Progress 09/15/23 to 09/14/24

Outputs
Target Audience: We enrolled 41 patients across eight clinics for the 2024 fresh food prescription program cycle. These patients were referred to our food resource navigator based on the following eligibility criteria: experiencing food security, has a diet-related chronic condition, is a member of an underrepresented population. All of the clinics providing referrals are located in the West Metro area of the Twin Cities, with patients coming from 25 different zip codes. Of our participants, 56% lived in a Minneapolis zip code, 34% lived in a St. Paul zip code, and the remaining 10% lived elsewhere. The breakdown of participants' primary care sites is as follows: Brooklyn Park (Brooklyn Park, MN): 5 Edina (Edina, MN): 2 Lakeville (Lakeville, MN): 1 Midway (St. Paul, MN): 9 Oxboro (Bloomington, MN): 1 Prior Lake (Prior Lake, MN): 1 Riverside (Minneapolis, MN): 8 Smiley's (Minneapolis, MN): 14 Our participants represent a wide variety of races and ethnicities, reflecting the Twin Cities' rich diversity as well as the stark reality that food insecurity and its associated health outcomes disproportionately affect communities of color. The race/ethnicity of our program participants was distributed as follows: Asian (including Asian American, people of the Far East, Southeast Asia, or Indian subcontinent): 4.9% Black, African: 7.3% Black, African American: 29.2% Hispanic, Latinx, or Spanish origin: 2.4% Native American or Alaska Native: 2.4% Native Hawaiian or Other Pacific Islander: 2.4% White/Caucasian: 51.2% We received referrals for program participants from all stages of life, with approximately 90% of them falling between the ages of 27-74, and just a handful either younger or older. However, the majority of participants' households did not have children living in the house, with only 29.2% reporting that they did and the median household size falling at 1 (the mathematical mean was 2.4 household members). Please see the following for our participants' age distribution: 19-26: 7.3% 27-44: 31.7% 45-64: 34.1% 65-74: 24.4% 85+: 2.4% We also asked our participants to report on their level of food security using the Hunger Vital Signs. Only 9.8% of those patients responded "Never True" to all of the screening questions, with the other 90.2% saying that at least one of the statements was sometimes or often true. Additionally, 92.7% of our participants were on public insurance, and 48.8% reported that they or somebody in their household received federal food assistance such as SNAP or WIC. The nearly 50-point gap between self-reported food insecurity and receipt of federal food assistance points to the importance of non-governmental initiatives such as Fairview's fresh food prescription program in alleviating food insecurity and remedying the health disparities that it engenders. Our program participants responded to the Hunger Vital Signs as follows: In the last 30 days... We worried whether our food would run out before we got money to get more: Often true - 41.5% Sometimes true - 39% Never true - 12.2% Prefer not to answer - 7.3% The food that my family bought just didn't last, and we didn't have money to get more: Often true - 36.6% Sometimes true - 39% Never true - 14.6% Prefer not to answer - 9.8% I or other adults in my household cut the size of my meals or skipped meals because there wasn't enough money for food: Often true - 39% Sometimes true - 24.4% Never true - 24.4% Prefer not to answer - 12.2% Changes/Problems: Two of the primary challenges we experienced in the 2024 programming cycle mirrored prominent barriers to food security faced by countless households: high cost and transportation. In recent years, food insecurity rates have increased substantially as inflation raised the prices of basic necessities, particularly at grocery stores. This not only affects retail consumers, but also wholesale purchasers such as ourselves. Soon into the program we realized that we were tracking overbudget due to the unprecedentedly high costof food. However, this particular challenge did not actually precipitate notable programmatic changes. After discussion, the collaborative team decided to continue purchasing all our produce from local growers at competitive market rates as planned, despite the unexpected expense; as an anchor institution, our commitment to supporting local farm partners should not attenuate in times of economic duress, but strengthen. Another challenge we faced was the cost and coordination of transportation. We know that lack of reliable transportation is one of our patients' most significant barriers to accessing food, and we encountered difficulties on the reverse side of the same coin. Rather than struggling to transport people to food, we struggled to transport food to people in a manner that was both affordable and accountable. We budgeted for 24 patients opting for home deliveries, but all 41 of our enrollees selected delivery over picking their boxes up from the clinic. This led to a higher than anticipated cost for courier services. In keeping with our commitment to investing in our community, we contract with a local courier service for our delivery needs. As a small, locally owned and operated company, they do not have sophisticated tracking software, making it difficult to communicate with patients about delivery times, failed deliveries, address changes, and other logistics. We plan on implementing some program improvements to allow us to better track delivery and utilization rates for the 2025 fresh food prescription boxes. The final programmatic change we implemented this year concerned our evaluation strategy. Our original program design included administering a weekly survey to assess participant satisfaction, food skill development, and other outcomes. However, upon further reflection we decided that the burden such frequent surveying would place on patients outweighed any potential insights we could gain. We settled on pre- and post-surveys and are in the process of compiling and analyzing the responses. What opportunities for training and professional development has the project provided?Our newly hired food resource navigator participated in regulartrainings led by the City of Minneapolis related to local hunger relief resources and government food assistance programs such as SNAP, WIC, and Market Bucks. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?Uponanalyzing and interpreting our post-survey data, we will be able to more accurately assess our progress towards our stated objectives and make the appropriate programmatic adjustments. Already, we plan on shifting the design of our fresh food prescription boxes to align with medically tailored meal recommendations for conditions including pre-diabetes and Type II diabetes, hypertension, and heart disease. Though this shift will come with additional logistical and administrative challenges, we hope it will lead to improved health outcomes and a more positive experience for patients and providers. Additional modifications including a two-way communication channel with participants and linguistically-cognizant survey design are also under consideration.

Impacts
What was accomplished under these goals? Throughout the 2024 programming cycle, the Fairview fresh food prescription program and food resource navigator served 41 participants enrolled across eight M Health Fairview clinics. Each of these clinics wasselected due to the high need demonstrated by their patient populations (Objective 1). We initially established an objective of two clinic sites with 18 participants apiece; however, the added capacity and expertise of the new food resource navigator allowed us to receive referrals for eligible patients from additional clinics. Because of this, rather than enrolling 18 patients in each of two clinics, we chose to work with a greater number of clinics to enroll more patients meeting our eligibility threshold (members of an underrepresented population who have a diet-related disease and are experiencing food insecurity) (Objective 2). Ultimately, we enrolled patients not only at our Riverside and Smiley's primary care sites, but also from Brooklyn Park, Lakeville, Midway, Oxboro, Prior Lake, and Edina. All of the enrolled participants received 24 weekly boxes of local produce, as well as protein options and pantry staples, either delivered directly to their home or available for pick up at their clinic (Objective 3). The program itself ran for 26 weeks, though we did not deliver any boxes the weeks of Independence Day and Thanksgiving. Our participants received their final boxes the week of December 4, and we are actively collecting and analyzing post-survey data. These surveys include questions aimed at capturing the patients' qualitative experience with the program, their level of food in/security, Core Healthy Days (self-assessment of physical and mental health over the previous 30 days), and GusNIP core metrics, among other dietary habits. In addition, we will access electronic health records for the enrolled patients in order to look at healthcare utilizations (in-patient stays and ED visits), as well as pre- and post-biometrics such as A1C, blood pressure, height, and weight. After post-survey collection has been completed in January 2025, we will assess our progress towards Objectives 4 - 6 and Goal 2. We look forward to reporting on participants' health outcomes and self-reported food security in our 2025 Annual Progress Report.

Publications