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A 12-week randomized study of 67 food-insecure older adults found that 89.2% of participants in either home-delivery program prepared and ate the delivered produce, compared with 28.3% in the voucher-based control group. The study suggests that making delivery the default may reduce barriers to food prescription programs; it did not find that adding meal kits increased produce use.
A 12-week randomized study by University at Buffalo researchers found that food-insecure older adults were much more likely to use produce when it was delivered to their homes than when they had to collect it through a voucher program. Produce use reached 89.2% in both delivery groups, compared with 28.3% among participants assigned to redeem vouchers at a market, according to the study published in Frontiers in Public Health.
The study enrolled 67 adults, most of them African American and older than 65, who reported experiencing food insecurity at times. They were recruited through primary care clinics at Erie County Medical Center in Buffalo. Researchers assigned participants to one of three approaches: weekly produce boxes delivered at home, healthy meal kits delivered at home, or vouchers redeemable at a mobile market or participating community markets.
The produce-box group could customize its selection if it wished. The meal kits included produce and ingredients for three meals, with participants choosing from five or six options each week. In the control group, participants had to travel to a market to collect the food associated with their prescription. The study defined redemption as preparing and consuming the produce, rather than simply receiving or collecting it.
Researchers reported the same redemption rate for both delivery approaches: 89.2%. In the voucher group, the rate was 28.3%. Adding meal kits did not raise produce use beyond the rate seen with produce boxes alone. Participants in both delivery groups rated the program above 9 out of 10 and said they would recommend it to others, according to the report.
Delivery Removes a Key Barrier
The findings point to a practical obstacle for food prescription programs: a voucher has limited value if a participant cannot easily reach the place where it can be used. Researchers said that transportation difficulties and concern about stigma at food pantries may deter people from collecting prescribed food. Home delivery makes receipt the default, avoiding an extra trip and the need to visit a food-distribution site.
That distinction matters for health and social-service providers designing programs for older adults experiencing food insecurity. The study suggests that how food is distributed may affect whether participants actually prepare and eat it, not just whether a prescription is offered. However, the results do not establish that delivery improves health outcomes, and the small study does not show that the same approach will work equally well in every community or at larger scale.
Participants also spoke positively about the delivery driver, the report said. Lead researcher Lucia A. Leone noted that a consistent, personable contact may help a program succeed. That observation is based on participant feedback and the researchers’ experience; the study was not designed to isolate the effect of the driver relationship from the effect of delivery itself.
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How the Buffalo Trial Worked
Food prescription programs provide food-insecure people with free or subsidized foods, often fruits and vegetables. The report says earlier voucher programs have recorded low redemption, with estimates of 9% to 18% cited by the researchers as background. That range is not the control-group result in this trial: participants assigned to the Buffalo voucher arm had a 28.3% redemption rate.
Leone, an associate professor of community health and health behavior at the University at Buffalo, said the research team wanted to compare delivery formats with the standard approach of giving participants vouchers for a mobile market. The study was conducted in partnership with FreshFix, a local food delivery company co-founded by Leone, and community food markets. Its paper, by Lucia A. Leone and colleagues, is titled “A randomized controlled study comparing three food prescription programs for older adults: program design, implementation, and utilization.”
The researchers said meal kits did not produce higher use than produce boxes, possibly because participants already knew how to prepare the foods. Leone also said the larger quantity of food supplied through the program helped improve food security. These are the researchers’ interpretations of the results; the reported comparison chiefly measures produce utilization across the three study arms.
“The problem historically with food prescription programs is that people get the vouchers but don’t redeem them.”
— Lucia A. Leone, corresponding author and University at Buffalo associate professor
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Limits of the Small Trial
The study involved 67 participants at one health system and lasted 12 weeks, so it remains unclear whether the results would hold over a longer period, in other regions, or among older adults with different needs. The report does not establish which parts of the delivery model mattered most: eliminating travel, making delivery the default, allowing customization, or some combination of those features.
It is also unclear how the approach would perform at a much larger scale, including through programs such as Medicaid. The researchers did not report evidence here that the higher produce use led to specific changes in participants’ health. The finding concerns program utilization and participant ratings, not proof of a health benefit or a cost-effectiveness comparison.
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Researchers Plan a Family Study
Leone and colleagues plan to test a similar food prescription approach with families enrolled in Medicaid who are experiencing food insecurity and have children ages 2 to 6. The team will work with local pediatric practices. That next study will examine a population the researchers describe as more challenging to serve and may help clarify whether delivery and program design have similar effects beyond older adults.
Until those results are available, the Buffalo findings offer evidence that home delivery can be associated with higher produce use in this particular group. The report does not specify when the family study will begin or when its results are expected.
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Key Questions
What did the study find?
In the 12-week trial, 89.2% of participants in each home-delivery group prepared and consumed the produce, compared with 28.3% in the voucher group, which required participants to collect food at a market.
Did meal kits lead participants to use more produce?
No difference was reported between the meal-kit and produce-box delivery groups: both had a 89.2% redemption rate. The researchers suggested participants may already have known how to prepare the produce.
Who took part in the trial?
The study included 67 adults recruited through primary care clinics at Erie County Medical Center in Buffalo. Most were African American, older than 65, and had at times experienced food insecurity.
Does the study prove home delivery improves health?
No. The reported results compare produce use and program ratings. They do not establish that delivery improved participants’ health or that the same results would occur in larger or different populations.
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