Non Technical Summary
UVA Health Children's, a major health care system, is implementing a prescription produce program called Fresh Farmacy by sourcing fresh produce from local farmers to food insecure patients and their families.This program strives to improve nutritional outcomes among food-insecure families.In the first year, the Fresh Farmacy: Fruit and Vegetable Prescription Program will be introduced to one hundred families self-reported food insecurity who are cared for at UVA Health Children's.Participants will receive bi-weekly shares of locally sourced fruits and vegetables, along with farm information, recipes, and access to cooking and nutrition classes. Over the subsequent eighteen months, participants will progress to a two-for-one Fresh Farmacy model and receive farmers market shopping incentives.

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
802	5010	1010	100%

Knowledge Area
802 - Human Development and Family Well-Being;

Subject Of Investigation
5010 - Food;

Field Of Science
1010 - Nutrition and metabolism;

Goals / Objectives
Original Objectives:Goal 1: Improvedietary health through increased consumption of nutrient-dense fruits and vegetables • Activities: Provide 100 food insecure participants with prescriptions for biweekly shares of local fruits and vegetables and the knowledge to use them • Outcome: Minimum 75% - 85% of participants demonstrate or report improvements in dietary health and changes in eating habits • How measured: Regular health assessments at recruitment and every 6 months; surveys every 3 months (quarterly) • Number of people affected: 100 participants (400 or more individuals counting household members)Goal 2: Reduce individual and household food insecurity through increased access to fruits and vegetables • Activities: Provide 100 food insecure participants prescriptions for local fruits and vegetables and incentives for shopping at farmers' markets • Outcome: Minimum 75% - 85% of participants report reductions in food insecurity • How measured: Self-reported food insecurity (using nationally-validated tools) at recruitment and every 6 months, and during quarterly survey calls • Number of people affected: 100 participants (400 or more individuals counting household members)Goal 3: Reduce healthcare use and associated costs • Activities: Provide 100 food insecure participants prescriptions for local fruits and vegetables and incentives for shopping at farmers' markets • Outcome: Minimum 40% decrease in non-routine outpatient or sick visits and visits to the emergency department • How measured: Survey questions at recruitment and every 6 months, as well as data on Medicaid reimbursements 6 months before recruitment and every 6 months for the duration of the project • Number of people affected: 100 participants (400 or more individuals counting household members)Goal 4: Build a body of knowledge about local food incentive strategies and benefit redemption methods • Activities: Assess the success of the proposed incentive program on consumer consumption of fresh fruits and vegetables • Outcome: A minimum of 85% of participants participate in Fresh Farmacy two-for-one incentive and use benefits at farmers' markets • How measured: Redemption of fresh produce bag incentive and farmers market credits • Number of people affected: 100 participants (400 or more individuals counting household members).Goal 5: Develop comprehensive approaches to addressing food insecurity and diet-related disease that engage participants and multiple public and private sector partners • Activities: Facilitate a network of stakeholders working together to improve the health and food security status of their constituents by ensuring the use of consistent survey and data collection methods across clinics, convening regular meetings of clinic directors, social workers, and market managers to share strategies for improving processes and programs • Outcome: Efficient and supported data collection across stakeholders • How measured: Usability of data by stakeholders and Nutrition Incentive Program Training, Technical Assistance, Evaluation, and Information Center( NTAE) • Number of people affected: All future produce prescription participantsGoal 6: Support local farmers in reaching a broader customer base and increasing sales • Activities: Incentivize produce prescription participants to purchase local produce from farmers' markets in their second and third years of the program • Outcome: Farms report a 20% increase in sales due to the program (both share purchases and increases in market sales) • How measured: Tracking food purchased for shares and use of incentives and SNAP at farmers' markets.What has been achieved and What will be expected to be achieved moving forwardWe have obtained IRB approval and have begun enrollment. Due to the closure of the Local Food Hub and the grant transfer, we have been unable to start the intervention. We have connected with 4P Foods, and they will continue to fulfill and deliver the bags of fresh produce as outlined in the original grant. We are currently working on executing any necessary contracts, data-sharing methods, and other arrangements.Moving forward, after the transfer of the grant is complete, we will achieve the following:1. Add Spanish Speaking participants to our approved study population. We have started translating all our materials and will submit a protocol modification to the IRB so that Spanish-speaking participants may be recruited and participate. This will increase the number of eligible participants.2. We will hire personnel who speak Spanish and will aid in enrolling, collecting data from, and communicating with Spanish-speaking participants3. Once the IRB approves of our protocol modification, we will ramp up participant recruitment, with the aim of recruiting enough participants to begin the intervention in May 2025.How it is expected to be accomplished We expect to achieve the objectives by: Organizing the project into months where we can observe the progress of the program:1. IRB modification and approval process: Months 1 - 3 a. In the new year, we will complete and submit a modification to our IRB, adding Spanish-speaking participants to our study population. We hope to receive approval by March 2024 at the latest.2. Finalization of contract with 4P Foods: Months 1-3 a. We will work with 4P Foods to execute any necessary agreements between UVA and 4P Foods and finalize our data-sharing plans and organization.3. Fresh Farmacy Prescriptions: Months 4 - 15 a. Over the next twelve months, all participants will receive biweekly bags of fresh fruits and vegetables that will be delivered to participants by 4P Foods. Each prescription share will be curated to include a diversity of low - and noculturally appropriate prep items. It will also include information about the farm where the produce originated, handling and storage tips, and simple recipes. Health data will be collected at recruitment and every six months. Participants will receive phone calls each quarter from the study team using a standard set of survey questions related to health and behavior change consistent with recommendations from the Nutrition Incentive Hub.4. Fresh Farmacy + Incentive Programming: Months 16 - 33 a. At month 16, participants begin a subsidized Fresh Farmacy model that runs another 18 months. Participants continue to receive two bags of produce and are introduced to the incentive period. A $40 credit will be issued to use at local Farmers' Markets.5. Final Analysis and Evaluation: Months 34 - 36 a. The final three months will be used for data analysis, process, and outcome evaluation. Outcome evaluation will follow the guidelines developed by the NTAE centers to ensure appropriate comparability of methods, outcomes, and measures.

Project Methods
Packout and delivery costs include brown paper shopping bags with handles to serve as share bags, plastic produce bags for items that require portioning or protection, physical labor required to assemble bags, and delivery of bags to recipients, paid either by the mile or by the route. This also includes costs for printing bag inserts and other marketing materials.Participants will participate in an incentive model designed to continue facilitating the intentional incorporation of fresh produce into their routines and utilization of community resources, such as farmers' markets.