Progress 10/01/23 to 09/30/24

Outputs
Target Audience:The primary target audience of Produce Rx is CommuniCare+OLE (CC+OLE) patients who are eligible for Medicaidand who have a diagnosis of prediabetes, diabetes, or gestational diabetes. CC+OLE provides comprehensive healthcare services to anyone in the community, regardless of their ability to pay or insurance status. While the poverty rate in Yolo County is 16%, 70% of CC+OLE patients live in households earning incomes that fall below the Federal Poverty Level. Accordingly, Produce Rx participants are, on average, very low income and at greater risk of food insecurity and food-related chronic conditions. The majority of Produce Rx participants identify as Latino. A secondary target audience is CC+OLE staff. Primary Care Providers, Medical Assistants, Diabetes Health Educators, and Certified Nurse Midwives play a very important role in understanding and communicating to patients the value of Produce Rx. Project activities include staff training and program promotion to ensure that the patients who might benefit most from the program are referred appropriately. A tertiary target audience is other program implementers, including food systems professionals (farmers, food hubs and nonprofit food-focused organizations, academic researchers, etc.) and Community Health Center staff outside of CC+OLE. Changes/Problems:Low voucher redemption rates in 2023 spurred program staff to partner with a regional chain of brick-and-mortar stores, Nugget Markets. The majority of 2025 participants opted to access their produce prescriptions at Nugget Markets. Preliminary findings suggest that the Nugget Markets option was associated with a higher redemption/utilization rate (~95% of all benefits available to participants were used each month) compared to the Davis Farmers Market (~65% of benefits available to participants were used each month) and the Center for Land-Based Learning's Mobile Farmers Market (~35% of benefits were used). As described in the section outlining plans for the next reporting period, POS system limitations required that participants use their Nugget Markets benefits in one single transaction each month. This will no longer be the case in 2025. Some individuals opted to access their produce prescriptions at a farmers market because they did not feel they could use $70 worth of fresh produce without it spoiling. We anticipate that some of those individuals may opt for the brick-and-mortar option in 2025 due to the elimination of the monthly transaction limit. A no-cost extension and project change will be submitted to USDA in 2024 to expand program services through 2026. Cost savings were realized in FFY 2023 during the project's pilot year of operations. What opportunities for training and professional development has the project provided?One MPH student conducted a practicum project to better understand participants' qualitative experiences with Produce Rx during this reporting period. Five undergraduate students supported evaluation efforts, and one postdoctoral scholar coordinated evaluation activities, all undergoing extensive training to conduct surveys according to the study protocol. An additional five undergraduate and postgraduate students were trained to support project operations as a component of service-learning and health equity focused internships. Approximately 200 clinical staff participated in trainings regarding the evidence supporting produce prescriptions as a means for supporting the management of blood glucose levels among individuals with impaired glucose tolerance. Staff were also trained to identify eligible patients and promote and refer the patients with whom they interact to Produce Rx. Professional development for the staff budgeted to support the project included participationin communities of practicemeetings offered by the NTAE, and attendance at the in-person Project Directors meeting in December 2023 and a PPR Mini-Convening in June 2024. How have the results been disseminated to communities of interest?Quantitative results are not yet available. Qualitative results from the MPH practicum project were shared with program participants engaged in Group Medical Visits and with the staff that work closely with the project. What do you plan to do during the next reporting period to accomplish the goals?In FFY 2025 we will continue and expandprogrampromotion among clinic staff, conduct baseline and endline surveys in collaboration with our UC Berkeley evaluation partners, and engage patients in diabetes and food education activities.Newly trained culinary educators will help expand access to more culinary medicine activities. The evaluation team anticipates completing at least 50 more matched pre/post-intervention surveys, with a goal of reaching 150 total complete data sets across three years of evaluation. Some preliminary data analysis will also begin in 2025. We will continue to offer participants a choice in how they access their produce prescriptions between the brick-and-mortar option (Nugget Markets) and a local farmers market (either the Davis Farmers Market or the Center for Land-Based Learning's Mobile Farmers Market). We will build on our successful partnership with Nugget Markets by taking advantage of improved functionality available through their new Point of Sale (POS) system. Participants who accessed their produce prescriptions at Nugget Markets in 2024 were required to make all their purchases in a single monthly transaction, but the new POS system will allow participants to shop multiple times until they exhaust their $70 allotment. Participants will also be able to see their remaining balance by scanning their card at check-out. We predict this may lead to better health outcomes because we anticipate that spacing purchases throughout the month will enable participants to consume produce more consistently rather than during a shorter window of time.

Impacts
What was accomplished under these goals? In its second year of implementation, Produce Rx staff and partner organizations expanded and improved systems for enrolling participants,distributing and redeeming produce prescription cards, vouchers or boxes, and evaluating project impact. A partnership with Nugget Markets led to Produce Rx participants being able to "fill" their produce prescriptions in a brick-and-mortar setting. We continued to collaborate with the Davis Farmers Market and the Center for Land-Based Learning's Mobile Farmers Market which offer participants access to farm-direct produce prescriptions. Program participation nearly doubled from 112 enrolled at baseline in 2023, to 216 individuals enrolled in the2024 program. Evaluation activities,led by UC Berkeley scientists, engaged 62 of the patients enrolled in 2024 program activities. Between 2023 and 2024, 99 participants have completed both pre- and post-intervention surveys. Clinical staff were significantly more enthusiastic about promoting participation in the program this year, likely due to activities to communicate the benefit of the program to staff and positive patient feedback from year one. Utilization improved significantly, led by those participants accessing produce prescriptions from Nugget Markets: individuals participating in this brick-and-mortar option accessed roughly 95% of the benefits available to them.

Publications