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

IMPLEMENTATION EVALUATION — Volume 16 — July 18, 2019

Jessica Marcinkevage, PhD, MSPH1; Alyssa Auvinen, BS1; Susmitha Nambuthiri, PhD, MSc1 (View author affiliations)

Suggested citation for this article: Marcinkevage J, Auvinen A, Nambuthiri S. Washington State’s Fruit and Vegetable Prescription Program: Improving Affordability of Healthy Foods for Low-Income Patients. Prev Chronic Dis 2019;16:180617. DOI: http://dx.doi.org/10.5888/pcd16.180617.

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Summary

What is already known on this topic?

Programs that increase affordability of fruits and vegetables through financial incentives have improved fruit and vegetable consumption and food security among participants. However, program scalability is limited when programs rely on partnerships with farmers markets and small-scale grocers.

What is added by this report?

Through a process and outcome evaluation, this report highlights program implementation successes and barriers of providing fruit and vegetable prescriptions in partnership with a supermarket chain to low-income residents in Washington State.

What are the implications for public health practice?

A statewide fruit and vegetable prescription program is scalable and translatable across various types of patient–provider encounters and helps improve affordability of fruits and vegetables for low-income residents.

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.