African Journal of Public Health and Health Systems | 09 August 2009
Evaluating the Impact of a "Food is Medicine" Prescription Produce Programme on Glycaemic Control in Type 2 Diabetics: A Mixed Methods Study in Cape Town, South Africa
F, a, t, i, m, a, P, a, t, e, l, ,, T, h, a, n, d, i, w, e, N, k, o, s, i, ,, P, i, e, t, e, r, v, a, n, d, e, r, M, e, r, w, e, ,, S, i, p, h, o, D, l, a, m, i, n, i
Abstract
Type 2 diabetes is a major public health burden in South Africa, with diet being a key modifiable factor. ‘Food is Medicine’ interventions, which provide prescriptions for nutritious food, may improve outcomes, but evidence from low-resource settings is scarce. This study evaluated the impact of a prescription produce programme on glycaemic control in adults with type 2 diabetes in Cape Town. Its objectives were to quantify changes in HbA1c and to explore participant experiences and barriers to adherence. A concurrent mixed methods design was used. The quantitative component was a pre-post study measuring HbA1c at baseline and six months in 150 programme participants. The qualitative component involved 20 in-depth interviews with a purposively selected sub-sample. Quantitative data were analysed with paired t-tests; qualitative data were analysed thematically. A statistically significant mean reduction in HbA1c of 0.8% (p<0.01) was observed. Qualitative themes included improved nutritional knowledge, the perceived dignity of the ‘prescription’ model, and logistical challenges such as transport to collection points. Financial strain was a major reported barrier to sustaining dietary changes after the programme. The programme was associated with a clinically meaningful improvement in glycaemic control. Qualitative findings indicate the model conferred dignity while also revealing systemic barriers to long-term healthy eating. Implementation should include strategies to mitigate transport barriers. Future programmes should integrate linkages to sustainable food access initiatives. Further research should investigate cost-effectiveness and long-term sustainability. Food is Medicine, type 2 diabetes, glycaemic control, mixed methods, South Africa, prescription produce, nutrition. This study provides evidence on the feasibility and impact of a ‘Food is Medicine’ intervention in a low-resource South African setting, highlighting both its potential benefits and the structural challenges to lasting dietary change.