Study of Produce Prescription Programs in Adults With Overweight or Obesity Experiencing Nutrition Insecurity

Johns Hopkins University48 enrolled

Overview

The goal of this study is to understand the best practices for implementing produce prescriptions among adults with overweight or obesity experiencing nutrition insecurity. Enrolled participants will receive an 8-week intervention aimed at increasing nutrition knowledge, self-efficacy for healthy eating, and barriers to healthy food access. Participants will be randomly assigned to one of two produce prescription implementation strategies: Program 1: Participants will receive weekly produce vouchers that are redeemable at a local vendor. Program 2. Participants will receive fresh produce delivered directly to the participant's home. These boxes will be tailored based on household size, cooking and preparation preferences, and produce the participant prefers to receive. Researchers will compare engagement in and adherence to the intervention and the patterns of difference in 8-week changes in fruit and vegetable consumption and weight.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Enrollment

Conditions

Overweight and Obesity

Interventions

Participants will receive a produce box delivered weekly to the participants home customized based on the participants cooking preferences and household size. Participants will also receive a daily text message aimed to support a healthy diet and lifestyle. These texts will include information to build participants' knowledge and skills for healthy eating. The participants will also include weekly goals that focus on eating a healthy diet. Participants will receive automated, personalized feedback via text messages based on participant goal attainment and daily responses.

Behavioral Text Message Program and Produce VoucherBEHAVIORAL

Participants will receive a weekly produce voucher redeemable at a local market vendor for fresh produce of the participant's choice. Participants will also receive a daily text message aimed to support a healthy diet and lifestyle. These texts will include information to build participants' knowledge and skills for healthy eating. The participants will also include weekly goals that focus on eating a healthy diet. Participants will receive automated, personalized feedback via text messages based on goal attainment and daily responses.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adult 18 years of age or older * Living with overweight or obesity, defined as a BMI ≥25 * Screens positive for nutrition insecurity * Has a smartphone with a data plan * Willing to receive daily text messages * Has an address that can receive delivery * Can read and write in English * Is willing to pick up produce at the Northeast Market Exclusion Criteria: * Participating in another related research study * Currently taking weight loss drugs * Cardiovascular disease event in the last 6 months * Active cancer * Recent hospitalization due to psychiatric condition or event * Pregnancy or planned during the study period * Currently breastfeeding * Documented dementia * On kidney dialysis * Planned or recent bariatric surgery * Weight exceeding 440 lbs. * Exclusion at principal investigators discretion

Outcomes

Primary Outcomes

Number of Participants Reached

The investigators will track the number of number of screening completions, number of eligible participants, and number of randomized participants, in addition to number of participants retained.

Time frame: From screening up to 8 weeks

Secondary Outcomes

Nutrition Insecurity as Assessed by the 4-item Nutrition Security Screening Questionnaire

Nutrition insecurity will be assessed using Center for Nutrition Health and Impact questionnaire with a 4-item scale. The higher the score, the greater the level of food security and control an individual has over their nutrition. The four items within the measure are scored from 0 to 4. Then, the measure's score is simply the mean of the responses.

Time frame: Baseline to 8 weeks

Fruit and Vegetable Consumption as Assessed by the 9-item Mini-Eating Assessment Tool (EAT)

Consumption of food groups will be assessed using the 9-item Mini-Eating Assessment Tool (EAT) questionnaire. Evaluates consumption of key food groups. Fruit and vegetable consumption were each based on two questions within the MINI eat scale, not subscales. Fruit ranges from 1 to 7 where 1 = less than 1 serving per week, and 7 = 4 or more servings per day. Vegetables range from 1 to 6 where 1 = less than 3 servings per week, and 6 = 4 or more servings per day. Mini-EAT score range 0-90. Higher scores better consumption.

Time frame: Baseline, 4 weeks, and 8 weeks

Weight (kg)

Weight will be taken by study staff and measured to the nearest 0.1 kg.

Time frame: Baseline, 8 weeks

Blood Pressure (mmHg)

Blood pressure was measured using the Omron 10 Series ® Upper Arm Blood Pressure Monitor. Participants were instructed to rest for five minutes before two blood pressure readings were taken on the upper arm, one minute apart. Measurements were averaged for analysis.

Time frame: Baseline, 8 Weeks

Health Self-Efficacy as Assessed by the 11-item Healthy Eating and Weight Self-Efficacy Scale

Self-efficacy was measured using the 11-item Healthy Eating and Weight Self-Efficacy Scale. Responses were rated on a Likert scale that ranged from "Strongly Disagree" to "Strongly Agree". Responses were summed to create a total score ranging from 11 to 55, with higher scores representing greater self-efficacy.