Recipient Organization
CHILDREN'S HOSPITAL CORPORATION, THE
300 LONGWOOD AVE
BOSTON,MA 02115
Performing Department
(N/A)
Non Technical Summary
The primary goal of this project is to facilitate increased intake of fruits and vegetables amongst children with risk factors for cardiovascular disease including elevated blood pressure, hypertension, and dyslipidemia. In doing so, we expect to increase patient compliance with a heart-healthy diet,improve cardiovascular health (decreased blood pressure, improved dyslipidemia), and decrease healthcare utilization. To accomplish these goals, we will form a first-time partnership between Boston Children's Hospital and Fresh Connect, a tech-enabled produce prescription program. We will recruit 150 patient/caregiver dyads fromBoston Children's Hospital and Boston Medical Center. We will provide families with monthly allotments on the Fresh Connect debit card to use for the purchase of fruits and vegetables of their choosing at grocery stores and markets convenient to them. In conjunction with this, we will create and enroll patients/caregivers into monthly dietitian-led, culturally-tailored virtual nutrition and cooking classes focused on a heart-healthy diet. We will assess the impact of these interventions after 6 months and will assess for sustained change at 12 months by measuring quantity of fruit/vegetable intake, surveying knowledge around a heart-healthy diet, assessing perceived health status, and measuring objective health metrics including body mass index, blood pressure, and a lipid panel. To ensure sustainability of these interventions, we will obtain qualitative feedback from anadvisory board throughout the intervention.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
(N/A)
Developmental
(N/A)
Goals / Objectives
The goalof thisproject isto facilitate an increased intake of fruits and vegetables amongst children with risk factors for cardiovascular disease. By doing so, we expect toincrease patient compliance with a heart healthy diet,improve cardiovascular health (lower blood pressure, reduce dyslipidemia), and increase access to healthy produce.Objective 1: To create a first-time partnership between the Boston Children's Hospital Cardiology department and a produce prescription program, Fresh Connect.Objective 2: To recruit patients with obesity, high blood pressure, or dyslipidemia to enroll with Fresh Connect and receive monthly funds to spend on fruits and vegetables purchased at local grocery stores.Objective 3: To create and host monthly virtual nutritional and cooking classes led by a dietitian specializing in cardiovascular health.Objective 4: To understand barriers to purchasing fruits and vegetables and assess whether our interventions improve access to these heart-healthy foods.Objective 5: To assess the effectiveness of these interventions in increasing fruit/vegetable intake, improving cardiovascular health metrics, and improving participant knowledge around a heart-healthy diet.
Project Methods
Pilot InterventionThe first six months of the grant will be spent conducting a mixed methods pilot study to implement and assess our intervention in a prospective cohort of 30 patient/caregiver dyads. We will create anadvisory board to assist in the development of virtual nutritional classes and to ensure community relevance. Key stakeholders on this board will include representative patients and their families, clinicians, dietitians, social workers, and Fresh Connect leadership. We will plan to conduct meetings with the community advisory board monthly during this pilot intervention via a virtual platform.We will recruit patients between the ages of 2-17 years old along with their caregiver from the BCH and BMC pediatric cardiology outpatient clinics. Patients will qualify for enrollment if they have a cardiovascular risk factors including high blood pressure,dyslipidemia, or obesity and who meet the following criteria specified by the GusNIP PPR protocol.Qualifying patients will be approached by a research assistant on the day of their clinic visit. If interested in participating, patients and caregivers will complete baseline surveys and evaluations. Participant contact information will be provided to the Fresh Connect team who will facilitate enrollment and will mail the produce card. The Fresh Connect team will track utilization of the card. We will be able to use this data in conjunction with data taken from the electronic medical record to assess how card utilization affects healthcare outcomes.Participants will receive monthly disbursements of $50 loaded to the Fresh Connect card for 3 months for this pilot intervention. They will receive the cards prior to beginning monthly 60-minute virtual nutrition classes, which will be offered in both English and Spanish.We will enroll cohorts of 10 patient/caregiver dyads into each nutrition class for the pilot intervention. The nutrition classes will be led by a dietitian who specializes in pediatric preventive cardiology and works in the cardiology clinics at BCH. These classes will be conducted via a virtual Zoom platform. There will be classes conducted twice per month (one in English and one in Spanish) and participants will enroll in one class per month.Course content will begin with an introduction to DASH and Mediterranean-style eating patterns, which align with healthy cardiovascular eating patterns with additional sessions discussing different aspects of healthy eating, including nutrition label reading and cooking classes. To encourage participation, we will send the recipe and ingredients needed ahead of time so that families can join in from home as they watch the virtual class.After each nutrition class, participants will complete a qualitative survey assessing participant satisfaction with the classes, as well as opinions regarding the $50 monthly value on the produce card. After 3-months of intervention, we will assess the pre-post survey data and improvements will be implemented prior to enrollment a larger prospective cohort of 120 dyads over the next 30 months.Larger Prospective CohortWe will recruit a total 150 dyads (children and caregiver) over the course of three years from the general and preventive pediatric cardiology clinics at BCH and BMC. This will help us achieve the required enrollment of 100-130 participants needed to have sufficient power to detect a ¼ cup change in fruit and vegetable consumption using the 10- item fruit and vegetable intake Dietary Screener Questionnaire (DSQ), as required by the GusNIP grant.We will measure pre- and post-implementation surveys to assess GusNIP PPR core metrics and other health factors/outcomes. We will obtain data including height, weight, blood pressure, fasting lipid panels pre- and post-intervention. Surveys on participant experience throughout enrollment will be conducted.As described in the pilot intervention, qualifying patients and caregivers will be in contact with the Fresh Connect team to facilitate produce card enrollment. Patients will receive monthly $50 disbursements to the Fresh Connect card for 6 months. They will also participate in monthly virtual nutrition classes led by our dietitians. We plan to host groups of 10-20 in each class to allow for interaction between participants and between participants and our dietitian. Post-intervention surveys and assessments will be completed at 6 months and 12 months.EvaluationWe plan to conduct pre- and post-intervention surveys at months 0, 6 months, and at 12 months. The 6-month surveys will assess the immediate impact of the interventions and the 12-month surveys will assess for sustained change. We will evaluate core metrics including: (1) participation in SNAP; (2) health education activities; (3) project satisfaction; (4) fruit and vegetable consumption using the 10-tiem Dietary Screener Questionnaire; (5) food security using the six-item Short Form of the USDA Food Security Survey module; (6) perceived level of health; (7) sociodemographic factors; (8) objective clinical measures including height, weight, BMI, blood pressure, and a fasting lipid panel; (9) qualitative surveys on the nutrition classes.We will obtain the objective clinical metrics from the BCH and BMC electronic medical record and correlate these with card utilization data provided from Fresh Connect and patient surveys.As the primary outcome, this study will have sufficient power to detect a ¼ cup change in fruit and vegetable consumption using the 10- item fruit and vegetable intake Dietary Screener Questionnaire (DSQ). Beyond the pre-defined enrollment of 100-130 participants to detect a meaningful change in fruit and vegetable intake, we conducted a power analysis to ensure we enroll enough participants to detect a meaningful change in blood pressure. We anticipate a reasonable expected mean change in blood pressure Z-score will be 0.43 based on prior studies.We ultimately determined that 150 participants is adequate for at least 90% power with alpha of 0.05.As long-term consequences of cardiovascular risk factors in children take decades to manifest and hospitalizations are rare for these diagnoses (high blood pressure, abnormal cholesterol), we plan to track clinical parameters to monitor healthcare utilization. We will monitor frequency and number of follow-up cardiology and nutrition clinic visits outside of the intervention and medication initiation as a metric for overall improvement in cardiovascular health and healthcare utilization.Prior to beginning the nutrition classes, we will administer surveys to assess the home environment, participants' existing knowledge regarding a heart healthy diet, and confidence in cooking skills. To gather feedback about the nutrition classes, we will assess qualitative surveys focusing on domains including virtual class format, frequency of classes, cultural relevance, and interaction between instructor and group and amongst participants, appropriateness of the level of instruction, confidence in applying lessons in daily life, and barriers to participation. We will administer this survey at three months for mid-term feedback and at 6 months after the intervention period.We will track enrollment of qualifying clinic patients, rates of participation in the nutrition classes, Fresh Connect card utilization (tracked by Fresh Connect team), and survey completion rates. Post-intervention, we will re-engage ouradvisory board of key stakeholders to discuss feedback and suggestions for continued enrollment and sustainability of these interventions.