Abstract
BACKGROUND: Food Is Medicine interventions show promise for improving cardiovascular health outcomes, particularly for addressing disparities affecting Black and Hispanic populations. However, their development often lacks community co-creation. Human-centered design approaches can enhance the acceptability and feasibility of interventions through co-design processes. We aimed to co-design the THRIVE program (Adaptive Personalized Dietitian Coaching and Messaging With Produce Prescriptions to Improve Healthy Dietary Behaviors) among Black and Hispanic adults with hypertension living in healthy food priority areas in Maryland. METHODS: Using social cognitive theory and the human-centered design double-diamond framework, 3 iterative co-design sessions were conducted. The first session included an orientation/listening (virtual), followed by 2 in-person prototyping and process mapping sessions. Participants included community residents with hypertension, health care providers, local food system representatives, and community organization leaders. Data collection included detailed session notes, post-session surveys, prototypes, and documentation of visual outputs. Content analysis identified key implementation themes. RESULTS: Thirty-six community stakeholders (29 female, 6 male, 17 English-speaking, 18 Spanish-speaking/bilingual) participated. Three primary themes emerged: (1) health care system integration, emphasizing personalized dietitian support with cultural competency; (2) food access and education, highlighting flexible produce prescription programs with practical nutrition education; and (3) community empowerment, emphasizing peer support networks. Process evaluation demonstrated high engagement, with 100% reporting valued contributions and 92% recommending similar approaches for future cardiovascular interventions. CONCLUSIONS: Human-centered design effectively guided community engagement in the development of a contextually tailored Food Is Medicine intervention. Integrating human-centered design with implementation science creates more effective, equitable, and sustainable health interventions for addressing complex health challenges.