Predictors of Voucher Redemption in Produce Prescription Programs in a Primarily Low-Income Population With Type 2 Diabetes

Introduction: Food as Medicine initiatives, including produce prescription (PRx) programs, provide incentives (ie, vouchers) for participants to purchase free or reduced-cost produce. Voucher redemption is central to PRx effectiveness, yet predictors of redemption are poorly characterized. Prior evaluations often excluded nonusers, potentially overestimating effects. We applied an intent-to-treat (ITT) approach to examine the association between baseline characteristics and voucher redemption rates (VRRs) in a PRx program among primarily low-income Hispanic/Latino adults with type 2 diabetes. Methods: In this single-arm, pre-post study, 154 participants were enrolled in a 7-month PRx program offering up to $90 in fruit and vegetable vouchers for attending monthly nutrition education sessions. Binomial logistic regression assessed predictors of ITT-VRRs, including transportation access, baseline fruit and vegetable intake, and knowledge of produce preparation. Results: The sample was majority female (66.2%), Hispanic/Latino (83.1%), and low income (using public health insurance [88.9%] or food insecure [76.0%]). Most participants shared purchased produce with others in the household (61.2%). The ITT-VRR was 65.8%, versus 84.3% in per-protocol analysis. Higher odds of ITT-VRR were associated with transportation access (personal car [odds ratio, 2.28; 95% CI, 1.94-2.67]), while little/no self-reported knowledge of how to prepare fruit and vegetables was associated with lower odds (odds ratio, 0.58; 95% CI, 0.52-0.63). Conclusion: Transportation access and baseline knowledge of how to prepare fruit and vegetables were associated with voucher redemption, suggesting vouchers alone may not sustain engagement or dietary change. To enhance program equity and effectiveness, future PRx programs may consider pairing vouchers with strategies addressing transportation challenges and supporting fruit and vegetable preparation-related capability.