Assessing the implementation and outcomes of a food prescription program in Ontario, Canada: A realist evaluation

Abstract

Background: Social prescribing has grown in popularity around the world as a method for health care practitioners to address the social determinants of health. Social prescribing is the process of a practitioner identifying a non-medical, social need in a patient, and then developing a non-medical prescription to connect them to community services. A subset of social prescribing is food prescribing, in which patients who are typically identified as food insecure are connected with services to provide access to nutritious foods. The Fresh Food Prescription Program (FFRx) was implemented beginning in 2021 by the SEED, a working group of the Guelph Community Health Centre (GCHC). Clients of the GCHC who were identified as food insecure and experiencing a cardiometabolic health condition were provided weekly vouchers for fruits and vegetables at the SEED’s online grocery store.

Research question: The objectives of this research were 1) to describe the experiences of participants with FFRx 2) to evaluate impacts of FFRx on household food security, diet patterns, health, and well-being and 3) to identify how various contexts and mechanisms shaped differential program experiences and outcomes among FFRx participants.

Methods: Semi-structured interviews (n=23) were conducted with FFRx participants along with follow-up focus groups and individual discussions (n=10). Guided by realist evaluation, a hybrid thematic analysis was utilized to identify context, mechanisms, and outcomes in the data.

Results: Three key program outcomes were identified: 1) increased food access; 2) improved physical health and diet quality; and 3) improved mental health. Participants shared that they enjoyed having more food available to them and were able to purchase produce that was previously inaccessible due to financial constraints. Participants also noted that they consumed more fruits and vegetables during the program, as well as less nutrient poor foods. As a consequence, many participants associated their increased consumption of fruits and vegetables with improved physical health symptoms, more energy, and better sleep. Participants highlighted that they felt less stress throughout the program due to the stability of food access, increased social connections, and improved self-esteem.

Discussion and conclusion: This study builds on current understandings of food prescribing, through demonstrating how these program can benefit participants through enhancing food access as well as self-reported physical and mental health. Importantly, this study also acknowledges the need for long-term, sustainable programming and funding to support food prescribing initiatives. The research elucidated the importance of developing programs that are context-aware and include supportive mechanisms that foster agency among participants. Further, this research serves as a starting point for future realist evaluations to be conducted, and highlights program design elements that could be implemented in future food prescribing programs.