Washington State's Fruit and Vegetable Prescription Program: Improving Affordability of Healthy Foods for Low-Income Patients

Jessica Marcinkevage, Alyssa Auvinen, Susmitha Nambuthiri, Jessica Marcinkevage, Alyssa Auvinen, Susmitha Nambuthiri

Abstract

Purpose and objectives: We conducted a mixed-methods process and outcome evaluation for a statewide fruit and vegetable prescription program. The process evaluation assessed program implementation, identified opportunities for quality improvement, and provided recommendations for future programmatic activities. The outcome evaluation measured how the program affected purchases of fruits and vegetables among low-income patients and patient satisfaction with the program.

Intervention approach: The Washington State Department of Health (WA DOH) partnered with public and private health care systems, public health agencies, a community-based organization, and a supermarket chain to launch a fruit and vegetable prescription program in 2016. The prescription was a $10 voucher redeemable for fruits and vegetables at any one of 169 participating supermarkets. Prescriptions were distributed to eligible low-income patients in clinics and community settings.

Evaluation methods: WA DOH reviewed quarterly reports, meeting minutes and notes, telephone call logs, and email logs to solicit feedback on program implementation processes. We calculated overall prescription redemption rates on the basis of the number of prescriptions distributed by implementing partners and the number of prescriptions redeemed at participating supermarkets. We assessed patient satisfaction through a web-based survey. The study period was July 1, 2016, through June 30, 2018.

Results: Best practices for implementation included using the prescription to improve patient engagement and retention and connect patients to additional services, and working in the community to enhance program support and uptake. Overall, $154,810 in fruit and vegetable prescriptions were redeemed during the study period (54.4% redemption rate). Most survey respondents (88.2%) reported eating more fruits and vegetables than previously as a result of the prescription.

Implications for public health: Fruit and vegetable prescriptions are an effective way to increase affordability of healthy foods for low-income patients. These programs are scalable and translatable across various types of patient-provider encounters.

Figures

Figure 1
Figure 1
Percentage of households receiving Supplemental Nutrition Assistance Program benefits by census tract and location of prescribing sites and participating supermarkets, Washington State’s Fruit and Vegetable Prescription Program, 2016–2018. Resources: Supplemental Nutrition Assistance Program data, American Community Survey, 2012–2016; clinic data, Healthy Eating Active Living Program, Washington State Department of Health.
Figure 2
Figure 2
Quarterly redemption rate of prescriptions for all implementing partners combined, Washington State’s Fruit and Vegetable Prescription Program, July 2016–June 2018. Redemption rates were calculated by dividing the number of prescriptions redeemed by the number of prescriptions distributed over the specified time period.
Figure 3
Figure 3
Dollar amount spent on fruit and vegetable purchases per prescription redeemed, Washington State’s Fruit and Vegetable Prescription Program, July 2016–July 2018.

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