Non Technical Summary
Project Open Hand (POH) proposes a SNAP Match Nutrition Incentive program in AlamedaCounty as a complement to our existing medically tailored nutrition intervention, with a goal toincrease consumption of culturally appropriate fruits and vegetables (FV). We aim to develop amore efficient and client-centered intervention, providing increased choice and a transition incare from more intensive medically tailored services that address highest acuity of need toincentives and engagement that facilitate improved food security and long-term behavior changefor managing nutritional health. POH will enroll 150 participants referred through CalAIMCommunity Supports and Ryan White programming and evaluate the impact of providing $70per month for six months to spend on SNAP-eligible fresh, frozen, or canned FV as $2 incentivefor every $1 of SNAP spent on any SNAP-eligible item at one of 32 Albertsons Companiesretailers in Alameda County. Participants will redeem benefits via an iQPay digital purchase card(print card available for those without a smart phone). Participants will receive automatedmessages to encourage participation. We will evaluate program usage through redemption rates,satisfaction, and feasibility of the program as a continuum of care model that provides incentivesin addition to in-house meal and/grocery services and for an extended period. We will also assessparticipant level outcomes around food security, FV intake and overall health. In addition toproviding the incentive, POH will develop a systematic process for screening clients for SNAPeligibility and supporting those eligible but not receiving the benefit by enrolling in SNAP.

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
703	6099	1010	100%

Knowledge Area
703 - Nutrition Education and Behavior;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
1010 - Nutrition and metabolism;

Goals / Objectives
The major goals of the Project Open Hand (POH) SNAP Match Pilot are to (1) Increase access to and consumption of culturally appropriate fruit and vegetables (FV), and (2)Develop a more efficient and client-centered Food is Medicine (FIM) intervention.The specific objectives that will be accomplished to reach these goals include the following:By December 2024, tailor and test iQPay card application in both digital and paper forms with at least three staff/volunteers.By December 2024, develop digital and paper-based client-facing orientationmaterials, including logistical incentive information and selection/incorporation of FV into eating patterns.By December 2024, develop library and schedule for TigerConnect text messaging and email support.By December 2024, train all East Bay POH Client Services staff in program work flows and SNAP 101/102 training via Alameda County Community Food Bank.By March 2025, enroll and complete baseline surveys for approximately 150 clients in the POH SNAP Match pilot (~30 HIV clients; ~120 Community Supports clients).Between January and August 2025, send automated text/email notifications or paper notifications to all consenting participants using library and schedule defined in Obj 3, removing and documenting any who opt out of messaging support.Between March and June 2025, conduct and document at least 1 outreach call/text/email to 90% of participants with an adherence rate to services of 50% or less to address any barriers to adherence.ByJuly 2025, collect 3-month surveys from 80% of program participants.By September 2025, collect 6-month surveys from 50% of program participants. (The difference in 3-month and 6-month survey completion rates is in recognition that particpants who receive 3-months of POH services will be more diffult to reach for survey completion at 6-months.)By September 2025, complete operational analysis of engagement with POH services, enrollment in CalFresh, opt-in status of text/email communications, and incentive redemption rates.

Project Methods
Compliance with SNAP/NAP Regulations: The POH SNAP Match pilot will offer benefits thatinclude only SNAP-eligible categories of foods. Incentives will be earned through purchase of anySNAP-eligible food, and incentives will be redeemed for FV (fresh, canned, frozen and seeds) thatdo not contain added sugars, fat or sodium. The IQPay app will be configured to these parameters,and reporting will include tracking of purchases to ensure compliance. Additionally, POH clientswill be screened at intake for CalFresh enrollment and household income. Clients already enrolledin CalFresh will be offered benefits and, if interested, oriented to the program.Clients who are eligible but not enrolled in CalFresh will be offered CalFresh enrollment assistance by POH Client Services staff. If successfully enrolled in CalFresh, those clients can then enroll in the SNAP Match program.POH and Retail Staff Training: POH Client Services staff will complete Alameda CountyCommunity Food Bank's SNAP 101 and 102 training to learn how to pre-screen and identifyindividuals who are likely eligible for SNAP. Retail cashiers are all trained in acceptance of QRCode tenders. There are multiple programs which use QR code tender,avoiding stigma at the pointof sale. IQ Pay's customer services team is available to answer questions about the use of thedigital card.Outreach Plan: As noted above, clients are screened and introduced to the POH SNAP Match pilot at the point of intake or recertificationfor POH's Food is Medicine programming. Participants will receive continued outreach to encourage participation in the SNAP Match program as long as they are eligible, including if/when they transition off of POH's Food is Medicine program.Ongoing Participant Engagement: Previous research indicates that despite offering increasedincentives for FV voucher redemption, redemption rates remain low. To address this challenge, wewill send motivational messaging and email reminders to participants.Summary of Evaluation Methods: The POH SNAP Match NIP will be assessed using metricscollected by POH via baseline, 3- and 6-month surveys, stakeholder interviews, regular meetingnotes and operational data, as well as usage data collected via the iQPay app. Process evaluationwill look to maximize client benefit and program sustainability. POH will conduct a formative outcome analysis that includes and expands on the coreparticipant and firm-level metrics for GusNIP programs to assess the potential effectiveness of thePOH SNAP Match pilot in meeting program goals. In addition to FI, overall intake of FV, andgeneral health, it will include assessment of perceived access to preferred FV, changes in barriersto FV intake, and confidence in selecting and preparing FV, and managing nutritional health. ThePOH team is accustomed to working with the Nutrition Incentive Program Training, TechnicalAssistance, Evaluation, and Information Centers (NTAE) Center, Qualtrics survey platform andmonthly participant-level and firm-level reporting to comparative analysis across PPR and NIprojects.