Performing Department
(N/A)
Non Technical Summary
Non-Technical SummaryCurrent Issue and Importance:Sub-optimal diets significantly contribute to chronic health conditions such as hypertension (HTN) and type-2 diabetes (T2D), particularly among low-income populations who face barriers to accessing and affording nutritious foods. Nutrition assistance programs like SNAP and WIC aim to mitigate food insecurity, but challenges remain in purchasing nutrient-dense produce over inexpensive, processed foods. This issue is critical as it leads to health disparities, increased medical complications, and higher healthcare costs, affecting both individuals and the broader community.In San Diego, nearly one in four residents experiences nutrition insecurity. At Family Health Centers of San Diego (FHCSD), over 25,000 of the 159,000 patients served are food insecure, with significant representation from low-income, Latino/a, and BIPOC communities. FHCSD also serves over 14,200 patients with T2D and 31,700 patients with HTN, reflecting the social determinants of health affecting our low-income population and the complex healthcare needs of those living with co-occurring chronic conditions. Addressing the underlying cause of this issue is essential for improving public health, reducing economic burdens, and enhancing community well-being.Methods and Approaches:To tackle this issue, the Produce Delivery Program and Food as Medicine (PDP-FaM) initiative will deliver 20-pound fresh produce box subscriptions directly from a local family farm to the homes of over 400 low-income, food-insecure patients with HTN or T2D. These deliveries will be paired with culturally tailored nutrition-health education, providing practical skills for incorporating fresh produce into their diets and managing their health conditions. Furthermore, the program aims to enhance sustainability through partnerships in the food and healthcare sectors, including managed care plans. By entering into contracts with providers through Medi-Cal (CalAIM), we will extend access to healthy foods for eligible patients for a minimum of 6 months, beyond the 12-months of farm-fresh produce box deliveries. In doing so, we will develop a model for effectively using underutilized medical benefits, such as CalAIM, to serve low-income populations in San Diego County. We will collect data through surveys and health metrics before, during, and after the intervention to track changes in diet quality, food security, health outcomes, and healthcare use.Goals and Expected Impact:The ultimate goal of the PDP-FaM initiative is to improve dietary habits and health outcomes for participants, reduce food insecurity, and lower healthcare costs. By achieving these goals, the project aims to create a ripple effect of benefits, including healthier communities, reduced strain on healthcare systems, and stronger support for local agriculture. This holistic approach not only addresses immediate health needs but also promotes long-term, sustainable improvements in public health and community resilience.
Animal Health Component
60%
Research Effort Categories
Basic
0%
Applied
60%
Developmental
40%
Goals / Objectives
Goals:The overarching goal of the Produce Delivery Program and Food as Medicine (PDP-FaM) initiative is to improve healthcare practices and health outcomes related to hypertension (HTN) and type 2 diabetes (T2D) in low-income, food-insecure communities across San Diego County by increasing access to and consumption of fresh fruits and vegetables (FF/V).Staff training, screening, identification and verification of eligible individuals, recruitment, development of surveys in qualtrics, and development ofan online tracking & reporting system with the farmObjectives: Toemploy a multi-component approachto:Reduce Food and Nutrition Insecurity:Home-deliver approximately 20 pounds of FF/Vmonthly for 12 months to 417 participants directly from a local family farm, monitored and managed through the online tracking & reporting system. Staff training, screening, identification and verification of eligible individuals, recruitment,and development of an online tracking & reporting system with the farm will be done during the start-up phase (the first 3 months of the project). Enrollment will occur during months 4-21 of the project, while implementation will continue till month 33.Enhance Community Knowledge and Diet Quality:Provide culturally sensitive and personalized nutrition-health education biannually to participants, supporting them in incorporating farm-fresh delivered FF/Vinto their daily diet to increase FF/V consumption by at least 1/4 cup by the end of the intervention period, and cultivating sustainable dietary habits.Improve Health Outcomes: Significant improvement in cardiometabolic markers, such as HbA1c, blood glucose, blood lipids, blood pressure, and body weight,in participants experiencing T2D and/or HTN by the end of the 12-month intervention.Decrease Healthcare Use and Costs: Significant reduction inhealthcare use and associated costs by the end of the intervention period as a result of improved food security, diet quality, and enhanced health outcomes assessed by EHR data and pre- and post-program comparisons of self-reported data through NTAE adapted questionnaire.Support Local Farmers and Locally Grown Produce:Source FF/V directly from local farmers (Yasukochi Family Farms), supporting the local agriculture community.Overcome Barriers to FF/V Consumption:Address barriers such as food iliteracy and transportation challenges to FF/V consumption by providing nutrition-health education and delivering FF/V directly toparticipants throughout the project period.Enhance Understanding of Produce Prescription Impact:Study and demonstrate how prescribing and delivering FF/V, combined with personalized nutrition-health education, can positively impact nutrition and health, and reduce healthcare costs upon completion of data collection, cleaning, and post-intervention analysis.
Project Methods
The innovation of this project lies in addresing the limitations of traditional Produce Prescription Programs (PPRs), such as economic constraints, operational burdens, and transportation issues, by directly delivering produce to participants. This is combined with personalized nutrition education and regular health monitoring, offering a holistic approach to improving food access, literacy, and behaviors in the target population.Efforts:Nutrition and Health Education: Provide personalized educational sessions every six months, emphasizing practical skills for incorporating fresh produce into diets and managing chronic conditions.The nutrition education will be customized to reflect the cultural preferences and dietary habits of the diverse participant population, making it more relevant and impactful.Produce Delivery System:Develop a home delivery system to supply participants with approximately 20 pounds of fresh fruits and vegetables directly from the farm every two weeks for 12 months.Extension and Outreach:Ongoing engagement with the community through meetings, phone calls,and online resources to identify and address potential issues andkeep participants informed and motivated.General Scientific MethodsData Collection:Baseline Data: Collect initial data on demographics, health status, dietary habits, food security, and healthcare use.Follow-Up Data: Conduct biannual follow-up surveys to monitor changes and gather data on diet quality, food security, health metrics, and healthcare use, as well as to assess participant satisfaction and identify issues and barriers.Post-Intervention Data: Collect final data after 12 months to assess the long-term impact of the intervention and participant overall experience.Health Metrics Monitoring:Use electronic health records (EHR) to track participants' health metrics, including HbA1c, blood lipids, blood glucose, body weight, and blood pressure. These metrics will be collected at baseline, every six months, and at the end of the intervention.EvaluationThe project will collect two types of data: firm-level information gathered electronically every month from the farm as the farm-direct firm, and participant-level data obtained via surveys.We anticipate data from 292 participants, assuming a 70% completion rate. As secondary outcomes, improvements in individuals' health, specifically HTN, T2D, and related risk factors, will be evaluated.Process Evaluation:We will document challenges and successes in each implementation phase, from staff training to participant satisfaction. FHCSD's implementation and evaluation staff will gather and analyze data monthly for continuous program monitoring, allowing for timely identification of issues and effective quality improvements.Monitor and document the implementation process, including participant enrollment and participation, produce delivery, and education session attendance.Use educational sessions, follow-up and post-intervention surveys, and participants' feedback to assess participant satisfaction and identify areas for improvement.Outcome Evaluation:We will use survey data and health metricsto evaluate the PDP-FaM's impact. The GusNIP NTAE further facilitates the process by annually providing specific participant-level survey results, encompassing both individual outcomes (raw data) and aggregated reports across participants. Anticipating a 30% attrition rate, we aim to gather complete data from 292 participants, exceeding the required sample size of 100-130 for detecting a ¼ cup change in FF/V consumption. The evaluation will concentrate on (a) enhancing individual and dietary health through increased consumption of FF/V, (b) reducing food insecurity, and (c) lowering healthcare use and associated costs.(a) Assess changes in FF/V intake and diet quality:analysis of data acquired through the DSQ fruit and vegetable module available at the Nutrition Incentive Hub conducted as part of baseline, follow-up, and post-intervention surveys.Health metrics for HTN, T2D, and related risk factorswill be evaluated by analyzing the cardiometabolic data (HbA1c and blood lipids) collected every 6 months, along with real-time data on blood glucose, body weight, blood pressure, and physical activity available in FHCSD's EHR system.(b) Assess food security:employ the USDA 6-Item Short Form, comparing baseline, follow-up, and post-intervention data using a rubric developed by USDA.(c) Healthcare use and cost:employs a multifaceted approach, using EHR data and pre- and post-program comparisons of self-reported data through NTAE adapted questionnaire supplemented by cost-benefit analyses and ongoing health outcome tracking.Expected Outcomes/AccomplishmentsEnrollment:Successfully enroll 417 participants from the target population with a completion rate of 70%.Produce Delivery:Ensure each participant receives approximately 20 pounds of fresh produce every two weeks for 12 months.Educational Sessions:Enhance participants' knowledge of nutrition & healthy eating/lifestyle patternsthrough biannual nutrition education sessions tailored to patients' needs.FF/V Intake:Achieve significant improvements in diet quality as indicated by a minimum of ¼ cup increase in FF/V consumption.Food security: Improved food insecurity as indicated by significant improvement in food insecurity score using USDA 6-Item Short Form.Health metrics: Improved health outcomes as indicated by significant improvements in cardiometabolic markers such as HbA1c and blood pressure.Healthcare Use and Costs:A reduction in healthcare use and associated costs among participants at post-intervention compared to the baseline.