Using implementation science to understand the implementation factors in a rural Produce Prescription program

Produce Prescription programs (PPRs), in which healthcare providers prescribe no- or low-cost produce, have shown promise in improving food security, health outcomes and produce consump­tion. However, research on essential implementa­tion components has been limited, especially across all sectors involved in implementation and in rural settings. This study utilized the Exploration, Preparation, Implementation and Sustainment (EPIS) framework to examine factors that facilitate and hinder implementation from all sectors of a rural Minnesota PPR. Through 14 interviews con­ducted between October 2023 and January 2024, this study explored factors from all sectors (health­care, food systems, and public health) that influ­ence successful PPR implementation. Across all sectors, three major themes were identified: (1) resources and support; (2) processes and infra­structure; and (3) staffing and roles. Within these themes we found critical factors that have implica­tions for the future of PPR implementation, including collaboration, sustainability, rurality and the local economy. The EPIS framework proved valuable in examining these factors, providing insights to inform future planning and decision making for PPRs. Further research can enhance understanding of successful implementation and support the development of sustainable practices and funding mechanisms.