Mixed Methods Evaluation of a Shipped Medically Tailored Meal Pilot Intervention

Purpose: Medically tailored meal (MTM) programs generally demonstrate meaningful health outcomes for patients. There is a need to evaluate novel MTM delivery methods to understand participant and organizational-level impacts. The objectives of this study were to assess a shipped MTM pilot intervention, including 1) initial and ongoing client reach, 2) effects on clients' health and behaviors, and 3) staff members' perceptions of factors that influence intervention maintenance. Methods: Based on the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework, the mixed methods design included quantitative data collected from participants and qualitative data collected from MTM provider staff. The pilot took place in San Diego County, California, through one MTM provider. The 12-week pilot intervention included 21 MTMs per week and two virtual nutrition education sessions with a registered dietitian. Initial and ongoing reach measures included enrollment and completion rates, disenrollment rationale, and participant demographics. Measures of effectiveness included dietary patterns, chronic disease management, perceptions of food-related programming, and intervention satisfaction. Factors influencing intervention maintenance were assessed qualitatively. Results: The MTM provider surpassed their goal of enrolling >50 clients, but only 40% completed at least nine weeks of the pilot. There were statistically significant increases in intake of vegetables excluding potatoes and number of meals per day from pre- to post-implementation. Clients perceived that MTMs and food-related programming helped them to achieve or maintain a healthy weight, eat healthier foods, improve their health, and feel better. Interview results with staff showed that some but not all factors leading to sustainability were present. Conclusions: Overall, this evaluation of a pilot MTM program in San Diego County revealed mixed findings in intervention reach, effectiveness, and potential intervention maintenance.