Comparing Two Food is Medicine Trials Using the RE-AIM Framework.

Introduction: Food is Medicine (FIM) interventions, such as medically tailored meals, groceries, and produce prescriptions, are increasingly embedded in healthcare delivery. To inform future policy and practice, the American Heart Association's Healthcare by Food initiative supported pilot studies to test scalable FIM models. This manuscript compares two such pilots, NutriConnect (Washington University in St. Louis) and Makin' Healthy Groceries (Louisiana Public Health Institute), using the RE-AIM framework to highlight cross-site lessons for design, delivery, and implementation. Methods: We conducted a comparative analysis of two FIM trials. NutriConnect enrolled adults ≥18 years recently discharged from Barnes-Jewish Hospital with diet-sensitive chronic conditions and food insecurity, randomizing participants to digital coupons, home-delivered produce boxes, and usual care. Makin' Healthy Groceries enrolled adults ≥50 years with uncontrolled hypertension at University Medical Center in New Orleans, randomizing participants to in-store debit vouchers or online grocery credits. Across both studies, we applied RE-AIM domains (Reach, Effectiveness, Adoption, Implementation, Maintenance) to examine participant characteristics, intervention delivery, operational challenges, and contextual facilitators. Results: Reach was constrained by digital barriers in both trials: NutriConnect participants struggled with email coupon redemption, while Makin' Healthy Groceries' online arm faced low digital literacy and payment concerns. Effectiveness data were collected through validated dietary questionnaires; full quantitative results will be reported separately. Adoption depended heavily on retail system readiness, NutriConnect benefited from tighter integration with the grocer, Schnucks', loyalty program, while Makin' Healthy Groceries encountered gaps in staff training and voucher controls at the participating grocery. Implementation challenges included high staff burden for manual troubleshooting and rapid customization of digital platforms, though both studies demonstrated strong adaptive capacity. Maintenance challenges included high program costs and reliance on sustained funding, yet technical enhancements (e.g., automated coupon systems) showed potential for broader scalability. Conclusion: This comparison highlights the heterogeneity of FIM trial design and delivery, underscoring the importance of aligning interventions with participant behaviors, retail system readiness, and digital accessibility. Successful scale-up will require hybrid models that combine technology with human support, strong cross-sector partnerships, and sustainable reimbursement pathways. Insights from these pilots inform the next generation of equitable FIM implementation strategies.