Non Technical Summary
Many people in our communities face chronic health conditions like diabetes, high blood pressure, and obesity. These conditions are often worsened by limited access to healthy food. The HonorHealth Desert Mission Produce Prescription Program (HHDM PPR) aims to address this issue by connecting healthcare with access to fresh fruits and vegetables. Through this program, eligible patients at HonorHealth Medical Group clinics will receive monthly produce credits to redeem for fresh fruits and vegetables at mobile farm stands, helping them make healthier food choices.Over six months, participants will receive nutrition education and support from their healthcare providers along with their produce credits. The program will track changes in participants' health, food security, and healthcare use to understand its impact. By combining medical care with access to nutritious food and education, the HHDM PPR hopes to improve health outcomes, reduce healthcare costs, and offer a model that can be adapted by other communities. This project has the potential to benefit individuals, families, and the broader public by promoting healthier lifestyles and reducing the burden of chronic disease.

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
704	6010	1010	100%

Knowledge Area
704 - Nutrition and Hunger in the Population;

Subject Of Investigation
6010 - Individuals;

Field Of Science
1010 - Nutrition and metabolism;

Goals / Objectives
The four goals of the proposed project are outlined below with the specific objectives and outputs pertaining to each goal listed.Goal #1: Integrate the HHDM PPR into the DM Mobile Farm Stand operations.Objective #1.1 - Expand mobile route to include new redemption sites.Output #1.1.1 - Operate 5 new farm stand redemption sites by end of Year 1.Output #1.1.2 - Operate 10 new farm stand redemption sites by end of Year 2.Objective #1.2 - Train Mobile Farm Stand Program staff on the acceptance/tracking of produce credits in Farmer's Register.Output #1.2.1 - Mobile Farm Stand staff trained to accept and track produce credits as payment by end of Q2 Year 1.Goal #2: Operate the HHDM PPR within HHMG clinics.Objective #2.1 - Complete a phased roll-out of the HHDM PPR to HHMG clinics.Output #2.1.1 - A total of 5 HHMG clinics operate HHDM PPR by end of Year 1.Output #2.1.2 - A total of 10 HHMG clinics operate HHDM PPR by end of Year 2.Objective #2.2 - Enroll patients in the HHDM PPR.Output #2.2.1 - Enroll 175 participants during Year 1.Output #2.2.2 - Enroll 350 participants during Year 2.Output #2.2.3 - Enroll 175 participants during Year 3.Goal #3: Provide educational opportunities related to nutrition to program participants.Objective #3.1 - Food Literacy Platform.Output #3.1.1 - 100% of participants will receive access to the Food Literacy Platform during their enrollment in the HHDM PPR.Output #3.1.2 - The Food Literacy Platform will see 10 visits per day during the operation of the program.Objective #3.2 - Group Medical Visits (GMVs)Output #3.3.1 - A total of 5 HHMG clinicians will offer GMVs in tandem with the HHDM PPR by the end of Year 3.Goal #4: Evaluate the effectiveness of the HHDM PPR.Objective #4.1 - Collect institution-level data and firm-level data from HHMG clinics and Farm Stand.Output #4.1.1 - HHMG clinics submit 100% of required reports on time.Output #4.1.2 - Farm stand submits 100% of required reports on time.Objective #4.2 - Administer Pre- and Post-Surveys to participants.Output #4.2.1 - 100% of participants receive pre-survey at enrollment.Output #4.2.2 - 100% of participants receive post-survey at 6 months.Objective #4.3 - Extract individual-level data from EHRs.Output #4.3.1 - EHR data as outlined in the data management plan is extracted for 100% of participants at enrollment, 6 months, and 1 year after enrollment.Objective #4.4 - Convene a Community Advisory Council for the HHDM PPROutput #4.4.1 - Collect input on HHDM PPR design, outreach, and implementation from Community Advisory Council every 6 months during program operation.

Project Methods
The HonorHealth Desert Mission Produce Prescription Program (HHDM PPR) will be implemented using an approach that integrates clinical care, community-based food access, and nutrition education. The project is designed to improve dietary health, reduce food insecurity, and decrease healthcare utilization among eligible patients of HonorHealth Medical Group (HHMG) clinics. The program design is informed by current literature on effective produce prescription programs and incorporates lessons learned from a prior pilot. The Program Manager will lead the onboarding of HHMG clinics, ensuring staff are trained to identify eligible patients, facilitate enrollment, and support program implementation.Eligible patients must be enrolled in Medicare or Medicaid (AHCCCS in Arizona) and meet at least one of the following criteria: screen positive for food insecurity, or have a diagnosis of pre-diabetes, type II diabetes, hypertension, or overweight/obesity (BMI>25). Patients eligible to participate in the HHDM PPR will be referred to participate through multiple referral pathways including direct referrals from HHMG clinicians and clinic staff, self-referral, or community outreach efforts. Once referred, the Program Manager will verify eligibility and ensure that biometric data (height, weight, blood pressure, HbA1c) and food insecurity screening results are current in the electronic health record (EHR). Participants will receive $50 per month in produce credits for six consecutive months, redeemable at Desert Mission (DM) Mobile Farm Stand. Credits are managed through the Farmer's Register system, which allows for real-time tracking of redemption activity. Participants will also receive access to the Food Literacy Platform and information about additional nutrition education opportunities, including community classes and GMVs. At the end of the six-month program, participants will complete a follow-up appointment at their clinic, where updated biometric data will be collected, and a post-survey administered. Participants who complete the post-survey will receive an additional $20 in produce credit.Evaluation of the HHDM PPR will be led by the Co-Principal Investigators (Co-PIs) in collaboration with the Project Director and Program Manager with assistance from the contracted statistician. The evaluation includes both a process assessment and an outcome assessment. The process assessment will monitor implementation fidelity and progress toward project objectives. The Project Director will document quarterly progress using a standardized template, identify implementation challenges and successes, and collect feedback during quarterly grant team meetings. These assessments will be compiled annually and submitted to the GusNIP NTAE Center, and will inform the completion of required reports to USDA NIFA, including the REEport Technical Reports, Financial Reports, and SF-425 Federal Financial Reports.The outcome assessment will evaluate the program's effectiveness in four key areas: dietary health, food insecurity, healthcare utilization and cost, and program retention. Data sources include participant surveys, EHR data, and clinic-level retention metrics. The dietary health component will assess changes in fruit and vegetable intake from baseline to six months, with the hypothesis that participants will report increased intake, particularly those who engage in nutrition education. In addition, it will assess improvements in clinical indicators such as BMI, blood pressure, and HbA1c. Food insecurity will be measured through surveys and EHR screenings, with the expectation that participants will report improved food security, especially those who frequently redeem produce credits. Healthcare utilization will be assessed through changes in ER visits, hospital admissions, and urgent care visits. The impact of GMV participation on program retention will also be evaluated, with the hypothesis that participants who attend at least one GMV will be more likely to complete the program.All evaluation activities will be reviewed and approved by the HRI Institutional Review Board (IRB). Data analysis will be led by the Co-PIs, with support from student learners, the GusNIP NTAE Center Program Advisor, and the contracted statistician. Quantitative data will be analyzed to assess changes over time and identify correlations between program participation and outcomes. Qualitative feedback from participants and staff will be used to contextualize findings and inform program improvements. Key indicators of success include the percentage of participants completing the program, increases in fruit and vegetable intake, reductions in food insecurity, improvements in clinical health indicators, and reductions in healthcare utilization. The evaluation will also track the number of participants attending GMVs and the frequency of produce credit redemption. Results will be disseminated through final evaluation reports, peer-reviewed journal articles, and conference presentations.