Developing and Testing a Produce Prescription Implementation Blueprint to Improve Food Security in a Clinical Setting

Developing and Testing a Produce Prescription Implementation Blueprint to Improve Food Security in a Clinical Setting: A Pilot Study

The goal of this pilot feasibility implementation trial is to assess preliminary feasibility and acceptability of a set of produce prescription implementation strategies. Produce prescription programs are one approach to addressing food insecurity, or the lack of adequate access to safe and nutritious foods. Produce prescriptions involve healthcare providers identifying patients at risk for food insecurity and writing prescriptions for those patients to receive subsidized vegetables. In this study, the investigators will work with a community advisory board to develop a set of enhanced implementation strategies (e.g., training, technical assistance) to support healthcare providers in delivering produce prescription programs. The investigators will assess the feasibility, acceptability, and appropriateness of these strategies. Pre-post changes in implementation outcomes (i.e., adoption) and effectiveness outcomes (i.e., food security) will be examined.

Study Overview

• Status: Completed
• Conditions: Food Insecurity
• Intervention / Treatment: Behavioral: Enhanced Produce Prescription Implementation

Detailed Description

Healthcare providers/staff and patients will be recruited from allied Integra health centers. Following enrollment in the already existing produce prescription program ("VeggieRx"), participants will be asked if they would be interested in participating in the research study that entails surveys regarding the program. The investigators expect to recruit participants into the study starting shortly after patients get enrolled in the program. Potential participants will be informed that their decision about whether to participate in the research study will not affect their eligibility or enrollment in the VeggieRx program. They will also be informed that this study seeks to understand strategies to improve the current VeggieRx program. A research assistant will follow-up with interested patients/providers/staff and complete enrollment, consents, and a baseline assessment, either in the waiting room to complete on their own, over the phone or Zoom, OR if they choose to complete it on their own, the study team will send them the link to the consent and survey. It should be noted that participants can either choose to complete the surveys on their own through a survey link (which will be the default) or the surveys can be administered by the study staff. The study team hopes to collect baseline measures before the delivery of their first vegetables which typically begins the second week in July. While providers/staff will not be receiving vegetables, the study team also hopes to collect their baseline data when the program begins (by second week of July). Follow-up data collection for patients will occur after their final delivery (usually end of November) and provider/staff survey will also occur around that time. The study team will communicate with the program to find out when the last deliveries are occurring (not gathering any patient information, just overall timeline).

Baseline and final measures for participating patients are each expected to take approximately 15-20 minutes. In addition, VeggieRx participants will also complete a biweekly measure of engagement which will take approximately 2-minutes each time and will be sent via text message or email depending on participants' preferences throughout the duration of the 6-month VeggieRx delivery period. These questions will ask if they received their vegetable delivery, how much they liked the vegetables, how much they used them and if they fit with their families' eating habits.

As described above, providers and staff will be contacted via email/text/phone by the research assistant asking them to participate. They can complete measures with a research assistant or on their own. Baseline and follow-up surveys for providers/staff are each expected to take 10-20 min. All previously mentioned study procedures can take place in Spanish for patients whose primary language is Spanish by the research assistant research staff that is fluent in Spanish.

• Study Type: Interventional
• Enrollment (Actual): 52
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Rhode Island
    • Providence, Rhode Island, United States, 02912
      • Brown Research on Implementation and Dissemination to Guide Evidence use (BRIDGE) Program
    • Providence, Rhode Island, United States, 02912
      • Department of Behavioral and Social Sciences/School of Public Health

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Healthcare providers/staff Inclusion Criteria:

• 18 years of age or older
• healthcare provider/staff member who makes referrals to produce prescriptions (VeggieRx)
• fluent in English and/or Spanish

Healthcare providers/staff Exclusion Criteria

• under age 18
• have not been involved in referral process for produce prescriptions (VeggieRx)
• are not fluent in English and/or Spanish

Patient Inclusion Criteria:

• 18 years of age or older
• enrolled in the produce prescription program (VeggieRx)
• fluent in English and/or Spanish

Patient Exclusion Criteria:

• under age 18
• declined to enroll in the produce prescription program (VeggieRx)
• are not fluent in English and/or Spanish

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Enhanced Produce Prescription Implementation; The study team will develop an enhanced implementation blueprint to support uptake of the produce prescription (VeggieRx) intervention that is informed by advisory board input and includes multiple implementation strategies to address identified barriers to implementation.	Behavioral: Enhanced Produce Prescription Implementation; Practices make modifications to their usual produce prescription program based on an implementation blueprint. While the exact implementation strategies to be added will be defined based on qualitative data (data collection in progress), possible implementation strategies may include training or technical assistance.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient Engagement with the Produce Prescription Program Questionnaire	Patient engagement will be measured with a 4-question biweekly questionnaire that includes items rated on a 5-point (1-5) Likert-scale related to whether patients received the produce and whether they used it and liked it. Higher scores on each item indicate higher engagement. Scores range from 4-20.	Baseline
Patient Engagement with the Produce Prescription Program Questionnaire	Patient engagement will be measured with a 4-question biweekly questionnaire that includes items rated on a 5-point (1-5) Likert-scale related to whether patients received the produce and whether they used it and liked it. Higher scores indicate higher engagement. Scores range from 4-20.	Week 2
Patient Engagement with the Produce Prescription Program Questionnaire	Patient engagement will be measured with a 4-question biweekly questionnaire that includes items rated on a 5-point (1-5) Likert-scale related to whether patients received the produce and whether they used it and liked it. Higher scores indicate higher engagement. Scores range from 4-20.	Week 4
Patient Engagement with the Produce Prescription Program Questionnaire	Patient engagement will be measured with a 4-question biweekly questionnaire that includes items rated on a 5-point (1-5) Likert-scale related to whether patients received the produce and whether they used it and liked it. Higher scores indicate higher engagement. Scores range from 4-20.	Week 6
Patient Engagement with the Produce Prescription Program Questionnaire	Patient engagement will be measured with a 4-question biweekly questionnaire that includes items rated on a 5-point (1-5) Likert-scale related to whether patients received the produce and whether they used it and liked it. Higher scores indicate higher engagement. Scores range from 4-20.	Week 8
Patient Engagement with the Produce Prescription Program Questionnaire	Patient engagement will be measured with a 4-question biweekly questionnaire that includes items rated on a 5-point (1-5) Likert-scale related to whether patients received the produce and whether they used it and liked it. Higher scores indicate higher engagement. Scores range from 4-20.	Week 10
Patient Engagement with the Produce Prescription Program Questionnaire	Patient engagement will be measured with a 4-question biweekly questionnaire that includes items rated on a 5-point (1-5) Likert-scale related to whether patients received the produce and whether they used it and liked it. Higher scores indicate higher engagement. Scores range from 4-20.	Week 12
Patient Engagement with the Produce Prescription Program Questionnaire	Patient engagement will be measured with a 4-question biweekly questionnaire that includes items rated on a 5-point (1-5) Likert-scale related to whether patients received the produce and whether they used it and liked it. Higher scores indicate higher engagement. Scores range from 4-20.	Week 14
Patient Engagement with the Produce Prescription Program Questionnaire	Patient engagement will be measured with a 4-question biweekly questionnaire that includes items rated on a 5-point (1-5) Likert-scale related to whether patients received the produce and whether they used it and liked it. Higher scores indicate higher engagement. Scores range from 4-20.	Week 16
Patient Engagement with the Produce Prescription Program Questionnaire	Patient engagement will be measured with a 4-question biweekly questionnaire that includes items rated on a 5-point (1-5) Likert-scale related to whether patients received the produce and whether they used it and liked it. Higher scores indicate higher engagement. Scores range from 4-20.	Week 18
Patient Engagement with the Produce Prescription Program Questionnaire	Patient engagement will be measured with a 4-question biweekly questionnaire that includes items rated on a 5-point (1-5) Likert-scale related to whether patients received the produce and whether they used it and liked it. Higher scores indicate higher engagement. Scores range from 4-20.	Week 20
Patient Engagement with the Produce Prescription Program Questionnaire	Patient engagement will be measured with a 4-question biweekly questionnaire that includes items rated on a 5-point (1-5) Likert-scale related to whether patients received the produce and whether they used it and liked it. Higher scores indicate higher engagement. Scores range from 4-20.	Week 22
Patient Engagement with the Produce Prescription Program Questionnaire	Patient engagement will be measured with a 4-question biweekly questionnaire that includes items rated on a 5-point (1-5) Likert-scale related to whether patients received the produce and whether they used it and liked it. Higher scores indicate higher engagement. Scores range from 4-20.	Week 24
Patient Engagement with the Produce Prescription Program Questionnaire	Patient engagement will be measured with a 4-question biweekly questionnaire that includes items rated on a 5-point (1-5) Likert-scale related to whether patients received the produce and whether they used it and liked it. Higher scores indicate higher engagement. Scores range from 4-20.	Week 26
Patient Engagement with the Produce Prescription Program Questionnaire	Patient engagement will be measured with a 4-question biweekly questionnaire that includes items rated on a 5-point (1-5) Likert-scale related to whether patients received the produce and whether they used it and liked it. Higher scores indicate higher engagement. Scores range from 4-20.	Week 28
Acceptability of Intervention Measure	Acceptability of produce prescriptions will be assessed using the 4-item Acceptability of Intervention measure with scores ranging from 1 (completely disagree) to 5 (completely agree). Higher scores indicate higher acceptability of the intervention. Scores range from 4-20.	Baseline
Acceptability of Intervention Measure	Acceptability of produce prescriptions will be assessed using the 4-item Acceptability of Intervention measure with scores ranging from 1 (completely disagree) to 5 (completely agree). Higher scores indicate higher acceptability of the intervention. Scores range from 4-20.	6 month follow up
Feasibility of Intervention Measure	Feasibility of produce prescriptions will be assessed using the 4-item Feasibility of Intervention Measure with scores ranging from 1 (completely disagree) to 5 (completely agree). Higher scores indicate higher feasibility of the intervention. Scores range from 4-20.	Baseline
Feasibility of Intervention Measure	Feasibility of produce prescriptions will be assessed using the 4-item Feasibility of Intervention Measure with scores ranging from 1 (completely disagree) to 5 (completely agree). Higher scores indicate higher feasibility of the intervention. Scores range from 4-20.	6 month follow up
Intervention Appropriateness Measure	Appropriateness of produce prescriptions will be assessed using the 4-item Intervention Appropriateness Measure with scores ranging from 1 (completely disagree) to 5 (completely agree). Higher scores indicate higher appropriateness of the intervention. Scores range from 4-20.	Baseline
Intervention Appropriateness Measure	Appropriateness of produce prescriptions will be assessed using the 4-item Intervention Appropriateness Measure with scores ranging from 1 (completely disagree) to 5 (completely agree). Higher scores indicate higher appropriateness of the intervention. Scores range from 4-20.	6 month follow up
Evidence-Based Practice Attitudes Scale	The Evidence-Based Practice Attitudes Scale measures providers' attitudes toward evidence-based practices - specifically produce prescription programs. Scores range from 0 (not at all) to 4 (to a very great extent); higher scores indicate more positive attitudes toward evidence-based practices. Scores are calculated as an average and range from 0-4.	6-month follow up
Feasibility of Participant Enrollment	Proportion of participants who agree to enroll in the study out of those who are enrolled in the produce prescription program	Baseline
Implementation Climate Scale	This measure of implementation climate will assess the innovation-specific organizational climate for implementing produce prescription programs. Responses will be rated on a 4-point scale ranging from 0 (not at all) to 4 (very great extent). Higher responses indicate a stronger implementation climate. Scores are calculated as an average and range from 0-4.	6 month follow up
Implementation Readiness: Organizational Readiness for Implementing Change	This measure will assess organizations' readiness to implement a new intervention. Responses will be rated on a 5 point scale ranging from 1 (disagree) to 5 (agree). Higher scores indicate higher organizational readiness for change. Scores range from 12-60.	Baseline
Implementation Readiness: Organizational Readiness for Implementing Change	This measure will assess organizations' readiness to implement a new intervention. Responses will be rated on a 5 point scale ranging from 1 (disagree) to 5 (agree). Higher scores indicate higher organizational readiness for change. Scores range from 12-60.	6-month follow up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adoption of Produce Prescriptions	Number of patients who enroll in the produce prescription program	Baseline
Adoption of Produce Prescriptions	Number of patients who enroll in the produce prescription program	6 month follow up
Effectiveness: Food Security	Measured by the 6-item United States Department of Agriculture measure. Total scores range from 0-6, with lower scores indicating food security.	Baseline; 6 month follow up
Effectiveness: Food Security	Measured by the 6-item United States Department of Agriculture measure. Total scores range from 0-6, with lower scores indicating more food security.	Baseline
Effectiveness: Nutrition security	measured by the 4-item Nutrition Security measure. Responses range from "never" (0) to "always" (4). Items are scored by finding a mean of included items. Lower scores indicate more nutrition security.	6 month follow up
Effectiveness: Patient Health Questionnaire-2	The 2-item Patient Health Questionnaire will be used to screen for depression. Responses range from 0 (not at all) to 3 (nearly every day). Scores greater than 3 suggest that major depressive disorder is likely.	baseline, 6-month follow up
Effectiveness: Patient Health Questionnaire-2	The 2-item Patient Health Questionnaire will be used to screen for depression. Responses range from 0 (not at all) to 3 (nearly every day). Scores greater than 3 suggest that major depressive disorder is likely.	6-month follow up
Effectiveness: Dietary Screener Guide	Fruit and vegetable intake will be measured by the 10-item Dietary Screener Guide, in which participants will be asked to rate the frequency with which they have eaten a variety of foods. Responses range from "never" to "6 or more times per day." The measure is scored using a scoring algorithm that converts survey responses to estimates of average daily dietary intake for fruits and/or vegetables.	baseline, 6-month follow up
Effectiveness: Dietary Screener Guide	Fruit and vegetable intake will be measured by the 10-item Dietary Screener Guide, in which participants will be asked to rate the frequency with which they have eaten a variety of foods. Responses range from "never" to "6 or more times per day." The measure is scored using a scoring algorithm that converts survey responses to estimates of average daily dietary intake for fruits and/or vegetables.	6-month follow up

Collaborators and Investigators

• Sponsor: Brown University
• Collaborators: Peter G. Peterson Foundation
• Investigators: Principal Investigator: Hannah E Frank, PhD, Brown University; Principal Investigator: Alison Tovar, PhD, Brown University

Publications and helpful links

General Publications

• Frank HE, Guzman LE, Ayalasomayajula S, Albanese A, Dunklee B, Harvey M, Bouchard K, Vadiveloo M, Yaroch AL, Scott K, Tovar A. Developing and testing a produce prescription implementation blueprint to improve food security in a clinical setting: a pilot study protocol. Pilot Feasibility Stud. 2024 Mar 23;10(1):51. doi: 10.1186/s40814-024-01467-7.

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2023
• Primary Completion (Actual): November 30, 2023
• Study Completion (Actual): December 31, 2023

Study Registration Dates

• First Submitted: June 9, 2023
• First Submitted That Met QC Criteria: July 10, 2023
• First Posted (Actual): July 12, 2023

Study Record Updates

• Last Update Posted (Actual): May 31, 2024
• Last Update Submitted That Met QC Criteria: May 29, 2024
• Last Verified: May 1, 2024

More Information

Terms related to this study

• Keywords: implementation science; food insecurity; produce prescription program
• Other Study ID Numbers: STUDY00000018; 008225 (Other Grant/Funding Number: Peter G. Peterson Foundation)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Given the small dataset, data will not be made publicly available. However, de-identified quantitative data will be made available to individual investigators following a written request to the study principal investigators.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No