2015-16 Fresh Prescription Final Report

The Ecology Center
Fresh Prescription Program
Final Evaluation Report
April 2016
Email: ssw.ccpeg@umich.edu
Phone: 734-615-3367
1080 S. University Ave.
Ann Arbor, MI 48109
http://ssw.umich.edu/research/curtis
-center/program-evaluation

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Curtis Center Program Evaluation Group
The Curtis Center Program Evaluation Group trains and professionally
prepares students and recent social work graduates in program evaluation
by providing evaluation services to a broad range of community-based
agencies. Established in September 2011, the Curtis Center Program
Evaluation Group at the University of Michigan School of Social Work
engages the community to provide professional evaluation services and
matches students’ educational goals with projects. Employing a utilization-
focused approach to evaluation, the Program Evaluation Group provides
high-quality, professional evaluation services through a social work lens.
Program Evaluation Staff
Sue Ann Savas, MSW
Principle Investigator
Sarah J. Lewis-Crow, MSW
Lead Evaluator
Meredith Philyaw, MS
Evaluator
Chad Jobin, LLMSW
Evaluator
Abigail Anderson
Evaluation Assistant
Alexandra Albers
Courtney Coleman
Savannah O’Neil

Fresh Prescription Program Final Evaluation Report
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Executive Summary
The Fresh Prescription program, first implemented at Community Health and Social Services
(CHASS) in 2013, is a community-based fruit and vegetable prescription program that bridges the
gap between the food and health care systems in Detroit, Michigan. Participants in the Fresh
Prescription program receive a “prescription to eat more fresh fruits and vegetables” from their
health care provider, and receive program dollars to spend at participating local farmers’ markets or
through a food share program. Participants also engage in nutrition education throughout the Fresh
Prescription program, learning how to eat a healthy diet, how to select, prepare, and store fresh
fruits and vegetables, and how to find fresh fruits and vegetables in their local communities.
Five unique sites participated in Fresh Prescription during the 2015-16 season: (1) American Indian
Health and Family Services (AIHFS), (2) Community Health and Social Services (CHASS), (3)
Henry Ford Health System (HFHS), (4) Joy-Southfield Community Development Corporation, and
(5) Mercy Primary Care Center. Each site tailored the fundamental Fresh Prescription model to meet
the needs of the specific communities that they serve. Together, these five sites formed the Fresh
Prescription Network – in partnership with Eastern Market and with the leadership of the Ecology
Center – meeting regularly to collaborate and discuss the progress of the program overall.
This report presents the findings of a process and outcome evaluation project completed by the
University of Michigan School of Social Work Curtis Center Program Evaluation Group. This
report also presents findings on the experiences of local vendors participating in the Fresh
Prescription program, and the benefits of the Fresh Prescription Network on both the site and
program levels. The report includes both quantitative and qualitative data, collected from program
participants, program staff, health care providers, and local vendors.
Fresh Prescription Program Implementation
An estimated 311 program participants took part in the 2015-16 Fresh Prescription season, which
started in July 2015 and continued into early 2016. The Fresh Prescription program reached a total
of 1,000 individuals, including 369 children. Low-income women of color who reported high rates
of food insecurity and limited access to fresh fruits and vegetables were the program’s primary
service recipients. 81% of all Fresh Prescription participants consumed two cups or less of fruit and
vegetables each day at the start of the program, which is less than the United States Department of
Agriculture’s recommended daily value of two cup-equivalents of fruit and two and a half cup-
equivalents of vegetables.
Overall, participants, program staff, and providers reported that the 2015-16 Fresh Prescription
season was a success. Program participants spent over $8,600 on fresh fruits and vegetables, which
accounts for about 91% of the “prescribed” produce made available through the Fresh Prescription
program. Program dollars spent by program participants supported local food vendors.
Key factors that reportedly facilitated program success included the financial accessibility of the
Fresh Prescription program, engaging site atmospheres, convenient schedules, and the buy-in of
program staff and health care providers. Nonetheless, the season was not without its challenges. Key

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barriers to program implementation included participants’ limited access to reliable transportation,
difficulty in meeting the sites’ goals for referrals, market timing, and the pressure of limited funding.
Fresh Prescription Program Outcomes
Despite the unique characteristics of the five 2015-16 Fresh Prescription sites, largely similar
outcomes emerged across the different organizations. Key program outcomes include:
Participant Outcomes
Positive outcomes among participants include increased access to fresh food, changes in knowledge
and attitudes, positive behavior changes, and positive changes in health. Overall, participants also
reported a high level of satisfaction with the Fresh Prescription program.
Fresh Food Access
• There was a statistically significant change in the frequency of participants shopping at
farmers’ markets or farm stands from the start of the program to the end.
• While 23% of participants identified themselves as food secure at the start of the program,
about 32% identified as food secure at the end of the program.
• Participants’ perceived ability to find the fresh fruits and vegetables they were looking for in
their community rose from 65% at the beginning of the Fresh Prescription program to 80%
at the end of the program.
Knowledge & Attitude Changes
• 88% of participants reported an increase in their knowledge about the importance of eating
fruits and vegetables.
• There was evidence that, by the end of the program, Fresh Prescription participants who
believed in the importance of eating more fruits and vegetables also reported positive
changes in their self-reported health status.
• Statistics suggest that participants who reported a high level of confidence in their ability to
eat more fruits and vegetables also reported a change in vegetable intake over the course of
the program.
• There was also evidence that, by the end of the program, participants who were confident in
their ability to eat more fruits and vegetables also reported an increase in the amount of
fruits and vegetables eaten each day.
• There was a statistically significant change in knowledge regarding how to prepare and
cook fresh fruits and vegetables from the start of the program to the end of the program.
• There was a statistically significant change in knowledge regarding how to store fresh
fruits and vegetables to increase their shelf life from the start to the end of the program.
• There was a statistically significant change in participants’ perceived ability to count on
the people around them for support in eating more fresh fruits and vegetables from the start
of the program to the end of the program.

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Behavior Changes
• There was a statistically significant change in both participants’ daily fruit consumption
and participants’ daily vegetable consumption from the start of the program to the end.
Specifically, the data shows that the percentage of participants eating 0-1 cups of fresh fruits
dropped from 53% to 34% while the percentage of participants eating 0-1 cups of fresh
vegetables dropped from 53% to 37% from the start of the program to the end of the
program. Meanwhile, the percentages of participants eating 1-2, 2-3, or 3+ cups of fruit and
vegetables all increased over the course of the Fresh Prescription program.
• 80% of participants report cooking with fruits and vegetables that they did not cook before.
• 81% of participants reported trying new fruits and vegetables that they had not eaten before.
• 82% of participants reported buying new fruits and vegetables that they did not buy before.
• 82% of participants reported an increase in knowledge about where to buy fresh fruits and
vegetables.
• 88% of Fresh Prescription participants reported an increase in the amount of fresh fruits and
vegetables that they eat each day.
• 87% of Fresh Prescription participants reported an increase in the amount of fresh fruits and
vegetables that their families eat each day.
53%
34%
28%
33%
14%
26%
5%
8%
53%
37%
28%
38%
10%
9%
13%
0-1 Cups0-1 Cups
1-2 Cups
2-3 Cups
3+ Cups
3+ Cups
2-3 Cups
1-2 Cups
Changes in Fresh Prescription
participants’ vegetable consumption
Changes in Fresh Prescription
participants’ fruit consumption

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• Statistics suggest that Fresh Prescription participants with high attendance rates also
reported an increase in participants eating fruits and vegetables by the end of the program.
• There was a statistically significant change in the number of times that Fresh Prescription
participants ate unhealthy foods each day; the average number of times that participants ate
unhealthy foods decreased from an average of 2.09 times per day at the start of the Fresh
Prescription program to just 1.62 times per day at the end of the program.
Changes in Health
• The percentage of participants who identified themselves as in “poor” health decreased from
12% of participants to 5% of participants from the start to the end of the program.
• The percentage of participants who identified themselves as in “fair” health stayed steady at
43% of participants from the start of the participants to the end of the program.
• The percentage of participants who identified themselves as in “good,” “very good,” or
“excellent” health increased from 46% of participants to 53% of participants from the start
of the program to the end of the program.
• Evidence suggests that participants who reported an increase in fruit consumption (number
of cups eaten each day) also reported a change in self-reported health status.
• There was also evidence to suggest that participants who frequently shopped at farmers’
markets or farm stands also reported a change in self-reported health status by the end of the
Fresh Prescription program.
• There was a statistically significant change in participants’ A1C levels at CHASS and
Mercy Primary Care Center (N=69); the average A1C level among participants at the start of
the program was 9.3, and the average A1C level at the end of the program was 8.5.
• 90% of participants report that they are able to manage their health conditions better.
Participant Satisfaction
• 95% of participants reported being “somewhat satisfied” or “very satisfied” with their
participation in the Fresh Prescription program.
• 85% of participants report that they would continue shopping at the Fresh Prescription sites,
even if they did not have Fresh Prescription program dollars.
• 97% of participants would recommend the program to a friend or relative.
Provider Outcomes
Health care providers at the Fresh Prescription sites noted subtle, yet meaningful changes in clinical
interactions. In interviews with Curtis Center evaluators, providers noted that by bridging the food
and health care systems, the Fresh Prescription program helped participants to see “food as
medicine.” Participation in the program also helps participants to see healthy eating as a way of
preventing health problems later in life. Furthermore, providers noted a slight increase in
participants’ motivation and involvement in their own health. Through involvement in the Fresh
Prescription program, participants seemed to be empowered to improve their own health.

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Organization Outcomes
Participation in the Fresh Prescription program helped organizations to expand their constituencies
and engage with health education and food access in an innovative, holistic way. Program staff at the
five Fresh Prescription sites also talked about how their participation in the Fresh Prescription
program had helped their organizations form partnerships with other agencies and local vendors.
Vendor Outcomes
Local vendors participating in the 2015-16 Fresh Prescription season reported a high level of
satisfaction and engagement with program participants. Key findings include:
• 75% of vendors participated in the Fresh Prescription program for the first time this year.
• Overall, vendors were content with the onboarding process, but expressed some uncertainty
about expectations for the first market day and their ability to answer participants’ questions.
• 92% of vendors reported talking to participants about fresh food and healthy eating.
• 100% of vendors reported developing new relationships with program staff and 85%
reported developing new relationships with customers and health educators.
• 70% of vendors reported strengthening existing relationships with Fresh Prescription
program staff and 60% reported enhancing existing relationships with other vendors.
• 57% of vendors reported an increase in revenue at farmers’ markets which offered the Fresh
Prescription program during the 2015-16 season.
Feedback on the Fresh Prescription Network
Participation in the Fresh Prescription Network was beneficial both for individual sites and for the
Fresh Prescription program overall. Individual sites benefitted from the peer support and shared
resources of the Fresh Prescription Network. On the program level, the existence of the Fresh
Prescription Network allowed members to share ideas, facilitated connections among organizations,
and created the opportunity for collaborative and centralized fundraising efforts.

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Table of Contents
Curtis Center Program Evaluation Group.....................................................................................................2
Program Evaluation Staff .................................................................................................................................2
Executive Summary...........................................................................................................................................3
Table of Contents..............................................................................................................................................8
Purpose of the Report.....................................................................................................................................10
Background.......................................................................................................................................................12
Methodology.....................................................................................................................................................14
Data Collection ............................................................................................................................................14
Data Collection Limitations.......................................................................................................................17
Data Analysis................................................................................................................................................19
Fundamental Fresh Prescription Model & Timeline..............................................................................20
Results................................................................................................................................................................21
Prescription Utilization...............................................................................................................................21
Participant Outcomes..................................................................................................................................23
Number of People Reached by the Fresh Prescription Program.....................................................23
Participant Demographics......................................................................................................................23
Participant Fresh Food Access..............................................................................................................26
Knowledge & Attitude Changes............................................................................................................29
Behavior Changes....................................................................................................................................33
Changes in Health ...................................................................................................................................39
Participant Satisfaction ...........................................................................................................................42
Provider Outcomes .....................................................................................................................................45
Organization Outcomes .............................................................................................................................47
2015-16 Fresh Prescription Implementation...........................................................................................49
Feedback on the Fresh Prescription Network ........................................................................................53
Vendor & Food System Outcomes...........................................................................................................55
Considerations for Next Steps.......................................................................................................................64

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Appendices........................................................................................................................................................68
Appendix I: Logic Models & Site Snapshots...............................................................................................68
Site Snapshot: American Indian Health & Family Services................................................................69
Site Snapshot: Community Health & Social Services (CHASS).........................................................72
Site Snapshot: Henry Ford Health System............................................................................................76
Site Snapshot: Joy-Southfield Community Development Corporation............................................80
Site Snapshot: Mercy Primary Care Center...........................................................................................84
Appendix II: AIHFS Survey Results.............................................................................................................87
Appendix III: Site-by-Site Breakdown of Survey Results..........................................................................93

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Purpose of the Report
The Curtis Center Program Evaluation Group prepared the following report to provide stakeholders
at the Ecology Center and Community Health and Social Services Center (CHASS) with data from
and pertaining to the 2015-16 Fresh Prescription program. The report focuses on the analysis of
qualitative and quantitative data to address the following key evaluation questions:
Process Questions
General Program
• What are the main components of a typical Fresh Prescription program?
• What is the timeline of activities for a typical Fresh Prescription program?
• What factors affected implementation of the Fresh Prescription program at each site?
o To what extent are these factors similar across sites?
Fresh Prescription Network
• In what ways has the Fresh Prescription Network helped Network members develop new
collaborations?
• What resources have the sites received as a result of their involvement in the Fresh
Prescription Network?
• What do Network members perceive to be the strengths and weaknesses of the Network?
Providers
• To what extent were providers engaged in the program?
Program Staff
• To what extent were program staff engaged in the program?
Local Food Vendors
• What is the onboarding process like for new market vendors?
• To what extent were vendors satisfied with their experience as a program vendor?
• What do vendors perceive to be the strengths and weaknesses of the market at each site?
Participants
• To what extent were participants engaged in the program?
• What factors affected participants’ engagement in the program?
• To what extent were participants satisfied with the program?
• What do participants perceive to be the strengths and weaknesses of the program?

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Outcome Questions
Sites
• How did the program impact participating sites?
• How did being a member of the Fresh Prescription Network benefit the sites?
• What new partnerships did the sites develop as a result of the Fresh Prescription program?
Providers
• In what ways did clinical interactions change between providers and patients whom they
referred to the Fresh Prescription program?
• In what ways did involvement in the Fresh Prescription program change the clinical
interactions between providers and patients who were not involved in the program?
• To what extent are provider outcomes similar across sites?
Local Food Vendors
• In what ways did the customer mix of participating vendors change through the program?
• To what extent did the revenue of participating vendors change as a result of the program?
• In what ways did the variety of foods sold by participating vendors change as a result of the
Fresh Prescription program?
• What new partnerships did the vendors develop as a result of the program?
Participants
• In what ways did participants’ access to fresh fruits and vegetables change from the
beginning to the end of the Fresh Prescription program?
• To what extent did participants’ awareness about being able to use their benefits at local
farmers markets change from the beginning to the end of the Fresh Prescription program?
• In what ways did participants’ knowledge about how to select fresh fruits and vegetables
change from the beginning to the end of the Fresh Prescription program?
• In what ways did participants’ knowledge about how to store fresh fruits and vegetables
• In what ways did participants’ attitudes about the importance of eating more fruits and
vegetables change from the beginning to the end of the Fresh Prescription program?
• To what extent did participants’ confidence in their ability to eat more fruits and vegetables
• In what ways did participants’ food shopping behaviors change from the beginning to the
end of the Fresh Prescription program?
• In what ways did participants’ meal preparation activities change from the beginning to the
end of the Fresh Prescription program?
• In what ways did participants’ eating patterns change from the beginning to the end of the
Fresh Prescription program?
• How did participants’ health indicators change from the beginning to the end of the Fresh
Prescription program?
• To what extent are participant outcomes similar across sites?

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Background
The Fresh Prescription program, previously known as Health
Rx, is a community-based fruit and vegetable prescription
program in Detroit, Michigan designed to: (1) increase access
to fresh, locally-grown produce among vulnerable patients at
participating local health centers; and (2) build a collaborative
network of local health centers, food retailers, and
community partners with a shared vision of providing fresh
produce and nutrition education activities to patients in
Detroit. The program was piloted at the Community Health
and Social Service Center (CHASS) in July 2013 and recently
completed its third year of implementation. Five sites
participated in the 2015-16 market season: CHASS, American
Indian Health and Family Services (AIHFS), Henry Ford Health
System (HFHS), Joy-Southfield Community Development Center,
and Mercy Primary Care Center. Each participating site implements
their own variant of the Fresh Prescription program, with differing
eligibility criteria, program timelines, variety of services and
education offered, and mode of service delivery.
During Years 1 and 2 of the Fresh Prescription program, the
Curtis Center Program Evaluation Group’s evaluation activities
focused on documenting: (1) program implementation of the
CHASS pilot; (2) program participation at the CHASS, AIHFS,
and Joy-Southfield sites; and (3) short-term outcomes among
CHASS program participants. Year 3 of the evaluation was
intended to build on previous evaluation activities, via continued
tracking of program implementation and participant outcomes at
all five participating sites1
. These activities were conducted with
the broader intent of investigating: (1) what common elements
emerge across the Fresh Prescription program variants implemented
at each site; (2) the overall impact of the program on participants,
providers, participating local vendors, and sites; and (3) to what
extent outcomes are similar across Fresh Prescription program sites.
1 Please note that this graphic is intended to demonstrate how the evaluation project developed over the course of 2013,
2014, and 2015. The size of the gears in the graphic reflects the number of participants at each of the sites.
Year 3:
HFHS
Year 3:
Mercy
Year 2:
Joy-Sfld.
Year 1:
CHASS
Year 2:
AIHFS

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Site Overviews
As noted above, the Fresh Prescription program’s 2015-16 season took place at five distinct sites in
Detroit, Michigan: (1) AIHFS, (2) CHASS, (3) HFHS, (4) Joy-Southfield, and (5) Mercy Primary
Care Center. The following provides a brief overview of each site:
American Indian Health & Family Services
At American Indian Health and Family Services (AIHFS), participants
are referred by staff to a nutritionist. The target population includes
those with chronic disease, pregnant women, and children. Participants
pick up fresh produce boxes monthly and the program runs year-round.
Community Health & Social Services Center
At the Community Health and Social Services (CHASS) site, participants
are referred to the program by their health care provider. CHASS targets
individuals with high blood pressure, high cholesterol, diabetes,
pregnant women, and caregivers of children 0-5 years old. Fruit and
vegetable prescriptions may be filled at the CHASS market in southwest
Detroit from July to early October.
Henry Ford Health System
At the Henry Ford Health System (HFHS) site, participants are referred
to the program by a provider. HFHS targets patients with a BMI of 30
or higher. From June to November, HFHS participants can go to the
weekly market, visit Peaches and Greens, or choose a delivery option.
Joy-Southfield Community Development Corporation
At the Joy-Southfield Community Development Corporation site,
participants are referred by a provider at Covenant Community Care.
Joy-Southfield focuses on those who live in the nearby neighborhoods,
those without fresh food access, and those who are overweight. The
program runs from June to October and participants can go to the
market weekly across from the clinic.
Mercy Primary Care Center
At the Mercy Primary Care Center site, participants are referred to the
program by a provider. The target population includes those with
chronic diseases such as hypertension and diabetes, and those with food
insecurity. The program runs from July to September and participants
can go to the weekly market at the entrance to the Samaritan Center.

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Methodology
Data Collection
Both quantitative and qualitative data were collected to answer the key evaluation questions. The
following data collection tools were used in the Fresh Prescription evaluation:
Biometric Data
AIHFS, CHASS, and Mercy Primary Care Center provided the Curtis Center evaluators with a
sample of Fresh Prescription program participants’ biometric data including A1C test results, weight,
height, blood pressure, cholesterol, low density lipoprotein (LDL), and waist circumference.
Card Utilization Data
Spending data from program debit cards used by participants at CHASS, HFHS, Joy-Southfield, and
Mercy Primary Care Center was provided to Curtis Center evaluators by My Epic Idea, the creators
of the application used for tracking Fresh Prescription debit card usage.
Key Informant Interviews
Between October 2015 and January 2016, Curtis Center evaluators conducted 20 semi-structured
key informant interviews with Fresh Prescription program stakeholders (i.e. participating sites’ staff,
administrators, and health care providers), participants, and vendors. Key informant interviews were
conducted both in person and over the phone. Interview participants were asked about their roles in
the Fresh Prescription program, their opinion of how the program went this year, and the level of
engagement that they observed. Depending upon the interview participant’s role, specific questions
were also included (e.g. providers were asked if they observed any changes in the nature of their
clinical visits). Interview participants were also asked about the program’s overall strengths and areas
for improvement, as well as what advice they would give to someone in their position in the future.
Participant Focus Groups
Curtis Center evaluators conducted focus groups with Fresh Prescription program participants from
the following sites: CHASS (conducted in both English and Spanish), Joy-Southfield, and Mercy
Primary Care Center. Focus group questions gauged participants’ level of participation in the
program, barriers that may have prevented their participation, program strengths and areas for
improvement, as well as changes in participants’ health, attitudes, knowledge, and beliefs regarding
healthy eating. Specifically, participants were asked to talk about any changes that they noticed in
their own or their family’s health; what they learned from participating in the Fresh Prescription
program; and how participation in the program impacted their everyday life. Participants were also
asked how they found out about the Fresh Prescription program; typical food purchasing habits; and
whether they would continue to shop at the sites without program dollars.

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Participant Pre-Program Surveys
A 28-item closed-ended survey, co-created by stakeholders at the Ecology Center and CHASS, was
administered to Fresh Prescription participants at the start of the program.
The pre-program survey assessed program participants’ current access to fresh fruits and vegetables,
their self-reported health status, and their household’s level of food security. Participants were also
asked about their typical daily fruit and vegetable consumption, how often they ate unhealthy foods
(such as chips, fast food, or soda/pop), and whether their children helped to prepared fruits or
vegetables for snacks or meals (if applicable). Surveys also assessed participants’ attitudes,
knowledge, and beliefs regarding healthy eating. Near the end of the survey, program participants
were asked to share demographic information such as age, gender, race or ethnicity, household
composition (i.e. number of adults, children ages 6-17, and ages 0-5), household income, and
participation in assistance programs like SNAP, WIC, Project FRESH, and Double Up Food Bucks.
Women were asked whether or not they were currently pregnant or breastfeeding. Lastly,
participants were asked whether or not they had a smartphone or tablet, and whether or not they
were interested in a diet, exercise, and healthy living application. At CHASS, pre-program surveys
were available in both English and Spanish.
Participant Post-Program Surveys
A 30-item closed-ended survey, co-created by Curtis Center evaluators and representatives of the
Ecology Center and CHASS, was administered to Fresh Prescription program participants at the end
of their participation in the program.
The post-program survey assessed program participants’ level of satisfaction with the program, the
likelihood of them recommending the program to a friend or relative, and their intention to shop at
the market or site in the future if they did not have Fresh Prescription dollars. The survey also asked
participants to report any changes in their behaviors, such as eating more fruits and vegetables,
managing a health condition, or buying and cooking with fresh fruits and vegetables that they had
not tried before. Participants were also asked to report how frequently they shopped at a farmers’
market or farm stand, how much money they spent in cash on fresh fruits and vegetables (beyond
program dollars), and how many adults came to the market with them. The post-survey also
repeated the questions regarding the participants’ self-reported health status, their household’s level
of food security, typical daily fruit and vegetable consumption, how often they ate unhealthy foods
(such as chips, fast food, or soda/pop), and whether their children helped to prepared fruits or
vegetables for snacks or meals (if applicable). The survey also re-assessed participants’ attitudes,
knowledge, and beliefs regarding healthy eating. At CHASS, post-program surveys were again
available in both English and Spanish.

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Program Attendance Records
The five Fresh Prescription sites provided Curtis Center evaluators with the following program
participant attendance data:
• AIHFS: attendance data is conveyed in terms of prescriptions picked-up by Fresh
Prescription program participants.
• CHASS: data consists of total markets attended by Fresh Prescription program participants,
with denotation for attendance at all four markets.
• HFHS: data includes visits to HFHS market, but specific data pertaining to affiliated box
delivery and participants’ visits to the Peaches and Greens store were not available.
• Joy-Southfield: data consists of Fresh Prescription program participants’ number of visits
to the Joy-Southfield market.
• Mercy Primary Care Center: data consists of Fresh Prescription program participants’ total
number of visits to the Mercy Primary Care Center market.
Site Observations
Curtis Center evaluators conducted in-person, largely non-participatory observations at each of the
five Fresh Prescription sites. Curtis Center evaluators noted the setting and layout of the site, the
atmosphere and general mood, the presence of educational materials, and interactions amongst
program participants, program staff, and local vendors.
Vendor Surveys
Curtis Center evaluators created an online Qualtrics survey containing 11 items to be answered by all
respondents and unique blocks of questions for vendors who participated in Fresh Prescription at
AIHFS (17 questions), CHASS (16 questions), HFHS (16 Questions), Joy-Southfield (16 Questions),
and Mercy Primary Care Center (16 Questions). The survey assessed the vendors’ satisfaction with
their overall experience, and asked them to evaluate the onboarding process and the support of
program staff. The survey also asked vendors about their interactions with program participants,
what they talked about, what handouts the vendors had available, what factors were important when
selecting produce for the sites. Vendors also reported whether they noticed changes in their
customer mix, the types of foods sold, their revenue, or any community partnerships.

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Data Collection Limitations
Evaluation Timing
As Curtis Center evaluators came onto the project after participants had already been enrolled at
some sites, detailed and consistent tracking systems for biological indicators and activities received
by participants (e.g. nutritional counseling) were not created.
Tracking Providers and Referrals
For this evaluation project, the tracking of Fresh Prescription program participants began with the
completion of the pre-program survey. Accordingly, no data was collected on those patients who
received a referral, but did not complete the pre-program survey. These patients may have a) never
formally enrolled in the program, or b) enrolled in the program but did not complete the survey. In
future evaluation projects, it would be beneficial to track the number of health care providers
involved in referring patients at each participating clinic, as well as the number of referrals that
providers make over the course of the market season.
Differences in Program Timelines
Among the differences between the five Fresh Prescription sites was a difference in program
timelines. The programs at CHASS, HFHS, Joy-Southfield, and Mercy Primary Care Center began in
the early summer and continued until early autumn. However, the Fresh Prescription program at
AIHFS (Fresh Food Share) continued past the end of data collection on March 3, 2016. The AIHFS
program was further extended since participants at AIHFS receive their prescriptions monthly, as
opposed to being available each week throughout the summer. As a result, AIHFS participants were
still receiving prescriptions at the end of data collection and 52% of AIHFS participants (N = 31)
had not yet completed the post-program survey.
Survey Question Differences
While the pre-program and post-program surveys administered at CHASS, HFHS, Joy-Southfield,
and Mercy Primary Care Center included the same set of survey questions, the AIHFS surveys
included a number of distinct differences. Accordingly, direct comparisons of survey results across
all five sites was not possible for some survey questions. The survey results and analysis from
AIHFS participants is included in Appendix II of this report.
Consistency of Biometric Measures
Curtis Center evaluators received biometric data from only three of the five Fresh Prescription sites:
AIHFS, CHASS, and Mercy Primary Care Center. At those sites, biometric data was only available
from some of the participants for a variety of reasons. At AIHFS, numerous participants were still in
the midst of the program and did not have both pre- and post-program data available. At CHASS,
biometric data was collected as a part of an optional ad hoc study and included only those
participants who had been diagnosed with diabetes and had an A1C level over 6.5 within three
months before the start of the program. At Mercy Primary Care Center, some participants expressed
concern about sharing their biometric data in spite of assurances that the biometric data would be
de-identified. Furthermore, there was no one biometric measure that was consistent across the three

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sites: AIHFS reported height, weight, body-mass index (BMI), and waist circumference. CHASS
reported A1C, weight, and blood pressure. Mercy Primary Care Center reported A1C, BMI, blood
pressure, cholesterol, and LDL. Accordingly, it was not possible to conduct statistical analyses
comparing the biometric outcomes across the three Fresh Prescription sites.
Participant Qualitative Data Collection at HFHS
Given the relatively small number of Fresh Prescription program participants at HFHS (8 total
participants) and the transportation concerns faced by those participants, the determination was
made to conduct key informant interviews with participants instead of conducting a focus group.
Due to various timing and staffing constraints, the participant key informant interviews could not be
completed. Future evaluation activities should include the collection of qualitative data from HFHS
program participants via either focus groups or key informant interviews.
Survey Completion Rates
While 311 program participants completed the pre-program survey, only an average of 60% of
participants went on to complete a post-program survey (See Table 1). This may have occurred for
a number of reasons, including program attrition and program timeline (in the case of AIHFS). This
survey completion rate later impacted statistical analysis, since pre to post paired t-tests could only
be conducted with a segment of participant survey data.
Pre-Program Post-Program % Completed
AIHFS 60 29* 48%*
CHASS 152 90 59%
HFHS 8 6 75%
Joy-Southfield 66 36 55%
Mercy Primary Care Center 25 25 100%
Total 311 186 60%
*Post-surveys completed as of March 3, 2016; AIHFS box distribution still in progress.
Participation in Multiple Programs
Since Curtis Center evaluators did not collect information on whether Fresh Prescription program
participants were involved in multiple programs focused on healthy eating, it is possible that
participant outcomes are not solely attributable to the Fresh Prescription program. Although
multiple stakeholders were asked about the changes that they have noticed in participants as a result
of the program, future evaluation activities could include an impact evaluation so the unique
outcomes of the Fresh Prescription program can be better teased out.
Table 1. Participant Survey Completion Rates

19
Data Analysis
Quantitative Analysis
IBM Statistical Package for the Social Sciences (SPSS; Version 22.0) was used to analyze all
quantitative data. Descriptive statistics, such as frequencies, will be employed to summarize program
participation and participant responses to survey questions asked at one time point. For data
collected at two time points, bivariate and multivariate statistical tests were conducted to identify
statistically significant changes in participant responses between pre- and post-program, as well as
statistically significant differences in participant outcomes between sites. Pearson Correlations were
also conducted to help us understand the relationships between variables.
Qualitative Analysis
Qualitative data collected through key informant interviews and focus groups was audio recorded
and later transcribed. Curtis Center evaluators then created pre-set codes and a code book based on
an initial high-level reading of the transcriptions. Following a brief test of inter-coder reliability, the
qualitative data was coded and analyzed using NVivo 10 to identify themes and patterns in
responses. Emergent codes were added to the coding scheme throughout the coding process. Matrix
queries were used to highlight differences between the sites on key themes and patterns.

20
Fundamental Fresh Prescription Model & Timeline
While each of the five 2015-16 Fresh Prescription sites adapted the Fresh Prescription model to
meet the needs of the communities that they serve, each site was guided by the same basic
principles. The Fresh Prescription model merges the healthcare system and food system by bringing
together participants, healthcare providers, social sector staff, and local food vendors in Detroit,
Michigan. The fundamentals of the Fresh Prescription program include:
Referral
A health care provider or other social sector staff member refers a prospective
participant to the Fresh Prescription program. In some cases, this is done via a
screening process; patients who meet specific eligibility requirements may be sent a
letter inviting them to participate.
Assessment
A clinician, community health worker, community educator, or dietitian determines
if a prospective participant is a good fit for the Fresh Prescription program. The
participant is assessed based on their current access to fresh fruits and vegetables,
their knowledge, attitudes, and behaviors in regards to healthy eating, as well as
their interest and availability to participate in the program.
Receiving the Prescription
Participants receive a prescription to “eat more fruits and vegetables” from their
clinician, community health worker, community educator, or dietitian, and set goals
for healthy eating.
Filling the Prescription
Participants receive up to $60 to spend at participating farmers’ markets, farm
stands, or to order boxes of fresh fruits and vegetables. These prescription dollars
are distributed in set increments (typically $10 each time) over the course of a set
time period. In most cases, participants receive $10 on a weekly basis, and in other
cases participants receive a larger sum on a monthly basis.
Educational Activities
To complement the prescription dollars, participants engage in a variety of health
education activities such as nutrition education, cooking demonstrations, or
exercise classes. Participants also receive a variety of materials, such as recipes for
cooking with fresh fruits and vegetables or maps to help participants find local
farmers’ markets or farm stands in their communities.

Results
The following section presents the overall results of the 2015-16 Fresh Prescription season,
including prescription utilization, participant outcomes, provider and organization outcomes,
feedback on the Fresh Prescription Network., and new insights on vendor experiences.
Prescription Utilization
Using data provided by the My Epic Idea application creators on Fresh Prescription debit card
usage, Curtis Center evaluators determined that participants spent an average of $32.96 per
participant over the course of the season (see Figure 1). The average dollar amount loaded onto each
card was $36.37. Accordingly, participants2
used about 91% of prescribed program dollars.
2 This debit card spending data does not include AIHFS participants.
Figure 1. Average total spending by Fresh Prescription participants in 2015-16 season

22
In total, over $8,600 was spent on fresh fruit and vegetables by Fresh Prescription participants this
year. That figure is equivalent to about 91% of the fresh fruits and vegetables “prescribed” to
participants throughout the 2015-16 market season (Figure 2).
Additional Cash Spending on Fruits & Vegetables
Fresh Prescription participants were also asked about how much they typically spend in cash on
fruits and vegetables. The intent of this question was to understand how much cash participants
spent in addition to their prescription dollars. However, there appears to have been some confusion
among participants regarding the wording of the question (specifically regarding the amount spent
with prescription dollars versus cash); there does not appear to be a clear pattern among responses.
Overall, 10% of participants reported spending $0, 9% of participants reported spending $1-$5, 28%
of participants reported spending $6-$10, 18% of participants reported spending $11-$15, 8% of
participants reported spending $16-$20, and 27% of participants reported spending $20 or more
(Table 59, Appendix III).
Figure 2. Percent of program dollars used by Fresh Prescription participants this season

23
Participant Outcomes
This section outlines the number of people reached by the Fresh Prescription program, participant
demographics, participant fresh food access, changes in participants’ knowledge and attitudes,
changes in participants’ behaviors, changes in health, and participant satisfaction.
Number of People Reached by the Fresh Prescription Program
Number of Participants
Curtis Center evaluators collected pre-program surveys from a total of 311 Fresh Prescription
participants. The site with the largest number of participants in the 2015-16 season was CHASS (152
participants), while the site with the smallest number of participants was HFHS (8 participants)
Number of Household Members Reached
Overall, the 2015-16 Fresh Prescription program reached an estimated 1,000 household members.
The majority of these household members (631 people) were adults. The program also reached 222
children ages six to seventeen, as well as 147 children ages zero to five (Table 3, Appendix III).
Participant Demographics
Participants from Last Year
Participants at AIHFS, CHASS, and Joy-Southfield were asked whether they or someone in their
household had participated in the Fresh Prescription program in the past. 35% of participants in the
2015-16 Fresh Prescription program also took part in the program in 2014.
Participant Age
Across program sites, the average participant age was 49 years old. The youngest program
participant was reportedly 18 years of age. Conversely, the oldest participant in the 2015 market
season was 90 years of age. At the site level, the average age ranged from 48 years of age (AIHFS) to
53 years of age (HFHS) (Table 5, Appendix III).
Participant Gender
Across program sites, 81% of Fresh Prescription participants identified as “female;” 19% of
program participants identified as “male” (n=57). This narrative remained consistent at individual
program sites as AIHFS, CHASS, HFHS, and Mercy Primary Care Center; all reported having at
least 83% of program participants identify as female. Joy-Southfield had the lowest number of
female Fresh Prescription program participants, at 62% (Table 6, Appendix III).

24
New & Expecting Mothers
Across sites, the 2015 Fresh Prescription program had few participants who were expectant mothers
(4%; n=9). Among individual sites, AIHFS had the largest number of expectant mothers (6%; n=5)
who took part in the Fresh Prescription program. There were 13 individuals who reported
breastfeeding during the 2015-16 market season. At the site level, CHASS had the largest number of
breastfeeding mothers (9%) (Table 7 and Table 8, Appendix III).
Households with Young Children
Thirty one percent of all 2015 Fresh Prescription participants reported having at least one child
between the ages of 0 and five years of age living in their household. At the site level, CHASS (39%)
and AIHFS (32%) had the highest percentages of program participant households with young
children (Table 4, Appendix III).
Race & Ethnicity
Forty four percent of all 2015 Fresh Prescription program participants identified as African
American or Black. The second largest group of participants (37%) identified as Latino, Hispanic, or
Spanish origin. The remaining 19% of program participants identified as either Caucasian/white,
Native American or American Indian, two or more races/ethnicities, or “other.”
African American or Black participants represented the largest group of program participants at
HFHS (88%), Joy-Southfield (88%), and Mercy Primary Care Center (100%). Among participants at
CHASS, 74% identified as Latino, Hispanic, or of Spanish origin. The largest group of AIHFS
participants (26.7%) identified as Native American or American Indian. (Table 9, Appendix III).
Household Income & SNAP Usage
Fifty two percent of all 2015-16 Fresh Prescription program participants reported an annual
household income of less than $15,000. The next largest segment of participants (27%) reported
household income between $15,000 and $24,999. 14% of participants said that they were “not sure”
about their annual household income.
At the site level, AIHFS (65%), Joy-Southfield (65%), and HFHS (75%) reported the highest
number of Fresh Prescription program participants who had a household income of less than
$15,000. Conversely, Joy-Southfield (2%) was the only program site to have participants with a
household income above $55,000 (Table 10, Appendix III).
Both at the start and end of the 2015-16 Fresh Prescription program, 57% of participants reported
receiving EBT, Bridge Card, Food Stamp, or SNAP benefits (Table 11 and Table 12, Appendix III).

25
Where Participants Buy Food
Sixty four percent of Fresh Prescription program participants indicated using grocery stores as their
primary spot for purchasing food (Figure 1). Produce markets such as Randazzo’s (45%) and
“supercenters” such as Walmart (26%) were also frequently mentioned as shopping destinations
among Fresh Prescription program participants (Table 19, Appendix III).
Barriers to Accessing Fresh Fruits & Vegetables
Many 2015-16 Fresh Prescription program participants (42%) indicated that the main barrier to
accessing fresh fruits and vegetables was that they are too expensive. The second largest group of
participants (28%) said that nothing was a barrier to such access. Program participants also cited
unreliable means of transportation (27%) and the distance to stores and/or markets (20%) as
barriers to acquiring fresh fruits and vegetables (Figure 4).
Counter to the overall averages described above, the largest group of program participants at Mercy
Primary Care Center (40%) indicated that distance was the primary barrier to acquiring fresh fruits
and vegetables (Table 20, Appendix III).
3%
6%
6%
20%
26%
45%
64%
Community Garden
Corner/Party Store
Food Pantry
Farmers' Markets
Supercenter
Produce Market
Grocery Store
8%
13%
20%
27%
28%
42%
Don't know how to select the best produce
Not available where I shop
Store/market too far away
No reliable transportation
Nothing
Too expensive
Figure 3. Participants primarily purchase food at grocery stores and produce markets
Figure 4. Barriers to accessing fresh fruits & vegetables

26
Consumption of Fruits & Vegetables at the Start of the Program
Upon starting the 2015-16 Fresh Prescription program, over a quarter of participants (29%)
reported eating a half cup or less of fruit per day. Over half (51%) reported eating between a half
cup and two cups of fruit per day, which is less than the USDA recommended two cups of fruit per
day3
At the start of the program, almost a quarter (23%) of participants reported eating a half cup or less
of vegetables each day. Over half (58%) reported eating a half cup to two cups of vegetables per day,
again less than the USDA recommended minimum of two and a half cups of vegetables per day
Participant Smartphone & Tablet Access
At the beginning of their involvement in the 2015-16 Fresh Prescription program, about 53% of
participants across sites indicated that they had access to a smartphone or tablet. At 53%, CHASS
had the largest number of program participants who lacked access to such technology. Of those
participants with access to a smartphone, about 75% of participants reported that the smartphone
was an Android (Table 13 and Table 14, Appendix III).
Participant Fresh Food Access
Frequency of Shopping at Farmers’ Markets & Farm Stands
Participants demonstrated a statistically significant change in the frequency of shopping at
farmers’ markets or farm stands from the pre-program survey to the post-program survey.4
Figure
14 below illustrates this change in participant responses. While 40% of participants reported never
or rarely shopping at a farmers’ market or farm stand at the start of the program, that number
decreased by half over the course of the program. Nearly a third (31%) of participants reported
shopping at a farmers’ market or farm stand “weekly or more” at the end of the program.
3
United States Department of Agriculture (USDA) “Healthy U.S.-Style Eating Pattern.” Retrieved from
http://health.gov/dietaryguidelines/2015/guidelines/chapter-1/a-closer-look-inside-healthy-eating-patterns/
4
Paired samples t-test; N=142; t = -5.408; p<0.000
40%
21% 23%
17%20% 20%
29% 31%
Never or Rarely Once a Month 2-3 Times per Month Weekly or More
Pre-Program Survey Post-Program Survey
Figure 5. Change in frequency of shopping at farmers’ markets or farm stands

27
Using SNAP Benefits at Local Famers’ Markets
Participants’ knowledge about SNAP benefits at local farmers’ markets also expanded over the
course of the Fresh Prescription program. At the start of the program, just over half (53%) of
participants reported that they were aware that people can use SNAP benefits at local farmers’
markets. By the end of the program, that statistic had increased to over two thirds of participants;
66% of participants reported being aware that people can use SNAP at local farmers’ markets.
While participants’ use of SNAP stayed steady at 57% throughout the program, the use of WIC
decreased from 25% to 19%, use of Project FRESH increased from 6% to 18%, and use of Double
Up Food Bucks increased from 4% to 12% by the end of the program (Table 11, Appendix III).
Change in Food Insecurity Levels
There was a statistically significant change in
participants’ reported food insecurity levels from the
pre-program survey to the post-program survey.5
Overall, about three quarters of the Fresh Prescription
participants identified themselves as some level of food
insecure throughout the course of the program (Figure
6). At the start of the program, only 23% of participants identified themselves as food secure
(“I/We always have enough to eat and the kinds of food we want”). At the end of the program, the
percentage of food secure participants had increased to about 32%. The category “I/We always have
enough to eat, but not always the kinds of food we want” was selected by the largest group of
participants on both the pre- and post-program surveys; 49% of participants selected this category at
the start of the program, and 53% of participants selected this category at the end of the program
(Table 34 and Table 35, Appendix III).
5
Paired samples t-test; N=143; t=-2.627; p=0.010
23%
49%
21%
7%
32%
53%
12%
3%
Figure 6. Change in participant food insecurity levels
I/We always have
enough to eat &
the kinds of food
we want
I/We always have
enough to eat, but
not always the kinds
of food we want
Sometimes I/We
do not have
enough to eat
“I’ve eaten fruit that I haven’t eaten
in a lot of years. Because of cost and
limited transportation… I haven’t
eaten a plum or pear in probably
almost 30 years.”– Participant
Often I/We do
not have enough
to eat

28
Finding Fresh Fruits & Vegetables in Participants’ Communities
There was a statistically significant change in participants’ perceived ability to find the fresh fruits
and vegetables they were looking for in their community.6
Overall, across all five sites, the percentage of participants who agreed with the statement “I can find
the fresh fruits and vegetables I am looking for in my community” rose from 65% at the beginning
of the Fresh Prescription program to 80% at the end of the program (Figure 7).
These findings were consistent at each of the five sites as well; AIHFS participants’ level of
agreement with the statement “I can find the fresh fruits and vegetables I am looking for in my
community” rose from 70% to 83%, CHASS participants’ level of agreement rose from 71% to
85%, HFHS participants’ level of agreement rose from 25% to 67%, Joy-Southfield participants’
level of agreement rose from 64% to 79%, and Mercy Primary Care Center participants’ level of
agreement rose from 44% to 64% (Table 46 and Table 47, Appendix III).
6
5%
9%
21%
44%
22%
3% 5%
12%
54%
26%
Strongly Disagree Disagree Neutral Agree Strongly Agree
Figure 7. Change in participant’s ability to find fresh produce in their community

29
Knowledge & Attitude Changes
Changes in participants’ knowledge and attitudes about healthy eating emerged across all five Fresh
Prescription program sites. The following section outlines specific knowledge and attitude changes:
Importance of Eating Fresh Fruits & Vegetables
Participants rated the importance of eating fresh fruits and vegetables on a 1 to 10 scale, where 10
was very important and 1 was not important. Overall, participants rated eating more fruits and
vegetables as highly important; the average rating was above 9 for both the pre-program survey and
the post-program survey. Specifically, there was a slight positive increase in participants’ average
ratings overall, from 9.21 on the pre-program survey to 9.28 on the post-program survey. This
increase in importance ratings was mirrored at the CHASS and Mercy Primary Care Center sites,
however there was a slight decrease in importance ratings among participants at HFHS and Joy-
Southfield from the start to the end of the program (Table 50 and Table 51, Appendix III).
At the end of the Fresh Prescription program, Curtis Center evaluators asked participants if they had
noticed an increase in their knowledge about the importance of eating fresh fruit and vegetables.
About 88% of participants noted some level of increase in their knowledge about the importance of
fresh fruits and vegetables in their family’s diet (Figure 8). Findings were fairly consistent across sites
(Table 54, Appendix III). For example, program participants at Mercy Primary Care Center reported
learning more about the importance of incorporating produce in their diets.
Statistics suggest that there is a weak positive correlation between participants’ belief in the
importance of eating more fruits and vegetables and a change in self-reported health status.7
In other
words, participants with high importance ratings for eating more fruits and vegetables also tend to
report positive changes in their perceived health status at the end of the program.
7
Pearson correlation; N=153; r=0.228; p=0.005
12%
22%
26%
41%
Stayed the Same
Increased a Little
Increased Some
Increased a Lot
Figure 8. 88% of Fresh Prescription participants reported some level of increase in their
knowledge about the importance of eating fruits & vegetables

30
Participants’ Confidence in Their Ability to
Eat More Fresh Fruits & Vegetables
Participants rated their confidence in their
own ability to eat more fresh fruits and
vegetables, on a 1 to 10 scale, where 10 was
very confident and 1 was not confident.
There was a slight positive increase in
participants’ average confidence ratings
overall, from 8.80 on the pre-program survey
to 8.85 on the post-program survey. However,
this increase was not consistent across all sites;
while there was an increase in confidence
ratings from 8.59 to 9.03 among CHASS
participants, the confidence ratings at the
HFHS, Joy-Southfield, and Mercy Primary
Care Center decreased slightly (Table 52 and
Table 53, Appendix III).
Statistics suggest that there is a weak positive correlation between participants’ confidence rating
for eating more fruits and vegetables, and a difference in vegetable intake over the course of the
program.8
Those participants with a high confidence rating for eating more fresh fruits and
vegetables tend to also report a change in the number of cups of vegetables eaten each day from
when they started the Fresh Prescription program to when they completed the program.
Statistics also suggest that there is a moderate positive correlation between participants’ level of
confidence in eating more fruits and vegetables, and an increase in the amount of fruits and
vegetables eaten each day.9
Participants with a high confidence rating for eating more fruits and
vegetables tend to also report a greater increase in the amount of fruits and vegetables eaten each
day (Post-program survey question “The amount of fruits and vegetables I eat each day has…”).
Belief that Eating Fruits & Vegetables Helps
Improve One’s Health
Participants across all Fresh Prescription sites
reported an increase in the belief that eating
fruits and vegetables helps improve one’s
health. This change was not statistically
significant. The percentage of participants who
“agreed” or “strongly agreed” with the
statement “Eating fruits and vegetables helps improve my health” increased from 90% at the start of
the program to 95% at the end (Table 44 and Table 45, Appendix III).
8
9 Pearson correlation; N=153; r=0.330, p<0.000
“I think their attitudes changed from the time
too. At the beginning it’s kind of like, “eh, like
we’ll see how this goes,” it’s something new
and then towards the end their just they’re
grateful, they’re happy they participated in the
program.” – Program Staff
“I think that as people felt more proficient,
their attitudes improved. So it didn’t become
as much as, ‘that’s too expensive,’ to yes, I
know this is healthy and I know what to do
with it.” – Program Staff
“I am not a veggie or a fruit eater, so that was
kinda new for me because I was trying to
change style a little bit, you know, and the
program really helped me…and that will save
me, you know?” –Participant

31
How to Select High Quality Fresh Fruits &
Vegetables
Participants across all sites reported an increase in
knowledge about how to select high quality fresh
fruits and vegetables. However, this change was
not statistically significant. Overall, the percentage
of participants who “agreed” or “strongly agreed”
with the statement “I know how to select high
quality fruits and vegetables” increased from 65%
at the start of the program to 75% at the end
(Table 38 and Table 39, Appendix III).
How to Prepare & Cook Fresh Fruits & Vegetables
knowledge regarding how to prepare and cook fresh
fruits and vegetables from the start of the program
to the end of the program, across all sites.10
For
example, participants at Joy-Southfield reported
learning new recipes and new cooking techniques
during the cooking demonstrations.
Overall, the percentage of Fresh Prescription
participants who “agreed” or “strongly agreed”
with the statement “I know how to prepare and
cook fresh fruits and vegetables” increased from
67% at the start of the program to 79% at the end
(Figure 9) (Table 40 and Table 41, Appendix III).
10
Paired samples t-test; N=144; t=-3.836; p<0.000
9% 12% 12%
38%
29%
4% 1%
17%
51%
27%
“[The participants] say ‘well I know I need to
incorporate more color in my diet.’”
– Program Staff
“Patients felt empowered with the
recipes and knowledge learned, and
were grateful.” – Provider
“[The chef] gives us ideas from what he
cooks or prepares for everybody… I sort
of take that back and try to sauté and do
the things that he does.”
– Participant
Figure 9. Change in knowledge about how to prepare & cook fresh fruits & vegetables
“A lot of people now started reading the
labels.” – Participant

32
“A lot of the changes I’ve seen are…social
changes… a sense of community, and a
lot of…personal changes in terms of them
changing their attitudes” – Program Staff
How to Store Fresh Fruits & Vegetables
There was also a statistically significant change
in knowledge regarding how to store fresh fruits
and vegetables to increase their shelf life from the
start of the Fresh Prescription program to the end
of the program, across all participating sites.11
For
example, AIHFS participants reported receiving
information about how to store the fruits and vegetables received in their produce boxes.
Participants at Joy-Southfield discussed the best ways to store bananas, tomatoes, and cucumbers.
The percentage of Fresh Prescription participants who “agreed” or “strongly agreed” with the
statement “I know how to store fresh fruits and vegetables to increase their shelf life” increased
from 51% at the start of the program to 67% at the end (Figure 10) (Table 42 and Table 43,
Appendix III).
Participants’ Social Support for Eating More Fresh
Fruits & Vegetables
participants’ perceived ability to count on the people
around them for support in eating more fresh fruits
and vegetables from the start of the program to the
end of the program, across all participating Fresh
Prescription sites.12
For example, participants at Joy-
Southfield talked about how family members hold
each other accountable for eating fresh fruits and vegetables.
11
12
6%
14%
30%
34%
17%
5%
9%
19%
41%
26%
“The presentation that we had at the
beginning of the program was to show us
how to preserve the vegetables and what
choices to make better.”
– Participant
Figure 10. Change in knowledge about how to store fresh fruits & vegetables

33
The percentage of participants who “agreed” or “strongly agreed” with the statement “I can count
on the people around me to support me to eat more fruits and vegetables” increased from 65% at
the start of the program to 75% at the end (Figure 11) (Table 48 and Table 49, Appendix III).
Behavior Changes
Fresh Prescription participants reported a number of positive behavior changes as a result of their
participation in the program. This section describes key behavior changes, such as buying new fruits
and vegetables that participants had not tried before, cooking with fruits and vegetables that
participants had not cooked before, and eating more fresh fruits and vegetables each day.
7% 9%
21%
36%
28%
4% 4%
15%
51%
25%
“I buy new fruits & vegetables that I
did not buy before”
“I cook with fruits & vegetables that I
did not cook before”
80%
81%
82%
“I have tried new fruits & vegetables
that I had not eaten before”
Figure 12. Positive behavior changes among Fresh Prescription participants
Figure 11. Change in ability to count on social support for eating fruits & vegetables

34
Changes in Shopping Behaviors
As Figure 12 illustrates, 82% of Fresh
Prescription program participants reported
buying new vegetables that they did not
previously purchase. This number varied to some
extent among the different sites; at Joy-
Southfield, 91% of participants reported buying
new fruits and vegetables that they did not buy
before, while only 60% of participants at HFHS
reported buying new fruits and vegetables that
they did not buy before (Table 58, Appendix III).
Furthermore, 82% of participants reported an increase in their knowledge about where to buy fresh
fruits and vegetables (Figure 13). This finding was fairly consistent across participating sites (Table
55, Appendix III).
Changes in Food Preparation
As demonstrated in Figure 12, 80% of participants
reported cooking with fruits and vegetables that
they had not cooked before. Again, responses to
this question differed among the participating
sites; 89% of participants at Joy-Southfield
reported cooking with new fruits and vegetables,
compared to 80% at CHASS, 76% at Mercy, and
50% at HFHS (Table 58, Appendix III).
18%
23%
25%
34%
Stayed the Same
Increased a Little
Increased Some
Increased a Lot
Figure 13. 82% of Fresh Prescription program participants reported some level of increase
in knowledge about where to buy fresh fruits & vegetables
“It kind of challenges me to expand my
repertoire of recipes because then like I get
beets. You know, I’ve never gone out of my
way to get beets or cauliflower, but I love
cauliflower. It’s amazing. You know like
Brussel sprouts, they’re fantastic… it’s still a
work in progress but we are consuming a
lot more fruits and vegetables than we
probably would otherwise.” – Participant
“Before I made some meat with rice and
beans, now I make meat with salad or with
potatoes or something. I try to give [my
family] more fruit and vegetables.”
– Participant

35
Children Helping to Prepare Fruits & Vegetables
for Snacks or Meals
Participants reported a very slight increase in their
children helping to prepare fresh fruits and
vegetables for snacks of meals. While it was not a
statistically significant change, the percentage of
participants who reported that their children
helped to prepare fruits and vegetables for snacks
or meals increased from 37% to 39% (Figure 14). The largest increase was at Mercy Primary Care
Center, where this statistic shifted from 17% to 26% (Table 32 and Table 33, Appendix III).
Trying New Fruits & Vegetables
Figure 12 shows how 81% of participants reported
trying new fruits and vegetables that they had not
eaten before. For example, participants at Mercy
Primary Care Center indicated experimenting with
new and different vegetables, especially given that
they were not using their own spending money.
This statistic was highest among Joy-Southfield
participants, 94% of whom reported trying new
fruits and vegetables. The statistic was lowest
among participants at Mercy Primary Care Center,
only 64% of whom reported trying new fruits and
vegetables that they had not eaten before (Table 58
in Appendix III).
37% 34%
28%
39%
27%
33%
Yes No Not Applicable
“Patients come in and say, ‘We talked about
trying new things and at the market they
have Swiss chard and I never had Swiss
chard. I don’t know how to cook it, but
could you give me some tips…?’”
– Program Staff
Figure 14. Only a slight increase in participants’ children helping to prepare fruits &
vegetables for snacks or meals
“I’ve actually given them tools on how to
get [their kids] to like a variety of veggies
and they’ve actually come back and tell me
how they got their children to actually eat
a variety of veggies instead of just one.”
— Program Staff
“[The participants] say…I never had sweet
potato and this is a good opportunity to
try sweet potato because if I try it and
don’t like it, I don’t have to pay because
the money is not coming from my
pocket.’” –Program Staff

36
Eating More Fruits & Vegetables
Participants were asked about their daily
consumption of fruit and vegetables both at the
start of the Fresh Prescription program, and when
they completed the post-program survey. Analysis
shows that there was a statistically significant
change in both participants’ daily fruit
consumption13
and participants’ daily vegetable
consumption14
from the start of the Fresh
Prescription program, to program completion.
Figure 15 and Figure 16 demonstrate how, for both fruit and vegetable consumption, the percentage
of participants eating just 0-1 cup of fruit or vegetables decreased over the course of the program,
13
Paired samples t-test; N=142; t=-4.577; p<0.000
14 Paired samples t-test; N=142; t=-3.903; p<0.000
53%
28%
14%
5%
34% 33%
26%
8%
0-1 Cup 1-2 Cups 2-3 Cups 3+ Cups
At start of program At end of program
53%
28%
10% 9%
37% 38%
13% 13%
0-1 Cup 1-2 Cups 2-3 Cups 3+ Cups
At start of program At end of program
Figure 15. Change in participant fruit consumption
Figure 16. Change in participant vegetable consumption
“Usually there would just be one portion
on my plate. Like meat... But now, since
[the dietitian] asks for the three portions
on the plate like vegetables, fruits, and
them, I normally do that with every meal
now, since the market.” – Participant

37
while the percentages of participants eating 1-2 cups, 2-3 cups, and 3+ cups increased (Table 25,
Table 26, Table 27, and Table 28, Appendix III).
Data also suggests that participants are conscious of this change in eating behavior; overall, 88% of
participants reported some level of increase in the amount of fruits and vegetables that they eat each
day (Figure 17). This finding is largely consistent across sites (Table 56, Appendix III).
Increased consumption of fruits and vegetables was not only reported among program participants,
but also among participants’ families. 87% of participants reported some level of increase in the
amount of fruits and vegetables that their family eats each day (Figure 18). This finding was also
largely consistent across sites (Table 57, Appendix III).
12%
23%
31%
34%
Stayed the Same
Increased a Little
Increased Some
Increased a Lot
13%
20%
33%
33%
Stayed the Same
Increased a Little
Increased Some
Increased a Lot
in the amount of fresh fruits & vegetables that they eat each day
in the amount of fresh fruits & vegetables that their families eat each day

38
Statistics suggest that there may be a relationship between this increase in eating fruits and
vegetables, and the frequency of market attendance/box pick-ups. There was a weak positive
correlation between participants’ attendance rate, and an increase in eating fruits and vegetables.15
Decrease in Eating Unhealthy Foods
In addition to adding more fresh fruits and
vegetables to their diets, Fresh Prescription
participants are also cutting back on the
number of unhealthy foods (such as fast food,
chips, soda, etc.) that they eat each day. For
example, participants at Joy-Southfield reported substituting fruits and vegetables for unhealthy
foods. At the start of the program, participants reported eating unhealthy foods an average of 2.09
times per day. At the end of the Fresh Prescription program, participants reported eating unhealthy
foods just 1.62 times per day. Statistics confirm that there was a statistically significant decrease
in the number of times that Fresh Prescription participants ate unhealthy foods each day.16
15
16
Paired samples t-test; N=132; t=3.274; p=0.001
“One of the participants… gained
custody of her granddaughter and she
was a diabetic and she said: ‘now I
know what it’s like to be diabetic…I
don’t want my granddaughter have to
grow up and have to deal with this
condition like I am. So I know I need to
set an example for her and when I’m
eating more fruits and vegetables, she’s
eating by me. She’s eating directly what
I’m eating.’” – Program Staff
“I didn’t buy junk this time, I bought
more fruit...my ten year old likes the
honey buns, he likes also those hot chips.
But when I did the grocery shopping I was
like ‘I’m not going to buy it this time.’ I
brought fruit, he mashed them grapes
before I could even get up through the
door.” – Participant
“Instead of eating candy, I eat a piece of
fruit now!” – Participant

39
Changes in Health
Fresh Prescription participants demonstrated several positive health outcomes, including a slight
improvement in self-reported health status, a decrease in A1C levels, and an improved ability to
manage their existing health conditions.
Self-reported Health Status
Participants were asked to rate their own health
status at the start of the Fresh Prescription program,
and again at the end of the program. At the start, a
total of 12% of Fresh Prescription participants
described themselves as being in “poor” health and
only 46% identified themselves as being in “good,”
“very good,” or “excellent” health.
At the end of the program, the percentage of Fresh
Prescription participants who identified themselves
as being in “poor” health had dropped to 5%, and
the percentage of participants who identified
themselves as being in “good,” “very good,” or
“excellent” health had increased to 53%.
For example, participants at CHASS suggested that
they felt better overall, noting weight loss and
increased bowel movements. Additionally, it was
suggested that the shift to eating more produce
inspired other changes, such as increased water
consumption and exercise. At Joy-Southfield,
program participants reported losing weight since
beginning the program. Interviews also suggested
that some program participants had more energy,
were able to sleep at night, and experienced
improved concentration and moods. Some program
participants at Mercy Primary Care Center stated
that they were sleeping better and had more energy.
Participants reported “feeling lighter” and having
lost some weight. One participant noted their skin
complexion seemed to be “brighter.”
“I’ve noticed that when I eat more fruits
and vegetables, I do feel better.”
– Participant
“I feel like I have more energy now. Now
I’m motivated to walk more. I come and
go, and I always walk.” – Participant
“Something as simple as eating more
produce, they start exercising, drinking
more water, it gets the ball rolling. It gets
them more motivated overall.”
– Provider
“For a lot of these people it’s a good time to get out of the house. It’s a break from their routine
and do something different. You know get out and come out and meet new people... And
sometimes we have activities for kids. So, it’s I think it’s a good time to come and interact with
other people.” – Program Staff
“Before, I could not see a reason to
apologize. My whole behavior has
changed. My mental attitude has
changed.”– Participant

40
Start of
Program
Both at the start of the program and at the end, the largest group of participants (43%) identified
themselves as being in “fair” health (Figure 19).
Participants’ self-reported health status differed to some extent between sites, however the
percentage of participants who identified themselves as being in “poor” health decreased over the
course of the program at all five sites. The percentage of participants who identified as in “good,”
“very good,” or “excellent” health stayed the same at Mercy Primary Care Center, and increased at
AIHFS, CHASS, HFHS, and Joy-Southfield (Table 23 and Table 24, Appendix III).
Self-reported health status appears to have some relationship with increased fruit consumption, and
with participants’ frequency of shopping at farmers’ markets or farm stands. Specifically, there was a
weak positive correlation between a change in fruit consumption and a change in self-reported
health status.17
There was also a weak positive correlation between participants’ frequency of
shopping at a farmers’ market or farm stand and a change in self-reported health status.18
Changes in Biometric Indicators
Overall, participants’ biometric measures showed little change over the course of the program;
statistical analyses did not reveal any statistically significant changes in blood pressure, BMI,
cholesterol, LDL, waist circumference, or weight. However, the analysis of participants’ A1C levels
reveled some promising results.
Participants’ A1C levels were tested before the start of the Fresh Prescription program, and within
the three months immediately following their program participation. The A1C test is a blood test
that helps diabetic patients monitor their blood sugar levels. Specifically, the test measures a patient’s
average blood sugar level over the course of the three months previous to the test. A normal range
17
18
Figure 19. Changes in participants’ self-reported health status
End of
Program
5%
12%
43%
43%
38%
37%
11%
7%
4%
Poor Fair Good Very Good Excellent

41
for A1C levels is below 5.7; patients with an A1C level from 5.7 to 6.4 are considered to be pre-
diabetic, while those with an A1C level of 6.5 or higher are considered to be diabetic.19
Fresh Prescription participants’ A1C levels ranged from 5.1 (normal) to 14.0 (diabetic). The average
A1C level among participants at the start of the program was 9.3, while the average A1C level at the
end of the program was 8.5 (Figure 20). Statistical analysis confirms that among Fresh Prescription
program participants at CHASS and Mercy Primary Care Center (N=69), there was a statistically
significant change in A1C levels from the start to the end of the program.20
Managing Health Conditions
Participants also reported improvement in their
ability to manage existing health conditions; 90%
reported that the statement “I am able to manage
my health conditions better” was true (Figure 21).
This finding was fairly consistent across sites (Table
58, Appendix III).
19
National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved from http://www.niddk.nih.gov/health-
information/health-topics/diagnostic-tests/a1c-test-diabetes/Pages/index.aspx#2
20
Paired samples t-test; N=69; t=3.902; p<0.000
90%
9.3
8.5
Start of
Program End of
Program
Figure 20. Decrease in Fresh Prescription participants’ average A1C levels
“I am able to manage my health
conditions better”
Figure 21. Participants’ improved ability to manage health conditions
“I had GI problems and I find that when I
eat more fruits and vegetables, I feel
much better health-wise.”– Participant

42
5% 10% 85%
Very Dissatisfied Somewhat Dissatisfied Neither Somewhat Satisfied Very Satisfied
Participant Satisfaction
Participant Satisfaction with the Program
Overall, the majority of participants were satisfied with their participation in the Fresh Prescription
program; 95% of participants reported being either “somewhat satisfied” or “very satisfied” with
their experience. Overall, 85% of participants reported being “very satisfied” (Figure 22).
Satisfaction rates differed to some extent among the five Fresh Prescription sites. At Mercy Primary
Care Center, 100% of participants reported that they were either “somewhat satisfied” or “very
satisfied.” At CHASS, 95% of participants reported that they were either “somewhat satisfied” or
“very satisfied,” while 5% reported that they were “very dissatisfied” (n=4). Joy-Southfield had both
the highest rate of “very satisfied” participants (86%) and the most variety in other responses: 92%
of participants reported that they were either “somewhat satisfied” or “very satisfied,” 3% reported
being neither satisfied nor dissatisfied, and 6% reported being “very dissatisfied” (n=2). At HFHS,
84% of participants reported being “very satisfied” and 17% reported being “very dissatisfied”
(n=1) (Table 61, Appendix III).
“For the people who participated, it
went well. I think that they were
happy with what they got.”
– Program Staff
Figure 22. Participant satisfaction
“I think the patients that were involved
were very engaged. They definitely asked
for additional tips, additional resources.”
– Program Staff

43
Participants Would Continue Shopping at Fresh Prescription Sites
The majority of participants (85%) report that they would continue shopping at Fresh Prescription
markets or participating in the Fresh Food Share program, without program dollars (Figure 23).
There was slight variation in this statistic among sites; at HFHS, 100% or participants report that
they would continue shopping at the site, compared to 88% at Joy-Southfield, 84% at Mercy
Primary Care Center, and 83% at CHASS (Table 62, Appendix III).
Figure 23. Majority of participants would continue shopping at the sites
“I really like the people in the
neighborhood. Everyone, at least at our
market, we try to make it a community
destination so I don’t know if that puts
people in a good mood. Everyone seemed
to be very thrilled with the Fresh
Prescription program.”
– Program Staff
“They were really excited to come back
every week and see new recipes and
produce. They came back usually very
engaged and telling us something they had
done that previous week which is… I think
that’s unusual for a program. They usually
don’t have that type of enthusiasm for a
program.” – Program Staff

44
Participants Would Recommend the Program
Nearly all participants (97%) would recommend the Fresh Prescription program to a friend or
relative (Figure 24). This statistic is fairly consistent among sites: 100% at HFHS, 100% at Mercy
Primary Care Center, 67% at Joy-Southfield, and 96% at CHASS (Table 63, Appendix III).
Figure 24. Nearly all participants would recommend Fresh Prescription
“We’ve had people who participated in
the program last year and they’re on a
waiting list because we want to make
sure we get new people. We have a lot
of interest.” – Program Staff
“It’s a very popular program. I mean, it’s
for prescription for fruit and vegetables
for free, I mean what, how much better
can you get right?” – Program Staff
“Word of mouth was the way the
prescription program really blossomed.
Some of the people really liked it and told
their friends and they came to our door
and asked to be a part of the
program…They got their family and
neighbors involved.”
– Program Staff

45
Provider Outcomes
Interviews with health care providers at the
Fresh Prescription sites offered a glimpse into
the important role that fresh fruits and
vegetables can play in our healthcare system,
and how the Fresh Prescription program may
have an impact on clinical interactions.
Fresh Prescription strives to bring together the
food system and the health system. One of the
key themes that emerged from interviews
with Fresh Prescription providers is the
importance of “food as medicine,” and the
important role that healthy eating can play in
preventing health problems later in life.
Eating more fresh fruits and vegetables is a
practical way in which patients can make a
difference in their long-term wellbeing, and
take control of their own health.
Interviews also revealed how the Fresh Prescription program benefits health care providers by
providing a rewarding way for them to offer additional to support to their patients, and by
encouraging providers to “practice what they preach” with healthy eating.
Changes in Clinical Interactions
Health care providers and staff at each of the sites
shared their perspectives on Fresh Prescription
participants’ clinical visits and provider-patient
interactions. Overall, providers appeared to support
the Fresh Prescription program, but were also
constrained by limited time and availability.
Providers typically played the crucial role of
introducing prospective participants to the Fresh
Prescription program and encouraging them to
participate; without the support of health care
providers, the Fresh Prescription program would
have difficulty gaining momentum. Accordingly,
while only subtle changes emerge in clinical
interactions, they remain worthy of consideration.
“[Participants are] exposed to more produce,
and as hard as it might be for some people,
their understanding and their desire to
include more produce in their daily life
definitely does improve. I’ve seen some that
have realized that this is a way to prevent
problems down the road. I think that’s really
encouraging.” – Provider
“It’s a good way to provide education
and actually make more of an impact …
These kinds of programs are a nice way
to provide extra resources for
[patients].” – Provider
“Knowing that I have this resource… I
need to practice what I preach.”
– Provider
“I think this program is very innovative and is
helping a lot of the providers tie those two
systems [together]. Because those two
systems, they kind of feed off each other –
it’s like a continuous circle between the
health system and food system.”
– Program Staff

46
For example, some providers noted an increase in
patient motivation and involvement in their own
health care. Providers reported that some
participants started to readily volunteer information
about their health. The Fresh Prescription
participants seemed to be empowered by the fact
that they were actively doing something to
improve their own health.
Through building relationships with Fresh
Prescription program participants, the health
care providers also gain a more nuanced
understanding of the barriers facing their
patients and can provide education accordingly
Providers at Mercy Primary Care Center also
noted that patients who were not enrolled in the
Fresh Prescription program sometimes inquired
about the program, hoping to get involved in
the future.
“I would say that the vast majority of
them felt a lot healthier and just felt
like really doing something for their
own health.” – Provider
“Instead of me having to ask how much
water they drink, etc., they bring it up to
me. They’ll tell me that they’ve been
exercising, they feel better, their sugars
are better, it all gets intertwined with all
the positive health aspects.” – Provider
“I love building relationships with [participants]... they say, ‘Well our electricity is out this week
and we don’t have a refrigerator right now.’ You know, I feel like if they weren’t comfortable
with me, I don’t know if they would’ve revealed that kind of information. And knowing that
gives me a different perceptive and I can change the type of education that I give.”
– Program Staff
“One of the main things that I think is most important for managing health conditions is the diet,
and I think that a lot of times in a medical setting the providers … focus on medications because
that’s also extremely important. One of the things that the providers have said is that their time and
their office visits are limited, and they often can’t spend as much time as they would to like to on
diet. So I think that I love being involved in the program because it gave me an opportunity to talk
a little bit about that with them – meal planning, and the importance of fresh fruits and
vegetables, and the importance of an overall healthy lifestyle, in conjunction with taking
medications to manage chronic illnesses.”
– Program Staff

47
Organization Outcomes
Beyond the impacts on program participants and health
care providers, the Fresh Prescription program also
strengthened organizations. Interviews with stakeholders
at each of the sites illustrated how the Fresh Prescription
program helped organizations address health in a new and
innovative way, and facilitated the development of
partnerships with other organizations in the community.
Program Impact
Key stakeholders at each of the sites talked to Curtis Center
evaluators about the impact that the Fresh Prescription
program had on their organizations overall, including how
the program helps expand the organization’s services and
address health care in a unique way.
For example, program staff at AIHFS explained that the
Fresh Prescription program allows their organization to
assist low-income, food insecure clients who they might not
otherwise be able to reach. Program staff at HFHS felt
that participation in the Fresh Prescription program
demonstrated their organization’s commitment to caring
for patients holistically. At Joy-Southfield, program staff
noted that the program helps their organization address
health disparities and provide fresh food access to those
living in the surrounding neighborhoods. Interviews at
CHASS suggested that the program increased the
understanding of healthy eating among CHASS staff, as
well as the program participants.
“This has been a huge impact on
our clinic. This has actually brought
more clientele in [because] we
have WIC also so I’m able to
advertise to WIC clients too.”
– Provider
“The staff really likes [the
program] and that’s something
they look forward to and that’s
something that brings us all
together – that shared
anticipation.” – Program Staff
“It just showed our
commitment to treating the
patients more holistically…we
are not just going to give you
drugs and send you on your
way. We’re going to talk to you
about nutrition and give you
the tools to better improve
your diet.” – Program Staff
“[The program] does a good job
of helping people understand
where their food comes from,
and why is it good for you. It
drives home the point that
medicine doesn’t necessarily
have to come in the form of a
pill. It’s what you put in your
body.” – Program Staff
“We were excited to be involved because it gives us a
chance to talk about the importance that diet has on
health. Providers don’t always have that time in the
office to stress it. It’s great being part of it and we just
hope that the things that the participants have learned
will continue to be used.”
– Program Staff

48
Partnerships & Shared Resources
Stakeholders also discussed how participation in the
Fresh Prescription program had facilitated partnerships
between their organization and other local
organizations. For example, several organizations
mentioned that participation in the Fresh Prescription
led to a closer partnership with the Ecology Center.
Program staff at AIHFS noted that participation in the
Fresh Prescription facilitated stronger connections
between agencies serving the same community. Staff at
HFHS mentioned the development of their relationship
with vendor Peaches and Greens.
Advice for Any New Sites
Program staff also offered their advice for any new
sites joining the Fresh Prescription program in the
coming years. Key themes that emerged included:
Have Patience & Be Flexible
Fresh Prescription program staff advised new sites
to be patient and flexible; starting a new program
takes time, particularly gaining buy-in from key
stakeholders and recruiting new participants to join
a program that they may have never heard of before.
Get the Whole Organization Involved
Program staff encouraged future sites to involve all
members of their team – from the doctors to
medical assistants to interns – in promoting the
Fresh Prescription program to participants.
Get the Word Out, But Emphasize Quality
Program staff advised new sites to start promoting
the program as early and as widely as possible, and
yet keep in mind program quality over quantity.
Choose Locations & Schedules Strategically
It is important to have the prescribing clinic and the market or box pick up located at the same site,
and to align clinic hours and food distribution schedules to accommodate the transportation needs
of the target population. Be prepared, think strategically, and walk through each and every step.
“It’s really strengthening those
connections within this
community [because] we all serve
the same community but there’s
so many of us and we’re all doing
different things.”
– Program Staff
“Some people they talk to the
patients and connect to the patients
and if the medical assistant is
passionate, they might advise the
patient and would tell them, “Hey,
ask your doctor about this!” Just to
not leave the whole responsibility on
the doctor... It needs to be a team
effort.” – Program Staff
“Think quality over quantity… It’s one
thing when you have to reach a 100
people and have them only come
twice and it’s another thing to have
them reach 50 people and have them
complete the entire 4 weeks.”
– Program Staff

2015-16 Fresh Prescription Final Report

2015-16 Fresh Prescription Final Report

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