Testing the Impact of Technology-based Engagement Strategies to Improve Adoption of Medically Tailored Retail Produce Prescriptions


Produce prescription (Produce Rx) programs have demonstrated a variety of important outcomes for participants including increased fruit and vegetable consumption, reduced food insecurity and in select programs, improved biomarkers like hemoglobin A1c for patients with diabetes. Retention and redemption rates in produce Rx programs are wide ranging, if reported at all, with numerous studies citing redemption lower than 60%. High participation, redemption and retention are critical not only to determine program efficacy but also to improve health equity. Stronger clinic-community partnerships or more engaged facilitators have been associated with higher participation rates or improvements in outcomes. Not yet tested in a rigorous study design is whether strategic text messaging might improve shopping activity trends and benefits utilization.

The purpose of this proposal is to test the impact of technology-enhanced communication on cardholder activity and benefits utilization, in other words, to test ways to significantly increase fruit and vegetable purchasing. This project leverages a parent study of 400 high risk pregnant patients with Medicaid in Houston, TX who will receive $100/month for fruits and vegetables via a pre-paid debit card from Fresh Connect. Our project will randomize these participants into two groups, the control group will receive usual engagement from Fresh Connect, and the intervention group will receive enhanced engagement consisting of additional targeted text messaging throughout the program period.

Project Aims

Aim One

Using a randomized controlled trial design, assess the effectiveness of enhanced cardholder engagement to improve Fresh Connect benefits utilization among high-risk pregnant patients.

Aim Two

To compare the changes in food security, nutrition security and fruit and vegetable consumption between the intervention and control groups.

Aim Three

To qualitatively determine barriers and facilitators that influence redemption through participant interviews.

Project Details

Principal Investigators

Ronit Ridberg

Research Assistant Professor, Food is Medicine Institute, Friedman School of Nutrition Science and Policy

Shreela Sharma

Professor of Epidemiology, University of Texas School of Public Health

Tufts Team

Dariush Mozaffarian

Director, Food is Medicine Institute, Friedman School of Nutrition Science & Policy


2023 – 2025


Naomi Tice

Project Manager, UT Health Center for Health Equity

Adam Shyevitch

Chief Program Officer, About Fresh

Machayla Fortin

Fresh Connect Cardholder Success Manager, About Fresh

Michael Lantow

Fresh Connect Director of Product Strategy, About Fresh


American Heart Association

Michael and Susan Dell Foundation (parent study)

Texas Children’s Health Plan (parent study)