Caregiver-Reported Barriers to Redemption of Pediatric Fruit and Vegetable Prescriptions

Objective The current study explored perceived barriers to redemption of fresh produce prescriptions among caregivers of pediatric patients who participated in a fruit and vegetable prescription program (FVPP) in Flint, Michigan. Use of Theory or Research The pediatric FVPP was grounded in Social Cognitive Theory (SCT), which suggests that behavior is explained by a three-stage, dynamic model between personal factors, environmental factors, and behavior. With self-efficacy central to behavior change, pediatrician issuance of a prescription for fruits and vegetables to every child at each office visit was designed to support fresh food access as well as self-efficacy to consume healthy foods. Target Audience Caregivers of pediatric patients (0-18 years) across three large pediatric clinics in Flint, Michigan that offered the identical FVPP. Program Description The FVPP provided one $15 prescription to pediatric patients at each office visit. Prescriptions (valid for 90 days) were ordered via electronic medical records, printed on prescription paper, and redeemable for fresh produce at a downtown farmers’ market or local mobile market/food hub. The program was introduced to the first pediatric clinic, co-located with a farmers’ market, in 2016. It was expanded to two additional clinics in 2018 and 2021. Evaluation Methods Barriers to prescription redemption were assessed through one qualitative question included in a caregiver survey that was designed to examine program effectiveness. Answers were then coded into discrete categories and analyzed. Results A total of 496 caregivers completed surveys. Of those, 379 caregivers (76%) answered the question related to barriers to redemption. Although 265 reported no challenges with prescription redemption, 114 caregivers identified at least one barrier. Primary barriers across three clinics were lost, forgotten, or expired prescriptions (25%), transportation to or distance from farmers’ market (24%), and lack of time (23%). Differences in responses based on pediatric clinic location were also noted. Conclusion Results indicated several consistent barriers to prescription redemption that could be addressed to improve program utilization among participating families. Funding NIH The current study explored perceived barriers to redemption of fresh produce prescriptions among caregivers of pediatric patients who participated in a fruit and vegetable prescription program (FVPP) in Flint, Michigan. The pediatric FVPP was grounded in Social Cognitive Theory (SCT), which suggests that behavior is explained by a three-stage, dynamic model between personal factors, environmental factors, and behavior. With self-efficacy central to behavior change, pediatrician issuance of a prescription for fruits and vegetables to every child at each office visit was designed to support fresh food access as well as self-efficacy to consume healthy foods. Caregivers of pediatric patients (0-18 years) across three large pediatric clinics in Flint, Michigan that offered the identical FVPP. The FVPP provided one $15 prescription to pediatric patients at each office visit. Prescriptions (valid for 90 days) were ordered via electronic medical records, printed on prescription paper, and redeemable for fresh produce at a downtown farmers’ market or local mobile market/food hub. The program was introduced to the first pediatric clinic, co-located with a farmers’ market, in 2016. It was expanded to two additional clinics in 2018 and 2021. Barriers to prescription redemption were assessed through one qualitative question included in a caregiver survey that was designed to examine program effectiveness. Answers were then coded into discrete categories and analyzed. A total of 496 caregivers completed surveys. Of those, 379 caregivers (76%) answered the question related to barriers to redemption. Although 265 reported no challenges with prescription redemption, 114 caregivers identified at least one barrier. Primary barriers across three clinics were lost, forgotten, or expired prescriptions (25%), transportation to or distance from farmers’ market (24%), and lack of time (23%). Differences in responses based on pediatric clinic location were also noted. Results indicated several consistent barriers to prescription redemption that could be addressed to improve program utilization among participating families.