Performing Department
(N/A)
Non Technical Summary
Food insecurity and chronic disease management are significant health and safety concerns in the rural South, especially in South Carolina where food insecurity rates (14.5%) are higher than the national average and 6 in 10 individuals are living with at least one chronic disease. Access to medically-tailored groceries (MTG) is necessary for nutritional management of diet-related chronic diseases, as highlighted in the national Food Is Medicine initiative; yet for food insecure individuals, access to MTG may be limited. The charitable food network, food pantries being the largest service provider within this network, is on the front line of alleviating hunger in the United States; yet their capacity to offer MTG to clients with chronic diseases is currently limited. In South Carolina, Rural Health and Nutrition Extension professionals are poised to support food pantries; but they are lacking resources targeting MTG. Thus, the goal of the proposed project is to improve rural community capacity to offer MTG to food insecure individuals with chronic diseases in South Carolina. This capacity-building project will address individuals and families living in rural areas through training of the Extension coaches and food pantry service providers and volunteers that serve them. To achieve our goal, the two objectives of the proposed project are to: 1) determine the capacity of South Carolina food pantries to offer MTG, and 2) assess feasibility of a capacity-building, Extension coaching-based intervention to increase sourcing and distribution of MTG by rural South Carolina food pantries.
Animal Health Component
100%
Research Effort Categories
Basic
(N/A)
Applied
100%
Developmental
(N/A)
Goals / Objectives
Our goal is to improve rural community capacity to offer medically-tailored groceriesto food insecure individuals with chronic diseases in South Carolina.To achieve our goal, we have the following objectives:1. determine the capacity of South Carolina food pantries to offer medically-tailored groceries; and2. assess feasibility of a capacity-building, Extension coaching-based intervention to increase sourcing and distribution of medically-tailored groceriesby rural South Carolina food pantries.
Project Methods
Phase 1.A series of focus groups (at least four or until saturation is reached) will be conducted across South Carolina (SC) with pantry staff to identify the wide variety of organizational factors upon which the capacity of SC pantries to offer medically-tailored groceries (MTG) is dependent. Our focus group moderator guide will be based on the Consolidated Framework for Implementation Research (CFIR), which guides systematic assessment of potential barriers and facilitators for implementation strategies, such as sourcing and distributing MTG.In conjunction with the focus group sessions, we will also administer a survey to all SC food pantries (N=179) to determine volume and source of food donated/received, inventory information, and characteristics of clients served (e.g., health status, cooking ability/cooking equipment availability), among other items. Inventory information, though potentially difficult to access, is necessary so we can better determine MTG needs of pantries by comparing provided inventory lists to the Nutrition Guidelines for the Charitable Food Systemand Medical Nutrition Therapy guidelinesfor diabetes,cardiovascular/cerebrovascular diseases,and obesity.Inventory evaluation will be guided by the Healthy Food Pantry Assessment Tool,adapted to assess not only general healthful foods but also MTG (e.g., specific non-starchy vegetables for diabetes, vegetables oils and salt-free seasonings, protein-containing snacks for weight loss, nut-free products for nut allergies, among others). Systematic adaptations to the Healthy Food Pantry Assessment Tool will be documented and reported using the Framework for Reporting Adaptations and Modifications-Expanded (FRAME).Results of inventory evaluation will inform customizable 20-item MTG capsule pantry boxes (i.e., groupings of grocery items that can be "mixed and matched" to make a wide variety of healthful meals). MTG capsule pantries will include items commonly found in food pantries that are also MTG, recipes, and seasonings/oils to help clients use items at home. Additional MTG needs of individual food pantries will be identified through the results of the adapted Healthy Food Pantry Assessment Tool. Focus group and survey findings will also inform guidelines on how to conduct targeted food drives and donations to source these additional MTG needs. Wewill create multiple MTG capsule pantries reflecting the needs of one who has a specific chronic disease (e.g., diabetes, cardiovascular), led by the PD who is a RDN licensed in South Carolina with the required scope of practice. Additionally, we will also include "wild card" foods - a small selection of foods that a pantry client can select in addition to "their" box.Phase 2. We will recruit at least 10 food pantries to participate in the capacity-building intervention (i.e., training followed by Extension coaching sessions). A problem-based learning (PBL) approach will be used to conduct training as this approach helps participants receive, adopt, and implement capacity-building strategies. Collaborative problem-solving is central to PBL as it requires individual contributions within a group setting to address complex problems (e.g., building capacity to offer MTG). It also will allow participants to customize strategies to best meet individual pantry needs. To help implement gained knowledge, we will assign an Extension coach to each participating pantry. Many interventions aim to change using a "one and done" approach - the intervention is delivered and learners are expected to implement and sustain change. In implementation science frameworks, coaching is an important competency "driver" better ensuring practices are implemented and sustained.Quality active coaching, when performed at least once/month, will help participants use gained knowledge as intended as well as offer support for trying new approaches during awkward periods following new knowledge acquisition. The coaching phase of the intervention can help pantry operators develop skills, judgment, and individualize use of capacity-building strategies to source and distribute MTG.The Extension coaches will betrained members of the Clemson University Rural Health and Nutrition Extension team.Train-the-Coach. The PD and co-PD Fraser will create a training manual and slide set for theExtension coachesto use with their assigned pantries (up to 2 pantries/coach). Additionally, a "playbook" will be created summarizing the usual problems encountered when training teams, helping teams to develop a tailored program for their assigned pantries, and checklists for a successful team training process. The playbook will also include information gathered from the focus group sessions and capacity survey (Phase 1 data). During training, the PD and co-PD Fraser will: reinforce adherence to the program; create a process for division of responsibilities among the group; discuss group dynamics and the need for team roles including leadership and resolution of process issues; evaluate team member's learning assignments; give feedback on mock training vignettes that the teams enact; and follow up with team-behavior checklists and booster sessions as needed.We will then test the capacity-building intervention targeting staff working in at least 10 SC food pantries in the rural Pee Dee region of South Carolina. Training delivery to all pantry staff will include a half-day session describing and discussing strategies to build capacity to source and distribute MTG followed by monthly, up to one hour Extension-led coaching sessions over one year. To monitor and improve delivery of the program, we will rely on regular (i.e., at least once/month) interaction between the coaches and food pantries. Extension coaches will record their observations using a field diary and self-report questionnaire. The self-report questionnaire will be designed to address questions about implementing strategies, training/retraining issues, and general concerns about progress and participation. PD Wilson will participate in all initial trainings as well as at least one coaching session per food pantry. During coaching visits, either virtual or face-to-face, the PD will record observations. Furthermore, coaches will meet with the PD and co-PD Fraser at least quarterly during the intervention year to address challenges, communicate resources needed, and clarify any questions as well as to review nutritional value of donated foods and data collection procedures.Determining feasibility of the intervention will be guided by the basic principles of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.Participants will complete a baseline and three follow-up surveys. Data collection will take place at four points in time: (i) before the initial training (baseline), (ii) 3 months after exposure to the initial training (3 months), (iii) 6 months after the initial training (6 months), and (iv) 12 months after the initial training and completion of coaching (post-intervention). Surveys will again assess the six organizational attributes influencing capacity (described in Phase 1 of Approach Description), volume and variety of MTG sourced and distributed, challenges to offering MTG, and any modifications of procedures (e.g., intake forms) to identify and serve clients with chronic diseases. Data will be entered into an Excel spreadsheet, checked for accuracy, then analyzed with appropriate statistical methodsusing SPSS software.In addition, we will conduct semi-structured interviews six and twelve months after the initial training with a representative from each participating pantry to determine progress and on-going challenges of implementing MTG strategies. Interviews will again be guided by the CFIR framework, and data will be analyzed using thematic content analysis. Six- and twelve-month interview data will be used to contextualize RE-AIM findings.