Optimizing Navigation and Text Messaging Interventions to Promote Participation in a Food Is Medicine Program Among People Participating in Cardiac Rehabilitation: Human-Centered Design Study

Background: Food Is Medicine (FIM) programs integrate interventions such as medically tailored meals or produce prescriptions into clinical care. However, there is limited evidence on how to design these programs to be responsive to the lived experiences of participants to optimize initiation, engagement, and long-term retention. Objective: The objective of the study was to develop interventions to promote initiation, engagement, and retention in FIM programs that are responsive to the lived experiences of participants. Methods: We used a human-centered design approach to engage current and former cardiac rehabilitation participants in the development of interventions to promote participation and engagement in a FIM program. We recruited participants through invitations sent via electronic health record messages. We interviewed participants about their experiences, preferences, and unmet needs related to healthy eating and program design. Additionally, we elicited participant feedback on draft versions of patient navigator scripts and text messages promoting healthy eating habits. Results: A total of six participants identified themes across Theory of Planned Behavior constructs and emergent themes, including the cost of healthy food, cultural appropriateness, clear and timely communication, transportation, local food access, scheduling flexibility, the ability to provide feedback to the program, and personalized support for navigating food resources. Participants described financial strain as a key barrier to healthy eating and noted that social influence often shaped eating behaviors. Feedback on navigator scripts led to revisions clarifying program logistics, addressing barriers such as language and cultural dietary restrictions, and tailoring positive endorsements to individual health goals. Based on participant feedback, text messages were made more concise, reframed positively (eg, humor and gratitude), and encouraged to be warmer, with respectful language that is easy to understand, while avoiding stigmatizing or overly clinical phrasing. Participants also suggested that messages should reflect empathy and offer actionable information to increase trust and engagement with the program. Trust in the health care system and a sense of dignity in receiving food support emerged as critical themes influencing overall satisfaction and retention. Participants emphasized that endorsement from their health care team and cardiologist was important for building trust in the program. Communication between health care navigators and FIM navigators could help reduce the burden placed on patients to navigate food resources. Conclusions: Using a human-centered design approach, we gained insights about participant-identified needs for navigation scripts and text messages that are culturally sensitive and personalized to promote optimal participation in a FIM program.