Review of Single Group Study Shows Associations Between Produce Prescription and Eating in Pregnant Women
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Key Takeaway
Interpret positive outcomes as associations due to single-group pre-post design limitations.
This review examines a single-group pre-post study evaluating the Food4Moms Produce Prescription Program. The scope includes pregnant Latina women in Greater Hartford, Connecticut. The intervention involved $100 per month Fresh Connect debit cards for 10 months, nutrition education sessions, and text messages. The comparator was baseline data in a pre-post design. Follow-up occurred 10 months after card activation.
Key outcomes included healthy eating stages of change, intake of fresh produce, and household food security. The results indicated a positive impact on healthy eating readiness, fruit consumption, and vegetable consumption with p < 0.001. Household food security also showed a positive impact with p = 0.034. The sample size included N=113 completers and N=41 non-completers.
Limitations are explicitly noted by the authors regarding the single-group pre-post study design. This design prevents definitive causal conclusions about the intervention effects. Safety data regarding adverse events, serious adverse events, discontinuations, and tolerability were not reported in the source.
Practice relevance suggests that implementation research is needed to find out how to effectively scale out and sustain programs like F4M. Clinicians should interpret these findings as associations rather than proven causal effects due to the study design. Further evidence is required to confirm long-term benefits.
View Original Abstract ↓
Produce prescription programs (PRx) targeting different populations and conditions have been found to be effective. However, few have focused on pregnant women. The objectives of this study were to assess the impact of the Food4Moms (F4M) PRx on 1) healthy eating stages of change 2) intake of fresh produce, and 3) household food security among pregnant Latina women. F4M recruited low-income Latinas living in Greater Hartford, Connecticut that received a "produce prescription" from a Registered Dietitian based at the community-based organization (CBO) where the program was implemented. Participants were offered $100 per month for 10 months through Fresh Connect debit cards to purchase fresh produce from two food retailers or the equivalent value in fresh produce delivered at home. To be fully enrolled in F4M, participants had to complete a baseline survey and the first nutrition education interactive session. Enrolled participants were offered additional nutrition education sessions at the CBO and received text messages with nutrition tips as well as reminders to spend their remaining benefit balances towards the end of each month. A single-group pre-post study design was used to assess the impact of F4M 10 months after the card activation. No attrition bias was detected when comparing the characteristics of those completing (N=113) vs. those not completing the endline survey (N=41). Pre-post Wilcoxon signed-test or paired t-test analyses showed that F4M had a positive impact on healthy eating readiness (p < 0.001), the consumption of fruits (p < 0.001) and vegetables (p < 0.001), and household food security (p = 0.034). F4M is a promising community-engaged PRx program that may improve readiness for healthy eating, produce intake, and household food security. Implementation research is needed to find out how to effectively scale out and sustain programs like F4M. The study was registered in ClinicalTrials.gov (identifier: NCT05907616).
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