMPLICATIONS: Findings from this pilot PRx intervention suggest a delivery-based PRx with tailored educational resources has the potential to reduce HbA1c and stress while improving fruit/vegetable consumption within rural patients with type-2 diabetes in underresourced communities.