Performing Department
Health
Non Technical Summary
Fruit and vegetable consumption is linked with weight status and health. According to Vermont's Behavioral Risk Factor Surveillance System (BRFSS 2013), Vermonters who ate fewer than two fruits or three vegetables per day during the last month were significantly more likely to report being obese compared to those eating two or more fruits daily (29% vs. 19%), with rates highest among low income people.Health care providers can play a critical role in helping people make lifestyle changes, such as improving diets, yet many providers are reluctant to suggest low income patients eat healthier without having supportive resources to offer. With this funding, Vermont will develop and implement a physician based "produce prescription program". Patients who receive SNAP benefits will be identified and given coupons by their physicians for local, fresh or frozen produce that can be redeemed in specific retail locations including 2 chain grocery stores, 1 independent grocery/co-op, and 1 year-round farmers market. Vermont will evaluate the success of integrating healthy eating conversations into health care visits, whether participants' access to, and consumption of, produce increases, and the ability of the State to develop and redeem state-specific coupons in a variety of retail establishments.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
(N/A)
Developmental
(N/A)
Goals / Objectives
The major goals of this "produce prescription project" are: to motivate and support SNAP recipients to purchase and consume more fruits and vegetables; for healthcare providers to engage high risk, low income patients in a discussion about the importance of fruit and vegetable consumption; and for chain and independently owned retailers to be incentivized to support increased purchases of produce by SNAP recipients.Goal 1: Motivate and support SNAP recipients to purchase and consume more fruits and vegetables. Actual and perceived cost of healthy food can be barriers for low income people purchasing this food. In addition, focus groups conducted by VDH of SNAP eligible Vermonters, and BRFSS data consistently reveal misperceptions about people's understanding of healthy food and their own and their children's weight. Physician's advice plus valuable incentives can be strong motivators for people to make lifestyle changes.Outcomes for Goal 1, by the end of the one year project period:680 SNAP recipients (270 in Rutland and 410 in Chittenden County) will purchase $150.00 worth of fresh or frozen fruits and/or vegetables that they otherwise would not have thought to, or have been able to, purchase.75% of participants will consume more fruits and/or vegetables because of the coupons.25% of participants will consume local produce because of the coupons.25% of recipients will increase their knowledge about fruit and vegetable purchasing, preparing, storing.Goal 2: Health care providers will develop procedures that enable them to identify low income patients and address the importance of fruit and vegetable consumption to health. Health care providers advising patients to make healthy lifestyle choices can be a powerful motivator, however, with all of the priorities health care providers have during each patient contact, working in messages about healthy eating can be difficult; and more so if the patient is lower income and does not have the ability (i.e. funds, access, resources) to follow through on that advice. A goal of this pilot is to help health care providers identify high risk patients who are motivated to make dietary changes, offer resources to enable them to make those changes, and develop a system using community supports to encourage successful follow-through. Outcomes for Goal 2, by the end of the one year project period:680 SNAP recipients will have two conversations with a heath care provider about the importance of eating fruits and vegetables to their overall health.Two health care provider practices (1 in each County) will establish methods for having a healthcare provider advise SNAP recipients about fruit and vegetable consumption, and offer education and incentives (coupons) to support their following through on that advice.Two health service areas will develop procedures to facilitate follow-up by health care providers (through provider offices or "Community Health Teams", CHT) in order to assure use of the coupons and integrated health services. Goal 3: Retailers will be incentivized to support increased fruit and vegetable purchasing by SNAP recipients. In order for low income people to purchase healthy food, it has to be available where they shop, and be affordable, while not jeopardizing retailer profits. For this pilot, we are investing as much of the total budget as possible into the coupons in order to benefit a high number of SNAP recipients, and also to provide enough potential spending in participating stores to make it attractive to retailers to participate.Outcomes for Goal 3:A Vermont-specific "produce coupon" will be created and used seamlessly in 4 retail stores.Four retailers will be reimbursed dollar for dollar for all coupons redeemed.
Project Methods
Upon initiation of award, the Vermont Department of Health (VDH) Project Director will facilitate a planning meeting that will consist of a team of partners representing health care, retail, and local food who have been involved in the development of the grant application. The overall goals and objectives of the project will be reviewed and tasks assigned by category (knowing there will be overlap): overall project planning and oversight; health care; retail; evaluation.A health care subcommittee will meet to review and develop tasks and procedures for implementing their part. Each provider office will work with Vermont's Department for Children and Families, DCF (Vermont's state agency responsible for the administration of SNAP) to develop a process for contacting potential recipients. DCF has offered to send letters to SNAP recipients in the health care provider service areas informing them that they may be eligible for up to $150.00 worth of fruits and vegetables if they are patients of those offices, and be asked to contact the participating health care provider office for more information.Upon contacting the office, an appointment will be scheduled (a check-up for the adult or "well child visit" for the children). They will be asked to bring the letter showing proof of SNAP participation. During their appointment, the provider will discuss the benefits and importance of fruit and vegetable consumption for all family members; culturally appropriate and relevant resources will be shared, including Vermont's SNAP-Ed Healthy in a SNAP and the Department of Agriculture's Buy Local information, and will be given a book of 75 $1.00 coupons to be redeemed at participating stores for fruits and vegetables (local, fresh or frozen). Patients will be informed that someone will contact them to follow-up on using the coupons and to schedule a second appointment at which time, if they have redeemed the first $75.00, they can receive a second book of $75.00 worth of coupons. A code on the initial book will be noted in their file and their information will be forwarded to the provider who is doing follow-up, who will contact the recipients for a second appointment within 3-6 months. Two or more contacts with participants will allow for better oversite of coupon redemption, on-going engagement with patients, and reinforcement of nutrition education messages over several months. The Retail subcommittee will provide input into the design of the coupons, discuss steps for redemption, rules, create guidance; discuss payment from the Vermont Retail and Grocers Association, VRGA. As coupons are redeemed, the VRGA will provide VDH reports with amount of money sent to retailers and the actual coupons that will be noted in a data base to track who is or is not redeeming them. VDH will share this with the provider to follow-up (VDH will not be able to follow up due to confidentiality concerns and will not know who the recipients are).At follow-up, the patient will complete a survey and get their second coupon book and cycle begins again - coupons are redeemed, retailers are paid, VDH receives report; healthcare provider does follow-up if coupons are not redeemed.Completed patient surveys wil be submitted to VDH and analyzed by an independent evaluator who will advise on the survey questions and provide training to offices about administering the surveys. Informational interviews will be conducted with participating healthcare providers and retailers. A final report of findings will be submitted by the end of the year.