Performing Department
(N/A)
Non Technical Summary
Southwest Virginia Produce Rx (SWPRx) is a regional, collaborative project led by food access, healthcare, university, and community partners. The project's goals are to 1) expand SWPRx that prioritizes community-based food and health resources in rural and urban localities in SW Virginia, 2) evaluate effectiveness of SWPRx to engage the target audience, increase food security, improve fruit and vegetable consumption, and improve participant health, 3) improve participant-level outcomes and healthcare utilization, and 4) establish flexible and sustainable implementation strategies.The SWPRx project builds on over ten years of experience implementing and refining small scale produce prescription programs in underserved communities in Roanoke City. SWPRx food and healthcare systems partners' strong and integrated infrastructure will support expansion across diverse, underrepresented communities in Southwest Virginia. Patients receiving care in Roanoke City, Franklin County, Floyd County, and Radford City who are enrolled in Medicaid and have elevated HbA1C and/or blood pressure will be identified by their healthcare provider and referred to the SWPRx program.Over three years, the SWPRx program will provide 300+ participants with a six-month intervention that includes ongoing support, nutrition education, and weekly fresh produce Rx to be redeemed on-site at nutrition education classes, at participating Virginia Fresh Match firms, and/or at participating food pantry sites. SWPRx participants will learn about and integrate into community-based programs and resources to support their long-term health and health behaviors. Learnings from the SWPRx expansion will highlight opportunities and implementation challenges of integrating produce Rx programs into community food and health systems.
Animal Health Component
0%
Research Effort Categories
Basic
(N/A)
Applied
80%
Developmental
20%
Goals / Objectives
The primary goal of this project is to develop, implement, and integrate a fresh produce prescription intervention that prioritizes community-based food and health resources specific to unique localities (urban and rural) in Southwest Virginia. The projects objectives are to:Expand, implement, and integrate the community food- and health resource- based SWPRx project in rural and urban localities in SW VA.Evaluate effectiveness of the program design to engage the target audience, increase food security, improve fruit and vegetable consumption, and improve health indicators of 300+ enrolled participants over the three-year period.Improve participant-level outcomes and healthcare utilization.Establish flexible and sustainable implementation strategies that can be utilized by other healthcare and food access organizations to replicate and/or scale the Rx intervention.
Project Methods
In order to achieve our goals, the SWPRx Leadership Team and stakeholders will employ a systems approach, a methodology that addresses the underlying factors behind complex problems to make enduring systems change (Neff, Merrigan, and Wallinga, 2015). The systems practice focuses on relationship building and interconnected thinking as opposed to siloed conversations and non-coordinated efforts. The SWPRx project includes collaborations between regional food and health systems partners including healthcare providers, Rx redemption firms, Rx participants, and health educators to refine the design and implementation of SWPRx. Through a systems approach, Rx participants will navigate health and food services within their community which will better support their individual health, increase consumption of fruits and vegetables, increase nutrition security, and increase use of preventative healthcare services.The efforts included in the SWPRx program over the three project will provide 300+ participants with a six-month intervention that includes ongoing support from community health workers, nutrition education, cooking tools, and weekly fresh produce Rx to be redeemed on-site at nutrition education classes, at participating Virginia Fresh Match firms, and/or at participating food pantry sites. Evidence-based nutrition education include the Full Plate Living program and Body Connection mindful movement education.LEAP agrees to participate in the GusNIP comprehensive program evaluation and facilitate contribution through data collection, and the use of Data Use Agreements and Memoranda of Understanding (MOU) as outlined in the RFA to measure the success of the SWPRx program. LEAP will follow USDA guidelines to ensure a high level of evaluation rigor including an appropriate level of comparability of methods, outcomes, and measures. LEAP will work with Carilion to collect core participant-level and healthcare utilization data and clinic firm core metrics, with VFM to collect Rx redemption firm-level metrics, and Radford University to conduct the process evaluation. LEAP will cooperate with and contribute this data to the NTAE. LEAP is also willing to participate in optional sub-studies and case studies to support NTAE evaluation efforts.The Evaluation Team (LEAP, VFM, Carilion, and Radford University) appreciates that evaluation is central to the GusNIP grant program and will work to ensure the highest level of evaluation rigor and objectivity possible in the implementation of this ambitious project seeking to expand the breadth, scope, reach, and success of PPR programs. Maureen McNamara Best will facilitate the Evaluation Team in close partnership with Burks, Johnson, and Baskette.The Evaluation Team will gain IRB approval through Carilion Clinic. The SWPRx evaluation will include (1) a process evaluation to document implementation fidelity, local adaptations, and implementation successes and challenges to support improvements and sustainability (2) an outcome evaluation to document the project's effectiveness on improving participant intake of fruits and vegetables, blood pressure and HbA1C, food security status, and healthcare utilization among SWPRx participants. The process evaluation will provide the Evaluation Team, healthcare providers, VFM firms, and other stakeholders with timely information to assist with meeting program outcomes. The Evaluation Team will meet monthly to ensure high-quality data collection and dissemination. Members of the Evaluation Team will also attend monthly Leadership Team meetings to share information about the challenges and successes of the regional SWPRx project.As part of the process evaluation, monthly meetings via Microsoft Teams will be conducted with CHO staff directly involved in the program implementation and data collection to gather feedback on implementation and data collection processes and data on participant referral volumes, eligibility rates, enrollment, attendance at nutrition/health education, participant-expressed barriers to participation, and lessons learned. Summary data will be recorded and shared with the Evaluation and Leadership Teams during regular meetings to allow feedback to be integrated immediately into SWPRx processes.The "Survey for Health Care Providers" will be distributed annually to participating referring providers to collect data on their experiences with the program. Survey data will be analyzed and aggregated and a summary of the results disseminated to the Leadership Team. Structured interviews will be conducted with VFM redemption firms annually (Y2-3). Testimonials from firm staff will be collected annually via Smartsheets. To gather feedback on perceptions about and satisfaction with the program, focus groups will be conducted annually with Rx program participants and with CHO staff.The outcome evaluation will follow the guidelines developed by the NTAE to ensure an appropriate level of comparability of methods, outcomes, and measures. Firm-level metrics will be collected monthly and annually as required. Participant biometric data (height, weight, blood pressure, and HbA1C) will be collected at enrollment and 6 months by Community Health Nurses and recorded in REDCap (research electronic data capture). REDCap data will be de-identified before aggregate data is reported. Participants will also complete pre/post participant-level surveys which will be tailored to the SWPRx program to include program-specific language and healthcare utilization questions. Surveys will be administered electronically via Qualtrics on Carilion laptops at baseline and 6 months during the enrollment and exit process at clinic sites. Community Health Nurses will assist participants with survey completion as needed. SWPRx participants will be provided with a $20 stipend for their time in completing the pre-program evaluation and another $20 stipend for completion of the post-program evaluation. Carilion's Health Analytics Research Team (HART) will be responsible for participant healthcare utilization data extraction from EPIC. Types and volumes of health services utilization among SWPRx participants pre, during, and post intervention will be collected and reported in aggregate.All process and outcome data will be compiled and presented to the Leadership Team at the Annual in-person meeting to allow for team discussion and course corrections. Preliminary results will be included in the annual report to NIFA and to the NTAE, abstracts will be submitted for presentation at conferences, and publications will be submitted to academic journals. In addition, LEAP agrees to participate in site visits and meet periodically with staff from NIFA, NTAE, and other GusNIP grantees to review project plans, evaluation objectives and methods, data collection and reporting requirements, and analysis and reporting of results.