Abstract P163: Lessons Learned From the Implementation of a Produce Prescriptions Pre-Randomized Clinical Trial in an Integrated Health Care System
Authors: Padilla Ariadna , Mozaffarian Dariush , Wu Jason H , Chao Ceping , Nelson Casey , Schwartz Pamela , Nau Claudia 
Published: March 2023

Introduction:
Produce prescriptions are one of several approaches that have been receiving national attention to increase food security while also improving diet for patients with diet-related health challenges. Implementation of produce prescriptions vary widely, from food vouchers to tailored, pre-arranged weekly home deliveries. Our study focuses on sending weekly curated produce boxes, scaled by family size up to 5 members. We curated 5 different culturally themed boxes for participants to choose from with the ability to change theme at any time throughout the study period. It was our hypothesis that pre-curated, culturally varied boxes would allow to address patient food preferences to assure continued retention.

Methods:
This produce prescriptions pre-randomized clinical trial is being conducted at Kaiser Permanente Southern California, an integrated health care system with over 4.5M members. Adult members with uncontrolled diabetes with recent Hemoglobin A1c >7.5% or 8% (if >65 years or certain comorbid conditions) were pre-randomized into a high or low-dose (intervention) versus usual care group. Surveys are conducted at 4 different time points (2 and 8-week, 3 and 6 months) for participants pre-randomized to the intervention group. The eight week and 3 months survey that are now completed provide participant feedback on utility and satisfaction of both the food and recipes provided.

Results:
Recruitment has closed to enrollment; the intervention is slated to end January 2023. There were 150 participants enrolled in each arm for a total 450 participants. The average age at enrollment was 59 years. Over 62% reported currently being unemployed, retired or disabled. Just over half (51%), reported Spanish as their preferred language. Although diabetes was the main eligibility for this study, participants on average had 2-3 additional comorbidities, with 65% also being diagnosed with hypertension and 8.5% having congestive heart failure. Generally, respondents (N=187) considered the foods culturally appropriate with 69% indicating being familiar with the foods delivered and 70% knew how to prepare the foods. Recipes were moderately useful familiarizing participants with new foods (26%). Only 41% reported that of the foods new to them, they would use again in the future. Deliveries could be improved for future with participants overwhelmingly asking for more fruit, vegetables, legumes (98%, 94%, 71%), while also stating diary would be important to add to the deliveries (94%). Overall, 72% of participants reporting being very satisfied with the weekly produce deliveries and 81% stated the food helped them eat healthier throughout the week.

Conclusions:
Weekly produce deliveries are a promising approach to promote healthier eating providing more variety and autonomy in choices will likely increase use of produce and overall satisfaction in such programs.