DOI: 10.3886/e238486v1
title: Enhancing the effectiveness of home-delivery based Produce Prescription program implementation strategies

description: Produce prescription
programs (PPPs) have emerged as a credible strategy to improve healthy food
consumption, and address diet-related disease risk among vulnerable populations.
Of the PPP implementation models, models in which patients are required to redeem
their prescription at a grocery store or a food pantry have demonstrated
challenges associated with incomplete redemption. Patient-related
factors such as participant demand and interest in consuming produce may be
better assessed by focusing on PPP implementation models that utilize home delivery
methods to provide produce to participants. Home delivery PPP models also have
the potential to facilitate patient engagement in nutrition education. Home
delivery-based PPPs that are supplemented with expanded nutrition and financial
literacy education have the potential to be considerably more successful in
promoting consumption of produce than unsupplemented PPPs. 

Our study was designed as an
RCT targeting pregnant women. The control arm was provided biweekly home deliveries
of fresh produce + standard nutrition education, and the intervention arm, in
addition to home delivered fresh produce, also obtained access to a Chatbot that
was programmed to provide health information, nutrition education and recipes
relevant to pregnant women. The objectives of this RCT are two-fold:
(a) to examine utilization of food basket contents and improvements in diet
quality in a standard home delivery PPP model (b) to evaluate if and the extent
to which these outcomes improve when a standard home delivery + tailored advice
on food preparation targeting the utilization construct of food insecurity to
convert food into healthy meals.
description: No survey weights were utilized.
description: Response Rates: Baseline survey 97.2%<br>Three-month survey 79.5%<br>Six-month survey 66.7%
description: Presence of Common Scales: Food security scale<br>Dietary Screener Questionnaire (DSQ)- 10 items to obtain fruit and vegetable consumption information.
description: Patients were recruited from up to seven high-risk pregnancy clinics affiliated with Harris Health, on a rolling basis, as long as they met screening criteria and consented to participate in the study.
description: The target population for this study were high risk pregnant women attending Harris Health clinics, which serves Medicaid eligible populations in Harris County, TX. Inclusion criteria are as follows: i) receiving prenatal care at HH obstetric clinics; ii) between 18 and 44 years of age; iii) &lt;= 20 weeks medically-confirmed viable pregnancy; iv) designated as high risk (high risk criteria includes: Age&gt;=35years, or obese or overweight (BMI&gt;=25.0 at pre-pregnancy self-report), or prior history of pregnancy hypertension or gestational diabetes), and v) within the zip code delivery radius. <br><br>To ensure that the women have the capability of interacting with the chatbot, an additional eligibility criterion will be used during screening. Specifically, to be eligible, women will need to confirm that they have access to a smartphone. Additionally women needed to reside within the zip codes where biweekly home food delivery was possible. . Smallest Geographic Unit: NA
description: computer-assisted self interview (CASI); other; 3 longer surveys including demographics, health status, diet quality, behavioral information were administered at baseline, 3 months and 6 months from the time of enrollment (unless 6 months occurred during the post-partum period. <br><br>In addition, utilization surveys were emailed to participants 10 days after each produce drop off, querying how much of the delivered produce was consumed. An average of 11 utilization surveys was completed by participants. <br><br>All surveys were sent to participants as a survey link via Redcap