The impact of a produce prescription programme on healthy food purchasing and diabetes-related health outcomes

Julian Xie, Ashley Price, Neal Curran, Truls Østbye, Julian Xie, Ashley Price, Neal Curran, Truls Østbye

Abstract

Objective: To evaluate a Produce Prescription Programme’s utilisation and its effects on healthy food purchasing and diabetes control among participants with type 2 diabetes.

Design: Prospective cohort study using participants’ electronic health records and food transaction data. Participants were categorised as ‘Frequent Spenders’ and ‘Sometimes Spenders’ based on utilisation frequency. Multivariate regressions assessed utilisation predictors and programme effects on fruit/vegetable purchasing (spending, expenditure share and variety) and on diabetes-related outcomes (HbA1c, BMI and blood pressure).

Setting: Patients enrolled by clinics in Durham, North Carolina, USA. Participants received $40 monthly for fruits and vegetables at a grocery store chain.

Participants: A total of 699 food-insecure participants (353 with diabetes).

Results: Being female and older was associated with higher programme utilisation; hospitalisations were negatively associated with programme utilisation. Frequent Spender status was associated with $8·77 more in fruit/vegetable spending (P < 0·001), 3·3 % increase in expenditure share (P = 0·007) and variety increase of 2·52 fruits and vegetables (P < 0·001). For $10 of Produce Prescription Dollars spent, there was an $8·00 increase in fruit/vegetable spending (P < 0·001), 4·1 % increase in expenditure share and variety increase of 2·3 fruits/vegetables (P < 0·001). For the 353 participants with diabetes, there were no statistically significant relationships between programme utilisation and diabetes control.

Conclusions: Programme utilisation was associated with healthier food purchasing, but the relatively short study period and modest intervention prevent making conclusions about health outcomes. Produce Prescription Programmes can increase healthy food purchasing among food-insecure people, which may improve chronic disease care.

Keywords: Clinic community partnership; Electronic health records; Food insecurity; Grocery store transaction data; Nutrition incentive; Produce Prescription Programme.

Figures

Graphical abstract
Graphical abstract
Fig. 1
Fig. 1
Data timeline for Produce Prescription Programme. Timeline for electronic health records (her), food transaction and Produce Prescription Programme enrolment data. Diagram showing dates of availability for each data source. Red rectangle shows EHR data from November 2017 to June 2019, a blue rectangle shows food transaction data from April 2018 to June 2019 and a green rectangle shows the Produce Prescription enrolment period from May 2018 to May 2019
Fig. 2
Fig. 2
Food purchasing patterns for Produce Prescription Programme participants by utilisation level. Changes in food spending for participants month to month among those who were Frequent or Sometimes Spenders. See Supplemental Material for a table of data included in this figure. Two stacked bar charts showing spending patterns for Produce Prescription Programme Frequent Spenders and Sometimes Spenders. Each stacked bar has three segments to represent fruit and vegetable spending paid with Produce Prescription Dollars, fruit and vegetable spending paid with other methods and non-fruit and vegetable spending. Accompanying data are shown in table form in the Supplemental Material

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Source: PubMed

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