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Abstract

Objective: Evaluate feasibility (primary), clinical, and cost outcomes (secondary) associated with the use of a screening decision tool for allocating rural and urban adults with hypertension into in a food is medicine (FIM) program.

Design: Participants were allocated to receive either medically tailored meals or grocery prescription (Rx), based on a user-centered designed screening decision tool. Medically tailored meals (MTM) provided 5 meals per week for 12 weeks. The grocery Rx program provided $100 each month for 3 months to purchase food consistent with guidelines for hypertension. Feasibility outcomes included engagement, dose, and program acceptability. Semi-structured interviews were completed with a subset of 20 participants to obtain feedback on the program. Baseline and post-intervention clinical measures were obtained from electronic medical records. Cost analyses data were collected for the 3-month program among both types of programs.

Setting: Two large hospital systems (one rural, one urban) in Kentucky.

Participants: Adults aged 18–64 with hypertension who screened positively for food insecurity and wanted assistance.

Results: A total of 159 participants referred were enrolled, and 144 participants completed all measures (complete case rate of 91%). The screening decision tool had a match rate of 94%−97% for grocery Rx and 73%−77% for medically tailored meals. 95% of participants (engagement rate) completed all 12 weeks or 3 months of the FIM intervention. The average net promoter score (i.e., if they would refer the program to a friend) was 9.4 out of 10. There were significant changes in systolic and diastolic blood pressure among rural and urban adults receiving the grocery Rx program. Those receiving the MTM program in urban communities also reported reductions in systolic and diastolic blood pressure. Qualitative findings reported that the FIM programs were associated with high levels of satisfaction, helped ease the burdensome cost of food, and improved various aspects of their health.

Conclusions: A screening decision tool is associated with high patient engagement and retention in a FIM program, while also improving blood pressure, dietary intake, and general health status.

Clinical trial registration: NCT07011251 on ClinicalTrials.gov

Document Type

Article

Publication Date

2026

Notes/Citation Information

© 2026 Gustafson, Lauckner, Bush, Dimond, Serrano, Mayfield and Steeves. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Digital Object Identifier (DOI)

https://doi.org/10.3389/fpubh.2026.1783076

Funding Information

The author(s) declared that financial support was received for this work and/or its publication. American Heart Association Healthcare by Food provided funding for this project.

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