Why patients stay in or leave a medically tailored meals program: a qualitative study.

Introduction: Medically tailored meals (MTMs) are home-delivered, nutritionally tailored meals designed for patients with complex or advanced diet-sensitive medical conditions and social stressors. Although MTM use can improve food security, diet quality, and health outcomes, and reduce overall healthcare use and cost, little is known about why patients enroll in, stay in, or withdraw from such programs. Methods: Between June 2023 and May 2024, we explored factors related to MTM program completion or withdrawal using semi-structured qualitative interviews among 28 patient participants in a program run by the non-profit Community Servings. Half had completed the 6-month program ("completers"), and half had requested early discontinuance ("non-completers"). The interviews covered patient factors (health status, health goals, motivation to participate) and program characteristics (perceptions of the program overall, logistics, meal characteristics). Interviews were recorded and transcribed, and then coded using NVivo software. We used directed qualitative content analyses and included matrix coding queries to compare themes overall and between the groups. Results: Both completers and non-completers described enrolling to alleviate symptoms, regain physical function, and engage in desired activities. Many non-completers also focused on weight loss. Before joining, non-completers had been more enthusiastic about changing their diets, while completers were more interested in alleviating financial strain and the time and physical challenges associated with meal preparation. Both groups had very positive perceptions of the program. Both groups initially found the meals bland and portion sizes small, but completers more readily adapted to both taste and portion size. In contrast, among non-completers, taste was a reason for discontinuation for some. Other non-completers withdrew for "good reasons": they felt better or their circumstances otherwise changed, making the meals seem unnecessary. Both groups found the experience of eating the meals to be educational, which supported sustained dietary changes. Discussion: These novel findings explore patients' reasons for starting, completing, and stopping MTMs. Findings suggest strategies to improve program completion, such as addressing expectations about weight outcomes, taste, and portion size. Our study demonstrates the value of patient feedback for learning how to improve program effectiveness.