Evaluation of the Fresh Start Program from the Patient's Perspective

Abstract

The objective of this study was to examine the experience and perceptions of participants from the Fresh Start Produce Prescription (FSPRx) program. Produce prescription (PRx) programs promote the consumption of fruits and vegetables by providing vouchers redeemable at a market or retailer and typically prioritize individuals with a nutrition and/or health risk. While PRx programs have demonstrated impact on nutrition and cardiometabolic outcomes, few have been implemented in rural areas and there is little research examining the experience of rural participants in PRx programming. This study used a pretest-posttest design and included uninsured patients diagnosed with type II diabetes or prediabetes who were recruited from safety net clinics in rural Eastern North Carolina. The FSPRx program included a PRx with non-starchy vegetables, group educational classes with a focus on improving food literacy, cooking demonstrations that aligned with the PRx, and individualized behavioral support via telephone- based health coaching. Audio-recorded phone interviews with a sub-sample of program participants (n=25) lasting 10-30 minutes were conducted post-program, transcribed verbatim, and analyzed. Themes from participants’ experience with the program included self-reported nutrition and health improvements (e.g., increased diet quality, culinary exposure, physical activity), the effectiveness of health coaching on self-efficacy and motivation for lifestyle changes, social support (e.g., group classes), and overall positive satisfaction with the synergistic manner of the program. Future programs should continue to examine and evaluate the experience and perceptions of participants in PRx programming within rural regions to better understand and overcome barriers to implementation and utilization of a PRx.