“You Guys Really Care About Me…”: a Qualitative Exploration of a Produce Prescription Program in Safety Net Clinics

  • Allison V. SchlosserEmail author
  • Samantha Smith
  • Kakul Joshi
  • Anna Thornton
  • Erika S. Trapl
  • Shari Bolen
Original Research



Although research shows produce prescription (PRx) programs increase fruit and vegetable (FV) consumption, little is known about how participants experience them.


To better understand how participants experience a PRx program for hypertensive adults at 3 safety net clinics partnered with 20 farmers’ markets (FMs) in Cleveland, OH.


We conducted semi-structured interviews with 5 program providers, 23 patient participants, and 2 FM managers.


Patients interviewed were mainly middle-aged (mean age 62 years), African American (100%), and women (78%). Providers were mainly middle-aged men and women of diverse races/ethnicities.


Healthcare providers enrolled adult patients who were food insecure and diagnosed with hypertension. Participating patients attended monthly clinic visits for 3 months. Each visit included a blood pressure (BP) check, dietary counseling for BP control, a produce prescription, and produce vouchers redeemable at local FMs.


Patient interviews focused on (1) beliefs about food, healthy eating, and FMs; (2) clinic-based program experiences; and (3) FM experiences. Provider and market manager interviews focused on program provision. All interviews were audio-taped, transcribed, and analyzed thematically.

Key Results

We identified four central themes. First, providers and patients reported positive interactions during program activities, but providers struggled to integrate the program into their workflow. Second, patients reported greater FV intake and FM shopping during the program. Third, social interactions enhanced program experience. Fourth, economic hardships influenced patient shopping and eating patterns, yet these hardships were minimized in some participants’ views of patient deservingness for program inclusion.


Our findings highlight promises and challenges of PRx programs for economically disadvantaged patients with a chronic condition. Patient participants reported improved interactions with providers, increased FV consumption, and incorporation of healthy eating into their social networks due to the program. Future efforts should focus on efficiently integrating PRx into clinic workflows, leveraging patient social networks, and including economic supports for maintenance of behavior change.


patient education nutrition health education hypertension disparities 



Produce prescription


Farmers’ markets


Fruit and vegetable


Produce prescription program for hypertension



We thank participating clinics (Northeast Ohio Neighborhood Health Center, Inc., (NEON) Hough Health Center; St. Vincent Medical Group Medical Arts Physician Center; and Cleveland Clinic Stephanie Tubbs Jones Health Center), providers, FM managers, and patients for their partnership in this work.

Funding Information

This publication is supported by Cooperative Agreement Numbers 5 U58 DP005851-03 and 1U48DP005013 from the Centers for Disease Control and Prevention, and Mt. Sinai Healthcare Foundation.

Compliance with Ethical Standards

All study procedures were approved by the MetroHealth Medical Center Institutional Review Board.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


The findings and conclusions are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Department of Health and Human Services. No copyrighted materials, survey, instruments, or tools were used.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Allison V. Schlosser
    • 1
    Email author
  • Samantha Smith
    • 2
  • Kakul Joshi
    • 3
  • Anna Thornton
    • 3
  • Erika S. Trapl
    • 3
  • Shari Bolen
    • 4
    • 5
    • 6
    • 7
  1. 1.Department of Bioethics, School of Medicine Case Western Reserve UniversityClevelandUSA
  2. 2.Epidemiology, Surveillance, & InformaticsCuyahoga County Board of HealthParmaUSA
  3. 3.Prevention Research Center for Healthy Neighborhoods, Department of Population and Quantitative Health SciencesCase Western Reserve UniversityClevelandUSA
  4. 4.Better Health PartnershipClevelandUSA
  5. 5.Department of MedicineMetroHealth Medical CenterClevelandUSA
  6. 6.Department of Population and Quantitative Health SciencesCase Western Reserve UniversityClevelandUSA
  7. 7.Center for Health Care Research and PolicyCase Western Reserve University at the MetroHealth SystemClevelandUSA

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