Background: Produce prescription programs (PRx) have the potential to improve participants' fruit and vegetable intake (FVI), and food security (FS), but further information is needed to understand which program characteristics contribute to these participant outcomes.
Purpose: To explore the associations between PRx design characteristics, incentive redemption, and program-level participant outcomes including FVI, FS, and perceived health.
Methods: An ecological, exploratory study with a quasi-experimental design (one group pre-test post-test) following the exploration, preparation, implementation, sustainment (EPIS) framework was used among Gus Schumacher Nutrition Incentive Program (GusNIP)-funded PRxs in the United States. Data were sourced from a GusNIP program operator survey (84% response rate; n = 80), PRx redemption data (n = 77), and an outcomes sample including redemption and participant outcomes data (n = 39 programs). Redemption data included program-level incentive distribution and redemption rates, measured as the dollar amount of incentives redeemed per participant per month. Participant data included changes in FVI (dietary screener questionnaire), FS (USDA household FS survey module), and perceived health (healthy days). Nonparametric and parametric comparisons were examined between program characteristics with program level-redemption rates and changes in aggregated participant-level outcomes.
Results: Program-level characteristics, design, and implementation features were associated both positively and negatively with redemption data and changes in participant outcomes including FVI, FS, and perceived health. Programs that provide more funds but serve fewer participants, offer transportation assistance, and offer staff training were positively associated with improved aggregated participant outcomes.
Conclusions: This exploratory research identified factors to be considered for promoting favorable program and participant outcomes in GusNIP PRx and similar initiatives.
Keywords: food is medicine; food security; fruit and vegetable intake; implementation science; perceived health; produce prescription.
This exploratory study examined the program design characteristics and implementation features of produce prescription programs, a type of food is medicine intervention, and their associations with incentive (i.e. prescription) redemption and participant outcomes. Participant outcomes include fruit and vegetable intake (FVI), food security (FS) status, and perceived health. Program-level characteristics, design, and implementation features were associated, both positively and negatively with redemption outcomes and average program-level participant outcomes, including FVI, FS, and perceived health. This exploratory study found that several program features were associated with better program-level participant outcomes, including providing more funding to fewer participants, and offering transportation support and staff trainings.
© The Author(s) 2026. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.