Progress 07/01/17 to 06/30/22
Outputs
Target Audience:The target audience for VNA's Fresh First program was VNA patients who received care within VNA's Aurora-based health centers and community members all of whom were SNAP recipients. Aurora is the 2nd largest city in Illinois and VNA serves approximately 30,000 low-income residents of the city. The dominant language of the participants in Fresh First was Spanish and the demographic breakdown of individuals in the program were approximately 63% Hispanic, 19% White, 14% Black, and 4% Asian. The program was offered in English and Spanish and translation services were available where needed for other languages. Many of the individuals served within the program experienced health disparities as a result of social determinants of health. In addition, many also experienced co-morbidities that included an increased risk for chronic disease. Changes/Problems:During the course of implementing this program, VNA experienced a number of challenges. The first challenge was that we had established a goal to engage new groups of participants each year and found that in fact, the behavior change that we were seeking in our participants happened at a slower pace and with considerably more dedicated encouragement, reminders and hand-holding than we had initially anticipated. As a result, it would have been good for participants to receive the tokens multiple years in a row as well as the ongoing nutrition education which was available and encourage. This would have further supported ongoing healthy lifestyle behaviors. During this program there was a change in federal administration that brought about the notable challenge of Public Charge. We saw that a significant number of our patients and program participants were extremely hesitant about accepting any support or engagement in a program that had any connection to the federal government for fear that they would become 'known to the government'. Whilst program participants were eligible for benefits such as SNAP or Medicaid, many had family members who were undocumented and they feared that if they engaged in the program, they might put these family members at risk. There was also a lot of fear that the administration could remove their eligibility for benefits without warning and their participation could create a huge unknown risk to them in the future. VNA program staff provided a great deal of education, reassurance where possible and applicable, but this nonetheless was a considerable challenge. At this time, there was also a large turnover of staff within the program at the USDA that also increased concern among our program staff as there were some gaps in communication during the relocation transition. Once this issue was resolved at the federal level, the next major challenge we faced was the emergence of the COVID-19 pandemic. VNA was heavily engaged in providing testing, treatment and later vaccination services and a lot of staff were redeployed to manage this work which required a lot of focus and was rapidly changing. In an effort to maintain the program, VNA transitioned the tokens to a drive-through collection of boxes of produce where the participants stayed in their car. Despite this, they still interacted with staff and the farmer who met with participants as they drove through to pick up their box. The nutrition education was moved to an online zoom platform but it was incredibly challenging to keep people engaged in this. We attribute this to a number of factors including the fact that many of the participants were front-line workers and those that were not often had a great many challenges associated with providing care for children and seniors at home as the schools were in remote session. The final challenge that is worthy of mention is that VNA transitioned our electronic medical record system to EPIC during this past year. We had intended using this no-cost extension period to make some professional videos of the classes for use on our website and in waiting rooms. However, this work was not able to be completed as a result of staff bandwidth and focus on transitioning back to in-person programming and pandemic recovery. What opportunities for training and professional development has the project provided?VNA delivers comprehensive primary care to our patients within health centers, community, and home settings. Program leaders promoted referral to the program within Provider care team meetings and with VNA case managers, WIC staff, and community health workers. Program leaders also promoted and provided education about lifestyle medicine that is focused upon the benefits of a plant-based diet. Many of the providers, particularly physicians receive little to no nutrition education during their extensive training so this was an opportunity to not only share with them the components of the program but also the health outcomes that are improved as a result of increasing consumption of fresh fruits and vegetables, particularly among the population we serve who are at increased risk of health inequity and health disparities. How have the results been disseminated to communities of interest?VNA Health Care participates extensively in Community Health Improvement Planning and Community Health Needs Assessments across each of the counties in which we have Health Centers and with all of our hospital partners. In addition, the Point of Contact on this project is the Co-Chair of the Kane County Chronic Disease Action Team. This grant project, and the positive outcomes that we are finding in participants, is discussed regularly. Also, the POC on this project presented about this project at the Illinois State Farmer's Market Association Conference and had the opportunity to share this project with local members of the USDA team. What do you plan to do during the next reporting period to accomplish the goals?
Nothing Reported
Impacts
What was accomplished under these goals?
During the course of the program, VNA successfully met the objectives of Fresh First through the targeting of patients who were SNAP recipients, many of whom were food insecure and had very low levels of comfort or knowledge and experience in buying and consuming fresh fruits and vegetables. Through the use of surveys and also anecdotal evidence from speaking with program participants we learned that there were a few factors that influenced this status as participants joined the program. One of these factors was that individuals expressed reluctance at spending limited resources on produce that they were unfamiliar with, particularly as they didn't know how to prepare or cook the item and didn't know if their family would like it. We learned that there was also a perception that shopping at a farmer's market would be intimidating and would be too expensive. As a result of the comprehensive nutrition education and use of cooking demonstrations, ability to sample dishes, recipes and support from program leaders, these barriers were removed by the program. At the outset of the program, participants exchanged tokens within the Aurora farmer's market for produce and received tokens dedicated to fruit and tokens dedicated to vegetables. We found that an overwhelming majority of participants gravitated to exchanging their tokens with one of the largest farm-stands that was operated by a Hispanic family. VNA program staff began to work very collaboratively with this farmer and the program really increased its success when we also offered access to this farm-stand within our largest health center parking lot. Unrelated to the project, but we encouraged the local, low-income community to access this resource in addition to program participants as our clinic is located within an area with limited resources. Access to this resource by the community at large was promoted by the Kane County Health Department as one of the goals of the Community Health Needs Assessment was to increase access to fresh produce. 86% of program participants reported an increase in fruit and vegetable consumption as a result of participation. During the course of this program, the project director, clinical dietician, and clinical pharmacist worked closely with the farmer to expand the offerings of produce and to coordinate recipes by what was in season so that there was enough for everyone to choose what had been prepared during the demonstration. This included discussing an interest in promoting vegetables that had not previously been grown but were of high nutritional value and possessed vitamins and minerals that helped reduce risk for high blood pressure, diabetes and vitamin deficiencies. This was not part of the original vision for the program but was an excellent outcome of the relationship-building that occurred. This farmer has shared with us how much he learned through the program and was particularly engaged as he felt that he was having a positive outcome on the health and well-being of a predominantly immigrant population that he identified with. Participation in the program was promoted through referral from Providers and in addition, VNA created a short video clip promoting the program that was shared on social media. Our collaboration with one of the largest school districts at which VNA has a school-based health center was also an intended and positive outcome of the project. VNA community health workers and dieticians worked closely with school staff and parent liaisons to promote the program and to promote increasing consumption of fresh fruit and vegetables by students and their families, both those who were program participants and others who were not eligible. The blender bikes proved to be a fun way to introduce increasing exercise while students made smoothies from the produce they had grown. This was also a good way to help increase acceptance of produce in its natural state that included bruising, irregular shapes and pieces that needed to be cut out or trimmed, but were nonetheless an incredibly healthy food source. We learned that often students had no idea what produce in its natural state looked like. Two examples of this were mistaking chopped cauliflower samples for popcorn and not recognizing carrots that still had the greenery attached because they had only ever seen them as baby carrots that were machine prepared into round-ended sticks. Approximately 64% of the participants in the program screened in the affirmative for food insecurity during the prior twelve months. Participation in the program therefore not only provided them and their families with access to nutritious food for the 20 week farmer's market season when they received the fruit and vegetable prescription, but also enabled VNA staff to link them with the local food pantries who in turn also promoted the program for participants. This collaboration led to VNA's clinical dietician ensuring that all of the recipes that were created for use in the program were readily accessible to individuals and available also in food pantries. An unintended result of this collaboration was that she worked with the food pantry to identify healthy choices within the pantry and would adjust recipes and highlight produce that may also have been received in bulk at the pantry, two examples were a bulk shipment of figs that were received and a very large shipment of Swiss chard. Throughout the course of this program, participants were encouraged to attend year-round free nutrition education classes. These wellness classes utilized an evidence-based curriculum that highlighted the seven self-care behaviors promoted by the American Academy of Diabetes Educators. These include increased consumption of fresh fruits and vegetables, increased physical activity, coping skills, medication management, monitoring, reducing risk and problem-solving. In an effort to increase attendance, the program tokens and cooking demonstration formed part of the class and occurred at the end of the session so it naturally encouraged participation. Once individuals were fully engaged in the program we found that they would attend the wellness program outside of the day that they picked up their produce. This program was offered in English and Spanish and was initially only in-person, however, as a result of the emergence of the pandemic, this educational component of the program transitioned to a digital platform. Many of the individuals also saw the clinical dietician and clinical pharmacist for one-on-one counseling. In addition to reporting increased consumption of fresh fruits and vegetables, many participants reported significantly improved health outcomes. An example of this was a grandmother who lost 40 lbs in weight after switching to a much healthier, plant-based diet. We found that most participants also shared that their families enjoyed the food that they made using the fresh produce received from the program despite feeling apprehensive that it wouldn't taste good. This was often a result of the recipes being tailored to use culturally familiar flavors that were prepared using fresh fruits and vegetables cooked in a healthier way.
Publications
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Progress 07/01/20 to 06/30/21
Outputs
Target Audience:The target audience reached with our Fresh First program during the reporting period consisted of VNA patients whom also participated in SNAP assistance for nutritional needs. VNA Health Care serves patients in the west and southwest suburbs of Chicago, and Fresh First was implemented in the Aurora/Kane County area. The demographic breakdown of the patients served by VNA is: 61.2% Hispanic, 12.9% Non-Hispanic White, 12.5% Black/African American, 3.6% Asian, 2.1% more than one race, and 7.7% refused to report. This was an accurate representation of the populations served by our program in the reporting period. In addition, the audience targeted and served by our program focused upon low-income individuals at increased risk of disparity as their consumption of fresh fruits and vegetables was hindered by cost and/or nutritional knowledge of the health impacts associated with low consumption. Many of the individuals served through Fresh First had little familiarity with how to use the fresh produce available within the Farmer's Market and prior to being in the program perceived it to be out of their reach from an economic standpoint. Changes/Problems:By the early summer of 2020, the COVID pandemic was in full swing. We knew that we wanted to continue to provide this programming but needed to make changes to the delivery model to ensure safety for both our participants and our staff. After consulting with our farmer, Ralph, it was decided he would assemble produce boxes with whatever was the most fresh fruit and vegetablethat week. The value of the boxes continued to be $25. He followed all health and safety guidelines while assembling boxes including wearing a mask and gloves. Weekly our participants would drive through our market and would pop their trunks for staff to deliver the box. Included in the box was a new recipe that correlated with the produce provided that week. In additon participants reaceived health information and were encouraged to schedule a one on one with our staff dietician. What opportunities for training and professional development has the project provided?VNA follows a multi-disciplinary care team model and each month Providers and other clinical staff gather to receive program updates and have the opportunity to ask questions or discuss challenges experienced in a primary care setting. This project has been shared within these meeting and increases awareness of the program and highlights the positive impact of providing cooking demonstrations and sampling of healthy recipes. Many of our providers have received little or no nutrition education within their medical training and so are more focused upon diagnosis and management of chronic disease symptoms rather than prevention. VNA's Clinical Dietician who works closely with this program and is passionate about preventive care and has worked tirelessly to engage providers in referring patients to the program and this has been accomplished through ongoing education and sharing program feedback. How have the results been disseminated to communities of interest?VNA Health Care continues to participate extensively in Community Health Improvement Planning and Community Health Needs Assessments across each of the counties in which we have Health Centers and with all of our hospital partners. In addition, during this project period the Point of Contact on this project was Co-Chair of the Kane County Chronic Disease Action Team. This grant project, and the positive outcomes that we are finding in participants, is discussed regularly within these meetings. What do you plan to do during the next reporting period to accomplish the goals? VNA plans to continue meeting the objectives of the program in addition to troubleshooting any challenges that may occur.
Impacts
What was accomplished under these goals?
During this project period, VNA recruited 158participants, many of whom had little or no experience of buying food from a farm stand within the United States. This fruit and vegetable prescription program not only served to increase access to locally grown produce but also provided an additional food source to those impacted economically due to the pandemic. The produce boxes were provided in a contact free drive thru system to reduce potential exposure to both participants and staff.Samples of recipes were providedin the box as a way to introduce new new foods without fearthat it would be wasted if they didn't like it.Participants learned how to use the produce in a healthy way whilst still maintaining flavor profiles that were familiar tothem and culturally appropriate. The opportunity to receive fresh fruit and vegetablesled to improvement in consumption of healthy foods, as reinforced by the assessment scores at theend of the program. As per the assessment referenced above, participants were given positive points for consumption of morenutritious food choices (vegetables, whole grains, lean proteins) and negative points for consumption of less nutritious foodschoices (high processed foods, high fat proteins, sugary drinks or snacks). When pre-program assessments were comparedto participants' post-program assessments, it was calculated that 48% of participants chose healthier food options for their families at the end of the 20-week farmers market season. This was accomplished in a population where in pre-program assessment it was determined that 60%of the participants in the program expressed having had food insecurities in the 12 months prior to the start of the program.
Publications
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Progress 07/01/19 to 06/30/20
Outputs
Target Audience:The target audience reached with our Fresh First program during the reporting period consisted of VNA patients whom also participated in SNAP assistance for nutritional needs. VNA Health Care serves patients in the west and southwest suburbs of Chicago, and Fresh First was implemented in the Aurora/Kane County area. The demographic breakdown of the patients served by VNA is: 61.2% Hispanic, 12.9% Non-Hispanic White, 12.5% Black/African American, 3.6% Asian, 2.1% more than one race, and 7.7% refused to report.This was an accurate representation of the populations served by our program in the reporting period. In addition, the audience targeted and served by our program focused upon low-income individuals at increased risk of disparity as their consumption of fresh fruits and vegetables was hindered by cost and/or nutritional knowledge of the health impacts associated with low consumption. Many of the individuals served through Fresh First had little familiarity with how to use the fresh produce available within the Farmer's Market and prior to being in the program perceived it to be out of their reach from an economic standpoint. Changes/Problems:During this program period issues related to Public Charge were impacting our ability to recruit a predominantly immigrant population as many eligible individuals were afraid that participation might negatively impact the future legal status of other family members. This was a national issue that was unrelated to the program and was also experienced within the health center with individuals who were eligible but afraid to come for WIC and Medicaid appointments. In order to maintain the recruitment goals, VNA accepted some individuals who had participated successfully in prior years in order that they may serve as positive role models to the new members of the group and also provide them with increased opportunity to continue building their healthy lifestyle habits. What opportunities for training and professional development has the project provided?VNA follows a multi-disciplinary care team model and each month Providers and other clinical staff gather to receive program updates and have the opportunity to ask questions or discuss challenges experienced in a primary care setting. This project has been shared within these meeting and increases awareness of the program and highlights the positive impact of providing cooking demonstrations and sampling of healthy recipes. Many of our providers have received little or no nutrition education within their medical training and so are more focused upon diagnosis and management of chronic disease symptoms rather than prevention. VNA's Clinical Dietician who works closely with this program and is passionate about preventive care and has worked tirelessly to engage providers in referring patients to the program and this has been accomplished through ongoing education and sharing program feedback. During this project period, VNA began working with student nurses from Aurora University. These students usually conducted their clinical experiences within a hospital setting and so VNA was thrilled to be able to offer them an opportunity to engage in this program. This rotation gave the students a first-hand experience of the health benefits that come from improving access to fruits and vegetables and increasing their consumption and several inthe group expressed an interest in considering future careers within a community health center setting. How have the results been disseminated to communities of interest?VNA Health Care continues to participate extensively in Community Health Improvement Planning and Community Health Needs Assessments across each of the counties in which we have Health Centers and with all of our hospital partners. In addition, during this project period the Point of Contact on this project was Co-Chair of the Kane County Chronic Disease Action Team. This grant project, and the positive outcomes that we are finding in participants, is discussed regularly within these meetings. What do you plan to do during the next reporting period to accomplish the goals?VNA plans to continue meeting the objectives of the program in addition to troubleshooting any challenges that may occur.
Impacts
What was accomplished under these goals?
During this project period, VNA recruited 176 participants, many of whom had little or no experience of buying food from a farm stand within the United States. They were used to buying produce within a grocery store setting and as a result, were very unfamiliar with what produce grows locally.This fruit and vegetable prescription program not only served to increase access to locally grown produce but also provided experiential learning opportunities that gave participants a demonstration of how to cook seasonal produce. Samples of the recipe were provided so that they were also able to try new foods without fear that it would be wasted if they didn't like it. This year, some examples of new foods were purple cauliflower, acorn squash and collard greens. Participants also learned how to use the produce in a healthy way whilst still maintaining flavor profiles that were familiar to them and culturally appropriate. Several patients brought in old family recipes and staff were able to make recommendations for healthy substitutes. Staff continued to provide printed recipes for participants that they were able to collect throughout the program and it was fun to hear patients recounting how they had shared these with family members who had enjoyed dishes that were made throughout the summer. In addition, patients who received help with modifying family recipes would share these with other participants in the group which also helped foster peer support. Several of the women in the group were also struggling with cooking multiple different meals for their families which was becoming a burden for them. They were sure that their husbands and children would not eat healthy food. With support and encouragement from staff and other program participants they were able to transition their families one meal at a time to all eat the same food in ways that were still visually appealing and yet were healthy a tasty. The education provided led to improvement in consumption of healthy foods, as reinforced by the assessment scores at the end of the program. As per the assessment referenced above, participants were given positive points for consumption of more nutritious food choices (vegetables, whole grains, lean proteins) and negative points for consumption of less nutritious foods choices (high processed foods, high fat proteins, sugary drinks or snacks). When pre-program assessments were compared to participants' post-program assessments, it was calculated that 79% of participants chose healthier food options for their families at the end of the 20-week farmers market season. This was accomplished in a population where in pre-program assessment it was determined that 64% of the participants in the program expressed having had food insecurities in the 12 months prior to the start of the program. All were provided resources for additional food security.
Publications
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Progress 07/01/18 to 06/30/19
Outputs
Target Audience:The target audience reached with our Fresh First program during the reporting period consisted of VNA patients whom also participated in SNAP assistance for nutritional needs. VNA Health Care serves patients in the west and southwest suburbs of Chicago, and Fresh First was implemented in the Aurora/Kane County area. The demographic breakdown of the patients served by VNA is: 63% Hispanic, 19% Caucasian, 14% Black/African American, and 4% Asian. This was an accurate representation of the populations served by our program in the reporting period. In addition, the audience targeted and served by our program focused upon low-income individuals at increased risk of disparity as their consumption of fresh fruits and vegetables was hindered by cost and/or nutritional knowledge of the health impacts associated with low consumption. Most of the individuals served through Fresh First had had little to no understanding with how to use the fresh produce that was unfamiliar to them and available within the Farmer's Market. Also, prior to being in the program, participants perceived the fresh produce to be out of their reach from an economic standpoint. Changes/Problems:A change from the project initiation report is that we have removed the goal relating to navigation and benefits assistance for WIC and SNAP. This element does not occur within this program as we were informed that USDA funds could not be used for this purpose. Additionally, when we embarked upon implementing this grant, we were confident that the level of incentive at $25 per week was sufficiently generous to be a major motivator in recruiting a new 'batch' of participants of 150 participants each year and moving our target population forward in increasing fruit and vegetable consumption. Our confidence was built upon the fact that this population often expresses food insecurity. Therefore, we felt this incentive would go a long way to meeting this need by providing healthy food and that recruitment and retention would not be such an obstacle as it was. However, we have learned that despite the generous incentive, we are still competing with multiple other factors that affect the lives of our patients causing competing priorities and often chaotic behavior that resulted in missed classes and token redemption. One such factor affecting our recruiting efforts was the change of the political climate. VNA Health Care serves many immigrant residents trying to make a case for U.S. citizenship status, and the fear of Public Charge leads them to avoid accepting SNAP (or any other government) benefits even if they are in dire need of assistance. Additionally, even when one of the family members does have SNAP benefits, participation in 'additional' programs is limited for fear of the erroneous perception that family members may be put at risk for deportation when congregating in environments with others they perceive may be deportation targets as well. Additionally, in the first year of the program, some work was required to remind patients on a weekly basis of class attendance and to follow up with them if they miss a class or miss redeeming their tokens for produce. In this reporting period, this issue was further compounded with those deportation fears as those possibilities spread across our communities at different points of the program. We had to recruit additional support staff across VNA to assist in the increased volume of outreach required for this reporting year's group of participants. The added level of effort was required to achieve the compliance we did and get to the point where the self-motivation was sufficiently developed to sustain the healthy behavior. Lastly, we also believe that the participants most motivated to make improvements and increases in healthy food consumption were captured in the first year of programming, given the participation criteria that previous participants were not allowed to re-enroll. This program year's participants did not seem as ready for change until further along the program timeline. This program year saw an increase in participant self-removal from program participation than year one. Thus, further exemplifying the potential benefit to including prior year participants in the following year's pool of available recruits. What opportunities for training and professional development has the project provided?The project continues to highlight the positive impact of providing cooking demonstrations and sampling of healthy recipes within our clinical team, whose medical training included little or no nutrition education. VNA's Clinical Dietitian has been a valuable resource to VNA patients and clinical staff for many years. During her tenure with VNA, she has constantly been stressing to obese, pregnant, and chronically ill patients the importance of increasing consumption of healthy fruits and vegetables. With the continuation of this program, VNA's Wellness team has been able to 'show' instead of 'tell' by putting her clinical advice into action through the provision of recipe demonstrations and sampling to a new group of participants. Additionally, when the recipes are reinforced by instruction on health benefits and they see the positive results of their efforts, patients are more willing consumers of fresh produce. VNA's clinical team has therefore moved from simply referring patients for dietetic consultation to actively being engaged in the program. Since last season, the clinic has hired new clinicians that have appreciated the results and output of the program and are expanding their nutritional knowledge while inquiring about the program. This project has allowed the continued growth of other clinical staff members, like our Clinical Pharmacist, to increase their comfort in providing nutritional counseling during group education or individual one-on-one counseling appointments to help supplement their traditional knowledge in their field of practice. We have also heard from our staff team that that they are more mindful and more confident when making their own nutrition choices as a result of observing this program in action. How have the results been disseminated to communities of interest?VNA Health Care participates extensively in Community Health Improvement Planning and Community Health Needs Assessments across each of the counties in which we have Health Centers and with all of our hospital partners. In addition, the Point of Contact on this project is Co-Chair of the Kane County Chronic Disease Action Team. This grant project, and the positive outcomes that we are finding in participants, is discussed regularly. In addition, the POC on this project presented about this project at the Illinois State Farmer's Market Association Conference and had the opportunity to share this project with local members of the USDA team. Additionally, the POC and the VNA Director of Wellness attended the annual FINI Project Directors meeting, where they were able to share successes of one another's' programs along with challenges. There was also a presentation of the program overview at a Kane County summit which focused on increasing fresh fruit and vegetable consumption in children. This summit was attended by different community organizations including the Health Department, school representatives, food pantry representatives, and hospital representatives. What do you plan to do during the next reporting period to accomplish the goals?VNA plans to continue meeting the objectives of the program in addition to troubleshooting any challenges that may occur. In addition, VNA hopes to obtain permission to change some of the recruitment criteria for the following program year to be able to include non-VNA patients. During recruitment, many community members with knowledge of the program (usually second hand from past participants) have expressed their desire in learning about healthier eating but unable to participate due to not being VNA patients. Also, inclusion of past participants in order for them to continue the meaningful changes they have implemented and facilitate the maintenance of their healthy behaviors. There has also been recorded video footage by program leaders, which should be edited and available for dissemination in our Health Center waiting rooms and social media. These videos should be ready in the next program period.
Impacts
What was accomplished under these goals?
Participants were introduced to a new world of fresh fruits and vegetables that have always been available at the local markets, but that they felt were out of reach. These participants were frequently familiar with the vegetable appearance and identification, but not comfortable with the preparation or consumption of them. Several months after program completion, a participant of the 2018 Fresh First season came across our Clinical Pharmacist, who was greatly involved with program facilitation, and expressed her appreciation for the program, as she was able to discover new favorite vegetables that have become a regular staple in her family's consumption (Brussel sprouts, Swiss chard, and spaghetti squash). At the beginning of the program, this participant, along with most participants, cited fear of the unknown flavor or improper preparation, potentially leading to the wasting of already scarce resources, as reasons for not consuming these vegetables. Through the recipes and cooking demonstrations provided, participants' level of comfort with new vegetables increased. Our program staff found it crucial for participants to not only get the printed systematic recipes and taste samples, but to allow participants to observe the preparation of the recipes. We made sure not to create overly complicated recipes so as to not discourage participants from attempting to prepare the dishes. Throughout the program, participants would share with us pictures of dishes prepared in their homes. At times, it was pictures of the recipe they learned during the program and other times it was pictures of their incorporation of these newfound vegetables, culinary skills, and knowledge of good nutrition into their traditional or newly created dishes. Our wellness kitchen continued to be our educational launching pad for this year's group of new participants. The recipes and seasonal produce would offer a starting point to the conversation and education about the therapeutic aspects of nutrition. Throughout the program, we made it a point to emphasize the phrase 'food as medicine', in order for patients to understand that the benefits of improved nutrition extended beyond weight management or perceived 'good looks'. We were able to emphasize to participants on how these products help improve outcomes in chronic conditions (such as diabetes, high cholesterol, or heart disease), in addition to their overall health (mental health, improved energy, pain reduction, and cognition). This year we were able facilitate a participant with heart disease continue her transition to a whole food, plant based diet which was suggested by her cardiologist. During the program, this participant was able to share with our community of participants, that her cardiologist was impressed by the dramatic 40 pound weight loss and improvement in her heart disease to the point that traditional medication treatment was avoided. Several other participants shared improvements in diabetes or blood pressure control they believed was previously unattainable. Additionally, other aspects of nutrition were able to be addressed during the program, such as: reduction of sodium intake by increasing use of herbs and spices; identification and selection of healthy grains, proteins, and fats; understanding of sugar content in common sweets and soft drinks; and encouragement of physical activity. The education provided led to improvement in consumption of healthy foods, as reinforced by the assessment scores at the end of the program. As per the assessment referenced above, participants were given positive points for consumption of more nutritious food choices (vegetables, whole grains, lean proteins) and negative points for consumption of less nutritious foods choices (high processed foods, high fat proteins, sugary drinks or snacks). When pre-program assessments were compared to participants' post-program assessments, it was calculated that 86.1% of participants chose healthier food options for their families at the end of the 20-week farmers market season. This was accomplished in a population where in pre-program assessment it was determined that 63.9% of the participants in the program expressed having had food insecurities in the 12 months prior to the start of the program. Not only did we provide access to much needed fresh fruits and vegetables as a direct result of the program, but we were also able to provide locations and contact information to local food pantries in the area to all our participants. Additionally, the post assessment asked the participants to estimate how many people they shared their newfound knowledge with, and this lead to an average of 5.95 additional community members outside of program participation to start to hear about healthier eating. The participants in the program reside within many of the same communities. As a result, they created positive bonds with others in the group that resulted in creations of exercise and motivational groups, thus reducing social isolation. One participant lost her mother during participation in the program and expressed her belief that if she was still eating in the unhealthy manner and limiting her interaction with others as she did prior to program participation, the grieving process would have been more difficult to endure. On the other hand, she believes her improved eating habits and health gave her a more positive outlook, as well as the well wishes of her peers also participating in the program. The community has been appreciative of our program as well. One of the participants was a mother who home schooled her daughter and 4 other teens in her neighborhood. While a participant of the program, this mother would bring the 'class' regularly to fulfill health and nutrition education required as part of the home school curriculum. The children not only learned the education during the class, but also put it to practice by choosing the healthy, seasonal vegetables that were highlighted during the class for the week. Lastly, the neighborhood residents appreciated easier access to fresh produce as the farmer would set up outside of the health center in the parking lot.
Publications
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Progress 07/01/17 to 06/30/18
Outputs
Target Audience:The target audience reached with our Fresh First program during the reporting period consisted of VNA patients whom also participated in SNAP assistance for nutritional needs. VNA Health Care serves patients in the west and southwest suburbs of Chicago, and Fresh First was implemented in the Aurora/Kane County area. The demographic breakdown of the patients served by VNA is: 63% Hispanic, 19% Caucasian, 14% Black/African American, and 4% Asian. This was an accurate representation of the populations served by our program in the reporting period. In addition, the audience targeted and served by our program focused upon low-income individuals at increased risk of disparity as their consumption of fresh fruits and vegetables was hindered by cost and/or nutritional knowledge of the health impacts associated with low consumption. Many of the individuals served through Fresh First had little familiarity with how to use the fresh produce available within the Farmer's Market and prior to being in the program perceived it to be out of their reach from an economic standpoint. Changes/Problems:A change from the project initiation report is that we have removed the goal relating to navigation and benefits assistance for WIC and SNAP. This element does not occur within this program as we were informed that USDA funds could not be used for this purpose. Additionally, when we embarked upon implementing this grant, we were confident that the level of incentive at $25 per week was sufficiently generous to be a major motivator in moving our target population forward in increasing fruit and vegetable consumption. Our confidence was built upon the fact that this population often expresses food insecurity. Therefore, we felt this incentive would go a long way to meeting this need by providing healthy food. However, we have learned that despite the generous incentive, we are still competing with multiple other factors that affect the lives of our patients causing competing priorities and often chaotic behavior that resulted in missed classes and token redemption. As a result, a considerable amount of work has been required to remind patients on a weekly basis and to follow up with them if they miss a class or miss redeeming their tokens for produce. With this extensive support, we see greater compliance and without it, the self-motivation is not sufficiently developed to sustain the healthy behavior. Towards the end of the reporting period, the participants were beginning to integrate what they were learning into their daily lives but are a considerable way from doing this without a lot of support. What opportunities for training and professional development has the project provided?The project has highlighted the positive impact of providing cooking demonstrations and sampling of healthy recipes within our clinical team, whose medical training included little or no nutrition education. VNA's Clinical Dietitian has been a valuable resource to VNA patients for many years. During her tenure with VNA, she has constantly been stressing to obese, pregnant, and chronically ill patients the importance of increasing consumption of healthy fruits and vegetables. Since the implementation of this program, VNA's Wellness team has been able to 'show' instead of 'tell' by putting her clinical advice into action through the provision of recipe demonstrations and sampling. The persuasion to consume underutilized fruits and vegetables has become much easier. Additionally, when the recipes are reinforced by instruction on health benefits and they see the positive results of their efforts, patients are more willing consumers of fresh produce. VNA's clinical team has therefore moved from simply referring patients for dietetic consultation to actively being engaged in the program. Also, when the recipes are kept simple and can be demonstrated by staff members not culinary adept but have learned through this program how to do this, such as clinical pharmacists or registered nurses, patients are less intimidated and more encouraged to attempt to recreate healthy recipes, particularly when these have been tasted and enjoyed by their children and other family members within the class. This project has allowed these other clinical staff members to increase their comfort in providing nutritional counseling during group education or individual one-on-one counseling appointments to help supplement their traditional knowledge in their field of practice. We have also heard from our staff team that that they are more mindful and more confident when making their own nutrition choices as a result of observing this program in action. How have the results been disseminated to communities of interest?VNA Health Care participates extensively in Community Health Improvement Planning and Community Health Needs Assessments across each of the counties in which we have Health Centers and with all of our hospital partners. In addition, the Point of Contact on this project is Co-Chair of the Kane County Chronic Disease Action Team. This grant project, and the positive outcomes that we are finding in participants, is discussed regularly. In addition, the POC on this project presented about this project at the Illinois State Farmer's Market Association Conference and had the opportunity to share this project with local members of the USDA team. What do you plan to do during the next reporting period to accomplish the goals?VNA plans to continue meeting the objectives of the program in addition to troubleshooting any challenges that may occur. In addition, VNA plans during the next program period to collect patient testimonials for use in program promotion and in demonstrating the benefits of increased fruit and vegetable consumption within populations at increased risk of chronic disease.
Impacts
What was accomplished under these goals?
Participants were introduced to a new world of fresh fruits and vegetables that have always been available at the local markets, but that they felt were out of reach. These participants were frequently familiar with the vegetable appearance and identification, but not comfortable with the preparation or consumption of them. At the beginning of the program, most participants cited fear of the unknown flavor or improper preparation, potentially leading to the wasting of already scarce resources, as reasons for not consuming these fruits and vegetables. Through the recipes and cooking demonstrations provided, participants' level of comfort with new vegetables increased. Our program staff found it crucial for participants to not only get the printed step-by-step recipes and taste samples, but to allow participants to observe the preparation of the recipes. We made sure not to create overly complicated recipes so as to not discourage participants from attempting to prepare the dishes. Throughout the program, participants would share with us pictures of dishes prepared in their homes. At times, it was pictures of the recipe they learned during the program and other times it was pictures of their incorporation of these newfound vegetables, culinary skills, and knowledge of good nutrition into their traditional or newly created dishes. Our wellness kitchen was utilized as our educational launching pad. The recipes and/or the ingredients would offer a starting point to the conversation and education about the therapeutic aspects of nutrition. Through this we were able to educate participants on many topics, first and foremost on the reasons and benefits to increasing consumption of fresh fruits and vegetables. We were able to emphasize to participants on how these products not only help their chronic conditions (such as diabetes, high cholesterol, or high blood pressure), but also their overall health (mental health, decrease BMI, improved energy and cognition). Additionally, other aspects of nutrition were able to be addressed during the program, such as: reduction of sodium intake by increasing use of herbs and spices; identification and selection of healthy grains, proteins, and fats; understanding of sugar content in common sweets and soft drinks; and encouragement of physical activity. The education provided led to improvement of consumption of healthy foods, as reinforced by the assessment scores at the end of the program. As per the assessment referenced above, participants were given positive points for consumption of more nutritious food choices (vegetables, whole grains, lean proteins) and negative points for consumption of less nutritious foods choices (high processed foods, high fat proteins, sugary drinks or snacks). When pre-program assessments were compared to participants' post-program assessments it was calculated that 85.9% of participants improved their consumption of healthy food choices. This was accomplished in a population where in pre-program assessment it was determined that 63.8% of the participants in the program expressed having had food insecurities in the 12 months prior to the start of the program. Not only did we provide access to much needed fresh fruits and vegetables as a direct result of the program, but we were also able to provide locations and contact information to local food pantries in the area to all our participants. The participants in the program reside within many of the same communities and as a result, created a positive bond with others in the group that resulted in them encouraging and motivating each other, thus reducing social isolation. The following feedback is a direct quote from one of our program participants who joined the program when she was newly pregnant and which helps highlight the benefit of this program: "This program was extremely beneficial to our family. We are eternally grateful for the educational cooking classes and the vegetables/fruits. This encouraged us to change our lifestyle to be healthier and make healthier consumption habits. Throughout my pregnancy, I ate much healthier (many more vegetables) than normal. Thank you! Please keep the program going!!!!" An additional goal accomplished as a result of this project was the ability to share nutritional education with the local Aurora school system. A goal of the program was to purchase a stationary 'blender' bike that is used as a tool to educate individuals on the benefits of fresh fruits and vegetables, as well as encouragement of increasing physical activity. The bike was purchased in time for it to be utilized to as a centerpiece to health education available to the parents during parent teacher conferences in November 2017 at Aurora East High School. Students provided healthy fruit and vegetable smoothies, made using the blender bike, for families in attendance to enjoy. Also, the nutrition education was able to be modified and provided to elementary school students in Aurora. Aurora's school district 131 was a USDA grant recipient for a farm to school program, supplying elementary and middle school students with after school nutrition education centered on locally grown fruits and vegetables. VNA's Clinical Dietitian was responsible for providing nutrition education material as well as quick, healthy recipes students could assist in preparing before tasting. The students and their respective families impacted by these collaborations provided some overlap with our program participants and reinforced the principal nutritional goals of this program. Our program definitely helps fill a large void in nutrition education to a community that sorely requires it for the improvement of the community's overall long term health and wellness.
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