TL;DR
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A University at Buffalo randomized study found that food-insecure older adults used significantly more prescribed produce when it was delivered to their homes than when they had to collect it at a market. Produce use was 89.2% in both delivery groups and 28.3% in the voucher-and-market group; adding meal kits did not increase use beyond delivery alone.
A 12-week randomized study by University at Buffalo researchers found that food-insecure older adults used prescribed fresh produce more often when it was delivered to their homes than when they had to collect it at a market. Produce preparation and consumption reached 89.2% in both delivery groups, compared with 28.3% among participants offered vouchers for market collection, according to the study published in Frontiers in Public Health.
The study included 67 adults recruited from primary care clinics at Erie County Medical Center in Buffalo. Participants were mostly African American, older than 65, and had reported experiencing food insecurity at times. Researchers assigned them to one of three groups for 12 weeks.
One delivery group received weekly fresh produce boxes through local company FreshFix and could customize the contents. The second received home-delivered meal kits containing produce and ingredients for three meals, with five or six kit options available each week. The comparison group received vouchers to collect produce at the hospital’s mobile market or participating FeedMore Western New York markets.
Researchers defined redemption as the preparation and consumption of the delivered produce. Both home-delivery groups recorded 89.2%, while the market-based group recorded 28.3%. The study also found that adding meal kits did not raise produce use compared with produce-box delivery alone. The researchers reported that participants in both delivery groups rated the program above nine out of 10 and said they would recommend it.
Why Home Delivery Raised Use
The results point to access and convenience as possible barriers to food prescription programs that depend on people collecting food themselves. In the study report, corresponding author Lucia A. Leone said people may lack transportation or feel uncomfortable visiting food pantries, where some voucher redemption locations operate. Those explanations are the researchers’ account of possible barriers; the trial does not establish how much each factor contributed to the difference.
For clinics and community organizations, the findings suggest that the delivery model can affect whether food assistance is actually used. A prescription or voucher does not, by itself, mean that a participant will obtain and eat the food. The higher use recorded in the delivery groups may help program planners assess whether removing the trip to a market is worth the added logistics and cost. The study did not report a cost comparison, so it cannot establish whether delivery is more cost-effective.
The findings also suggest that meal kits may not be necessary to increase produce use for this particular group. Leone said participants may already have known how to prepare the produce; providing a greater quantity of food, rather than cooking instructions, may have contributed to improved food security. That explanation is an interpretation from the study’s author, not a separately proven mechanism.
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How the Three Programs Differed
Food prescription programs provide food-insecure patients with access to foods such as fruits and vegetables, often through vouchers or market partnerships. In the approach used as the study’s comparison, participants had to take vouchers to a mobile market or other participating market to collect produce. The Buffalo trial tested whether home delivery changed use, and whether pairing delivery with meal ingredients added further benefit.
Leone described voucher non-redemption as a longstanding challenge for these programs and said the team wanted to compare delivery with the market-based standard approach. The study’s design made delivery the default for participants in the two intervention groups, while allowing them to customize produce if they wished. The authors said that default and the option to customize may have contributed to the results.
The trial was conducted in Buffalo and partnered with FreshFix, a local delivery company co-founded by Leone. Participants also spoke positively about the delivery driver, Charles Humphrey. Leone said that a connection with a consistent, personable program representative may help a program succeed, but the study’s reported results do not isolate the driver’s role from delivery, customization or other differences between groups.
“The problem historically with food prescription programs is that people get the vouchers but don’t redeem them.”
— Lucia A. Leone, corresponding author and University at Buffalo associate professor
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Limits of the Buffalo Trial
The findings come from a small sample of 67 people in one city and cover a 12-week program. The study does not show whether the same differences would appear in larger programs, other locations or populations with different needs. It also does not establish long-term effects on diet, health outcomes or sustained food security.
The report says produce use was 89.2% in both delivery groups and 28.3% in the market group, but the supplied study summary does not provide further detail on how those percentages were calculated across participants or deliveries. Participants sometimes missed deliveries because they were out of town or felt they already had enough food, according to Leone. The relative contribution of delivery, order customization and personal interaction also remains uncertain.
The study authors said that the meal kits did not improve produce use over produce boxes in this group. That result does not show whether meal kits might help a different population, such as families with young children. Nor does the study establish whether home delivery’s higher use outweighs its costs for health systems or public programs.
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Researchers Plan a Family Trial
Leone and colleagues plan a similar study with families enrolled in Medicaid who experience food insecurity and have children ages 2 to 6. The research is to be conducted with local pediatric practices. That population may face different barriers and food needs, so the researchers will be able to examine whether program design and delivery matter in a different setting.
The Buffalo study was published in Frontiers in Public Health under the title “A randomized controlled study comparing three food prescription programs for older adults: program design, implementation, and utilization.” Further results from the planned family study, including how its program is delivered and whether its findings resemble the older-adult trial, have not yet been reported.
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Key Questions
What did the study find about home-delivered produce?
In this 12-week trial, 89.2% produce use was recorded in each of the two home-delivery groups. The market-based voucher group recorded 28.3%. The study defined redemption as preparing and consuming the produce.
Did meal kits lead participants to use more produce?
No additional increase was reported. Produce use was 89.2% in both delivery groups, whether participants received produce boxes or meal kits with ingredients for three meals.
Who took part in the trial?
The study recruited 67 adults from primary care clinics at Erie County Medical Center in Buffalo. Participants were mostly African American, over 65 and had reported experiencing food insecurity at times.
Can the results be applied to all food prescription programs?
The study does not establish that. It was a small, 12-week trial in Buffalo, and the results may not apply to other populations or program designs. Researchers say they plan a related study with Medicaid families who have children ages 2 to 6.
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