Veggie Script Incentive Encourages Walk With Ease Participant Retention

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Submission Date: October 2019

State/Territory Submitted on the Behalf of: Texas

States/Territories Involved: Texas

Funding Source: CDC, NACDD

CDC Funding:


Domain Addressed:

Health Systems Strategies

Public Health Issue:

Arthritis is a major public health problem in the United States.  It affects over 54 million American adults and will increase to 78 million by 2040.  The condition limits 24 million people from performing their daily tasks.

Texas has a 21.5% age-adjusted prevalence of arthritis.  While that is the in lowest quartile of all states, the efforts of the project being highlighted in this success story are specifically working in an underserved area of south Dallas, which has higher than average prevalence of chronic diseases, including arthritis, among residents.  An estimated 9.7% of seniors in the greater Dallas/Fort Worth area are food insecure, according to a recent report from Feeding America—that’s higher than the national average.

Texas ranks No. 1 in obese elderly: More than 35% of Texas adults 65 or older are obese, according to Trust for America’s Health annual State of Obesity report. The state ranks 10th at nearly 35% obesity for all ages and seventh for adults either obese or overweight at nearly 70%. Nationwide, 1 in 3 American adults are obese, a historic high.

Based on U.S. Census data, communities served by the Baylor Scott & White Health and Wellness Center (BSW HWC) are low-income, uninsured/government insured, and ethnic/racial minority (~ 40% African American and 50% Hispanic), and live in USDA identified low-vehicle access food desert zip codes.

Project Objectives:

Funding BSW is helping NACDD to achieve the following component 1 outcomes, as defined in CDC-RFA-DP16-1606: increased availability of AAEBIs, increased participation in AAEBIs, increased knowledge and awareness about the benefits of self-management among adults with arthritis, improved arthritis self-management behaviors and increased physical activity among adults with arthritis.

Program Action:

Studies have found walking to be a safe and effective way to manage arthritis. In 2018-2019, the National Association of Chronic Disease Directors awarded a mini-grant to the Baylor Scott & White Health and Wellness Center in Dallas, Texas for the purpose of engaging 3,000 participants in Walk With Ease (WWE), an arthritis appropriate evidence-based intervention. WWE is offered in either a group or self-directed format.

Baylor Scott and White Health and Wellness Center exists to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. In fulfillment of the BSW HWC’s mission, the organization provides services at the Juanita J. Craft Recreation Center and sends community health workers and staff into the community to educate residents about healthy lifestyles and available resources including the WWE program and their fresh produce farm stand.

While BSW is advertising WWE throughout the local community, they are making a significant effort to meet residents where they are as transportation access is low in the areas around the BSW HWC. To this end, BSW targeted the Dallas Housing Authority (DHA) senior living complexes for WWE.

Upon starting the weekly meet-up walks for a group of self-directed participants, BSW staff recognized the opportunity to expand fresh produce access to WWE participants while also encouraging participant retention by offering them a “veggie script.”

The “veggie script” program provides participants with four weeks of $15 vouchers that can be used to purchase produce at one of the BSW farm stands. BSW aims to provide veggie scripts to individuals in food desserts or who are food insecure. Many of the WWE participants at the DHA sites are elderly or lack transportation. Therefore, BSW would fill the produce orders during the week and return to the next week’s meet-up walk with each participant’s produce order.

Data/Other Information Collected:

BSW collects select pre and post-test data on WWE participants. Additionally, the veggie script redemption data were collected for WWE participants.


The DHA has a community liaison to support outreach, which helped generate initial interest in the WWE program.  Even though BSW is implementing the self-directed program, they run the program as a “session” with a defined start week, so participants have peer support.  Each session hosted at the DHA senior communities has had 15-18 participants start and complete the program.  Not only did participants express benefit from the WWE program, but they also had incentive to join to the meet-up walk each week to redeem their veggie script and collect their fresh produce order from the week before.

For this initial pilot, 40 seniors participated in WWE and received a veggie script.  Each voucher is worth up to four purcahses.  Participants redeemed 54 vouchers and 14 participants redeemed two vouchers for a total of 142 purchases of fruits and vegetables.

Additionally, the weekly meet-up walk was such a positive experience for participants that they requested for BSW staff to continue visiting the complex to facilitate a weekly walk even after the WWE sessions were complete.

Challenges/Lessons Learned:

Offering veggie scripts (both the opportunity for fresh produce and the delivery of the food) directly to the location where WWE was being offered at the DHA complex for seniors didn’t just provide week-to-week incentive to attend the WWE meet-up walk, but it was so effective that participants came back in subsequent weeks with friends who wanted to both partiapate in the program and reap the veggie scripts benefit.  This resulted in a group that was sometimes too large to manage effectively and also caused the BSW staff leading the group walk difficulty with regard to personally knowing everyone.  BSW staff recommend keeping weekly meet-up sessions and WWE groups to less than 15 people.

Next Steps:

BSW is looking for additional financial support so they can expand the veggie scripts incentive to other WWE participants.

Program Areas:

Health Equity and Cultural Competency, Social Determinants of Health

State Contact Information:


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