Public health approaches for addressing diet-related health in the USA include nutrition incentive (NI) and produce prescription (PPR) projects. These projects, funded through the US Department of Agriculture Gus Schumacher Nutrition Incentive Program (GusNIP), aim to support the intake of fruits and vegetables through healthy food incentives. Measuring the GusNIP impact is vital to assessing the ability of incentives to improve public health nutrition outcomes across populations. Shared measures used across GusNIP projects assess fruit and vegetable intake, food security and demographics, among other variables, through a participant survey. This study explored challenges and opportunities to evaluation across populations within a national public health oriented program, GusNIP.

This qualitative study used a sociodemographic survey, semi-structured interviews and focus groups. Descriptive statistics were used to summarise survey data, and applied thematic analysis was used to identify patterns in interview and focus group data.

Data collection occurred in the USA virtually using Qualtrics and Zoom from fall 2021 to fall 2022.

Eighteen GusNIP PPR and NI data collectors, twenty-four external evaluators and eleven GusNIP National Training, Technical Assistance, Evaluation, and Information Center staff participated.

Opportunities to improve evaluation among GusNIP’s participants include tailoring surveys to specific subpopulations, translations, culturally appropriate food examples, avoiding stigmatising language, using mixed methods and intentional strategies to enhance representation.

To increase applicability of data collection in public health programs, evaluation tools must reflect the experiences across populations. This study provides insights that can guide future NI, PPR and public health evaluations, helping to more effectively measure and understand outcomes of all communities.

To assess the relationship between programme attendance in a produce prescription (PRx) programme and changes in cardiovascular risk factors.

The Georgia Food for Health (GF4H) programme provided six monthly nutrition education sessions, six weekly cooking classes and weekly produce vouchers. Participants became programme graduates attending at least 4 of the 6 of both the weekly cooking classes and monthly education sessions. We used a longitudinal, single-arm approach to estimate the association between the number of monthly programme visits attended and changes in health indicators.

GF4H was implemented in partnership with a large safety-net health system in Atlanta, GA.

Three hundred thirty-one participants living with or at-risk of chronic disease and food insecurity were recruited from primary care clinics. Over three years, 282 participants graduated from the programme.

After adjusting for programme site, year, participant sex, age, race and ethnicity, Supplemental Nutrition Assistance Program participation and household size, we estimated that each additional programme visit attended beyond four visits was associated with a 0·06 kg/m2 reduction in BMI (95 % CI –0·12, –0·01; P = 0·02), a 0·37 inch reduction in waist circumference (95 % CI –0·48, –0·27; P < 0·001), a 1·01 mmHg reduction in systolic blood pressure (95 % CI –1·45, –0·57; P < 0·001) and a 0·43 mmHg reduction in diastolic blood pressure (95 % CI –0·69, –0·17; P = 0·001).

Each additional cooking and nutrition education visit attended beyond the graduation threshold was associated with modest but significant improvements in CVD risk factors, suggesting that increased engagement in educational components of a PRx programme improves health outcomes.