Determination of the Capacity Building Framework that Support a Collaborative Fruit and Vegetable Prescription Program

Over half of U.S. adults, roughly 117 million individuals, suffer from at least one preventable chronic disease, such as obesity, hypertension, coronary heart disease, and certain types of cancer. Epidemiological studies suggest that fruit and vegetable intake may be protective against these diseases, yet it is estimated that less than one-quarter of the population meets current fruit and vegetable recommendations. Low consumption rates may be attributed to lower income, food insecurity, and poor access and availability to fruits and vegetables. As a result, access to affordable and nutritious foods and beverages, particularly in underserved communities, such as “food deserts,” has become a national priority. An emerging strategy to address this is prescription programs, whereby physicians provide prescriptions or vouchers for fruit and vegetables to clients to encourage increased consumption, implemented in the form of the Farmacy Garden, which was the result of collaboration between multiple agencies. For collaborative efforts to be able to implement and sustain their shared goals, partnering individuals, agencies, and organizations need to first have the capacity or the potential to build capacity as a ‘unit.’ The purpose of this study was to concretely examine different factors and domains within Matachi’s Capacity Building Framework related to the Farmacy Garden in order to replicate the program in other locations. This framework conceptualizes organizational capacity building as dependent (and interdependent) on three different domains - individual, organizational, and environment. The study utilized semi-structured, openended interviews to ascertain concrete factors of organizational capacity building present at each level among Farmacy Garden collaborative project stakeholders (n=7). Interviews with six stakeholders (85.7% response rate) ranged in length from thirty-two minutes to one hour and twenty minutes. Common themes were coded separately by two members of the research team, first for overall recurring themes and second, to reveal connections between themes. Relevant quotes were identified and any discrepancies between researchers were resolved. Common themes often crossed over different levels, such as time, beliefs, values, and attitudes and inter-organizational linkages/partnerships, attitudes, and relationships, highlighting the inter-dependence of various factors across domains of capacity building. In addition to identifying specific factors that were necessary for the creation and sustainability of the Farmacy Program, the analysis revealed the importance of a “shared belief and value system.” In other words, individuals and organizations “valorized” this project in different ways than more traditional programs and/or interventions. The findings of this study can help guide leadership in cultivating relationships and new benchmarks to ensure transparency in project goals, in addition to time and physical resources, as well as inform the organizational capacity research area within nutrition and food systems fields.