Source: CLEMSON UNIVERSITY submitted to NRP
CHRONIC DISEASE MANAGEMENT WITHIN FOOD INSECURITY: BUILDING CAPACITY IN THE RURAL SOUTH
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
ACTIVE
Funding Source
OTHER GRANTS
Reporting Frequency
Annual
Accession No.
1032701
Grant No.
2024-46100-43169
Cumulative Award Amt.
$349,903.00
Proposal No.
2024-04503
Multistate No.
(N/A)
Project Start Date
Sep 1, 2024
Project End Date
Aug 31, 2027
Grant Year
2024
Program Code
[LX]- Rural Health & Safety Education
Recipient Organization
CLEMSON UNIVERSITY
(N/A)
CLEMSON,SC 29634
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)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
7046050101050%
7036099302050%
Knowledge Area
703 - Nutrition Education and Behavior; 704 - Nutrition and Hunger in the Population;

Subject Of Investigation
6099 - People and communities, general/other; 6050 - Communities, areas, and regions;

Field Of Science
3020 - Education; 1010 - Nutrition and metabolism;
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.

Progress 09/01/24 to 08/31/25

Outputs
Target Audience:The target audience of reporting period 1 included staff and volunteers of the 179 food pantries across South Carolina (SC) identified through a Crowdsourcing site listing U.S. food pantries. To identify these and any additional food pantries not included on the Crowdsourcing site, the research team also contacted the fourfood banks that serve all Feeding America-participating pantries in SC (Lowcountry Food Bank, which serves the Savannah Valley and part of the Pee Dee regions of SC, the target region for phase 2 of the project which will beginin reporting period 2; Harvest Hope Food Bank, which serves a majority of the Pee Dee as well as portions ofthe Midlands and Upstate regions of SC; Golden Harvest Food Bank, which serves portions of the Savannah Valley and Piedmont regions of SC; and Second Harvest Food Bank of Metrolina, which serves portions of the Piedmont and Upstate regions of SC). Pantry contact information was received from the two largest of these four food banks (Lowcountry and Harvest Hope), and contact information for pantries associated withGolden Harvest Food Bank and Second Harvest Food Bank of Metrolina was manually pulled from the food banks' websites. To date, 107 of these pantries have completed at least a portion of ourAdapted Healthy Food Pantry Assessment Tool (HFPAT) survey, and 4 focus groups have been conducted with subsetsof these pantry survey respondents. The research team is continuingoutreach attempts to increase survey response rates and focus group participation for improved representativeness of our sample.Given the rurality of many contacted pantries, alternative survey distribution and collection methods are being utilized into reporting period 2, including survey collection at the point of food pick-up at Harvest Hope Food Bank. Given scheduling challenges for focus groups, the research team is also offering pantry staff/volunteers to complete one-on-one interviews (instead of focus groups) with a research team member when coordinating schedules of multiple pantries for a focus groupwould limitparticipation. Changes/Problems:The research team is continuingoutreach attempts to increase survey response rates and focus group participation for improvedrepresentativeness of our sample.Given the rurality of many contacted pantries, alternative survey distribution and collection methods are being utilized into reporting period 2, including survey collection at the point of food pick-up at Harvest Hope Food Bank. Given scheduling challenges for focus groups, the research team is also offering pantry staff/volunteers to complete one-on-one interviews (instead of focus groups) with a research team member when coordinating schedules of multiple pantries for a focus groupwould limitparticipation. What opportunities for training and professional development has the project provided?The Project Director participated in two conferences, one state-level conference (Food is Medicine South Carolina Annual Meeting)and one national-level conference (Nutrition Incentive Hub National Convening), that provided professional development on optimizing Food is Medicine approaches, including medically tailored groceries. One graduate student funded by the project participated in the South Carolina Academy of Nutrition and Dietetics annual conference, which provided a professional development session on Food is Medicine approaches, including medically tailored groceries. Both graduate students funded by the project participated in a 2-part "Food is Medicine: Eating for Your Health" webinar series to further develop their professional knowledge and skills for delivering Food is Medicine community-based interventions. How have the results been disseminated to communities of interest?Given phase 1/reporting period 1 results are still being analyzed, the results have not yet been disseminated. However, survey and focus group results are being utilized to develop phase 2/reporting period 2training materials, which will be disseminated to the pilot sample of pantries in phase 2/reporting period 2 and, following refinement of materials after pilot testing, will be disseminated to all food pantries in South Carolina and other regions as interested in reporting period 3 of the project. Preliminary results on adaptation and use of the Healthy Food Pantry Assessment Toolhave been submitted for a poster presentation at the Clemson University Graduate Research Symposium. What do you plan to do during the next reporting period to accomplish the goals?Based on survey and focus group results, a capacity-building training for pantry staff/volunteerswill be developed in the first quarter of reporting period 2. Training materials for pantry staff/volunteers will includecustomizable 20-item medically tailored grocery (MTG)capsule pantry boxes for pantries that use pre-packed boxes/bagsor lists for client-choice pantries. "Capsule pantries"will begroupings of grocery items that can be "mixed and matched" to make a wide variety of healthful meals that align with general medical nutrition therapy guidelines. Items will be chosen based onitems commonly found in pantry inventories assessed and/or items that would be feasible to source through donations or purchases. MTG capsule pantries will also include recipes and seasonings/oils to help clients use items at home.Developed materials will include resources on how to conduct targeted food drives and donations to source additional MTG needs. We will create multiple MTG capsule pantries reflecting the needs of one who has a specific chronic disease (e.g., diabetes, cardiovascular), led by the Project Director (PD) who is a registered dietitianlicensed in South Carolina (SC) with the required scope of practice. We will recruit at least 10 food pantries to participate in the capacity-building intervention (i.e., training followed by Extension coaching sessions).The coaching phase of the intervention can help pantry operators develop skills and individualize use of capacity-building strategies to source and distribute MTG. The Extension coaches will be trained members of the Clemson University Rural Health and Nutrition Extension team. The PD willcreate a training manual and slide set for the Extension coaches to use with their assigned pantries. A "playbook" will be created summarizing potential problems they may encounter. 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/volunteers will include asession 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. 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 implementationstrategies, training/retraining issues, and general concerns about progress and participation. Pantry staff/volunteers will complete surveys at baseline and 3, 6, and 12 months post-training to assess organizational factors influencing capacity, volume/variety of sourced MTGs, challenges to MTG sourcing/distribution, and any modification of processes. Survey data, along with interviews conduted at6 and 12 months post-training, will be quantitatively and qualitatively analyzed according to the Consolidated Framework for Implementation Research and RE-AIM frameworks to determine feasibility and pilot effectiveness.

Impacts
What was accomplished under these goals? Reporting period 1 focused on objective 1 of this project, that is, determining the capacity of South Carolina food pantries to offer medically tailored groceries. The research teamcontacted the fourfood banks that serve all Feeding America-participating pantries in South Carolina (Lowcountry Food Bank, Harvest Hope Food Bank,Golden Harvest Food Bank, and Second Harvest Food Bank of Metrolina). Pantry contact information was received from the two largest of these four food banks (Lowcountry and Harvest Hope), and contact information for pantries associated withGolden Harvest Food Bank and Second Harvest Food Bank of Metrolina was manually pulled from the food banks' websites. To date, 107 of these pantries have completed at least a portion of ourAdapted Healthy Food Pantry Assessment Tool (HFPAT) survey, and 4 focus groups have been conducted with subsetsof these pantry survey respondents. The research team is continuingoutreach attempts to increase survey response rates and focus group participation for improvedrepresentativeness of our sample.Given the rurality of many contacted pantries, alternative survey distribution and collection methods are being utilized into reporting period 2, including survey collection at the point of food pick-up at Harvest Hope Food Bank. Given scheduling challenges for focus groups, the research team is also offering pantry staff/volunteers to complete one-on-one interviews (instead of focus groups) with a research team member when coordinating schedules of multiple pantries for a focus groupwould limitparticipation. Data collected from Adapted HFPAT surveys and focus groups is being analyzed to identify barriers to address and facilitators to capitalize on to increase capacity of pantries to source and distribute medically tailored groceries. Barriers and facilitators identified is informing development of training materials in reporting period 2, which will bepiloted with a sample of pantries in phase 2/reporting periods 2 and 3of the project.

Publications

  • Type: Conference Papers and Presentations Status: Submitted Year Published: 2025 Citation: Taylor A, Wilson H. 2025. Adaptation and Use of the Healthy Food Pantry Assessment Tool to Evaluate Food Pantry Capacity to Provide Medically Tailored Groceries. Poster. Clemson University Graduate Research Symposium.