Progress 07/01/17 to 09/30/22
Outputs
Target Audience:Kentucky consistently ranks in the bottom ten states nationally for diet-related health outcomes and is 45thin the nation for overall health. With around 22% of Kentucky's children living in poverty, and more than 17% of Kentuckians living beneath the poverty line (45th in the country) - many of Kentucky's households struggle to afford a nutritionally adequate diet. The average adult Kentuckian consumes only 1.9 and 1.3 servings of vegetables and fruit respectively, per day. These dietary factors significantly contribute to Kentucky's poor health outcomes and many health conditions can be positively impacted by a diet high in fruit and vegetable consumption. However, low-income individuals are often unable to locate affordable, healthy foods. With 527,256 Kentuckians participating in SNAP, it and the other Federal Nutrition Programs have been instrumental in improving access to fresh food among low-income individuals and have the potential to both increase access to fresh produce while supporting Kentucky farmers and stimulating economic development. Changes/Problems:Evaluation Program evaluation proved to be an exceptionally challenging component of the project. Early on in project implementation, CFA partnered with Wholesome Wave as an evaluation lead. Wholesome Wave and CFA both experienced significant staff turnover during this period, which caused the evaluation to be pushed aside, as new staff members focused on onboarding and getting acclimated to their work. After the staff transition at Wholesome Wave, CFA was unable to advance evaluation efforts with Wholesome Wave as the evaluation lead. In response, CFA transitioned all evaluation tasks to CEDIK. Administering and collecting participant surveys was another challenge experienced. The initial plan for was farmers markets to distribute participant surveys to KDD customers. The KDD program requires a significant amount of oversight from participating markets for implementation, and consistently the markets were unable to administer surveys in addition to managing the program. In response, CFA and CEDIK attempted to collect surveys on designated days and times. This method did not provide enough surveys as a sample size. Finally, with private funding, the team changed approaches again, this time allocating CFA staff time specifically to survey distribution and collection. This method proved to be the most fruitful, and in future years, will be the method CFA uses for survey data collection. Data Collection With additional support from a USDA NTAE grant, CFA transitioned the program's data collection from FM Tracks to Smartsheet beginning in the 2021 season. CFA worked with consultants at Smartsheet to design a custom solution to KDD's data collection and evaluation needs. This includes customized monthly surveys and a personalized dashboard for each market, as well as a backend database that allows for quick budget and outcome evaluation. Data collection and evaluation have been a consistent challenge with this program, largely due to difficulties with capturing consistent, reliable data from markets, vendors, and customers. Some of our rural markets in particular struggle with computer literacy, so an intuitive and simple reporting system is crucial to their success in the program. The new Smartsheet data collection system was designed with ease of use in mind and it has already been successful in collecting higher-quality data with less frustration from users. COVID-19 The pandemic added challenges to many aspects of the program. One such challenge was the rapid rise in food insecurity since the onset of the pandemic. In Kentucky, the number of SNAP recipients increased by 30% in 2020.During COVID, CFA, the Kentucky Department of Agriculture, and other organizations were able to quickly provide farmers markets with additional resources and technical assistance that enabled many Kentucky farmers markets to not only remain open but to be safe places for shoppers.Though farmers markets and KDD were able to scale and meet the new demand, it required a sustained increase in the capacity to administer the program. In the years following 2020, SNAP allotment totals have dropped significantly, which consequently has reduced the amount of KDD incentives being redeemed. This is important to note, as the pandemic artificially and temporarily inflated redemption numbers across outlets. What opportunities for training and professional development has the project provided?Numerous opportunities for training and professional development were provided by this project. CFA staff facilitated multiple pieces of training each year focused on teaching participating markets the fundamentals of program implementation, general program management, and in-depth explanations of how to track and collect data. This project also provided CFA staff members with the opportunity to attend trainings focused on strengthening Nutrition Incentive Programs such as the FreshLink Ambassador Program training where staff members learned about the importance of outreach in the implementation of Nutrition Incentive Programs. The FreshLink model utilizes community-level outreach to increase participation in the program and redemption of incentives. CFA staff members also provided presentations about the implementation of this project numerous times at local and national conferences, including to entities such as the Kentucky Agricultural Development Board, the Kentucky Tobacco Oversight Committee, the SNAPEd/Nutrition Education Program Staff Professional Development Conference and the Nutrition Incentive Hub Grantee Conference. CFA staff members participated in a variety of professional development opportunities including participation in the Food Research & Action Center Annual Conference, USDA SNAP Online Purchasing Listening Session, National Grocers Association Retail Incentives Working Group, and the annual GusNIP/FINI Project Directors Meeting. CFA's Executive Director was invited to provide testimony to the Senate Subcommittee on Food and Nutrition, Specialty Crops, Organics, and Research on Food as Medicine. This testimony included lessons learned and challenges specific to the implementation of this project. How have the results been disseminated to communities of interest?The results of the project have been disseminated to communities of interest primarily through various reports published by CFA and CEDIK. These reports and other outreach information can be found on the KDD website. Additionally, CFA staff members have spoken extensively about the program and its impacts at numerous conferences, at multiple community organizations, as a component of various training, at annual state legislative committees, and at press release events. Further, CFA and community partners are currently campaigning for the Healthy Food and Farm Innovation Fund, which would legislatively create a state fund capable of receiving public and private funds to support access to healthy food, with federal grant matches as a priority. This legislation is anticipated to be introduced in early February. As part of these campaign efforts, CFA staff have presented about KDD to multiple committees in Kentucky's legislature. Additionally, in an effort to engage priority populations, CFA staff have created a variety of educational materials about KDD and shared them with stakeholders, including farmers and food-insecure community members. What do you plan to do during the next reporting period to accomplish the goals?
Nothing Reported
Impacts
What was accomplished under these goals?
Goal 1: In 2022 the project partnered with 44 farmers market entities representing 66 physical locations, from 95 of the state's 120 counties. Nearly 1000 farmers were vendors at these markets in 2022. This project met its goal of partnering with five retail locations. Partnering KDD with retail locations has the potential to significantly impact the purchasing power of SNAP participants and farmers on a much larger scale than incentivizing purchases at farmers markets alone. CFA has documented a steep increase in incentive spending that coincides with the retail expansion. KDD has partnered with an urban cooperative supermarket since 2015, and a small grocery chain of IGAs in rural eastern Kentucky since 2020. Beginning in 2021, KDD partnered with three additional grocery stores in rural, eastern Kentucky. This partnership has resulted in an 832% increase in the total number of KDD incentives redeemed at retail locations participating in the program, resulting in more than $190,000 in Kentucky-grown produce sales tied to participation in the program. This robust retail expansion has been one of the project's most significant successes and has laid an important foundation for future nutrition incentive program implementation at retail locations in Kentucky. KDD nearly met its goal of partnering with 13 Fresh Stop Markets (FSM) during the grant period, partnering with 11 FSM locations. FSM provide participants with a sliding-scale fresh food market that pops up in food-insecure neighborhoods, acting as a pickup point for pre-paid shares of fresh, local produce. Following a model like a multi-farmer CSA, CMs operate using a sliding scale, offering reduced rates for low-income participants. This alternative model has shown great success in making fresh produce more accessible, especially for transportation-limited populations. The project team estimates that more than 50,000 SNAP customers participated in the KDD program during this grant period. This is significantly lower than CFA's purposed target of 20,000 customers per year, and through implementation, CFA has realized that this goal was perhaps unrealistic. If CFA's customer counts are accurate, the program use has tended to lean toward fewer total customers with higher incentive spending per transaction. This suggests that there may be a barrier to trying out the program, but once SNAP users begin utilizing KDD, they begin to rely on the program to stretch the value of their SNAP dollars. This customer data has been consistently difficult to collect throughout the program period. Farmers market managers have struggled to regularly provide this data point, which has resulted in low-quality and likely inaccurate data. The current implementation model does not lend itself well to identifying the use of KDD by individual SNAP participants and identifying a viable method for tracking this important dataset will take priority in the future implementation of the program. During the grant period, $395,809 in SNAP Kentucky Double Dollars were redeemed across all participating markets. While the program showed consistent growth in incentive spending from year-to-year, the expansion of the retail component contributed significantly to the program's ability to meet this goal within the grant period. GOAL 2: Participating outlets experienced a growth in sales of 84% over the duration of the grant period.KDD provides essential support to farmers markets, as outlined by the following participant's comment, "Without the support of KDD, this season might have been the last season for the market. We had a stellar opening month and the customers just disappeared. Some vendors quit coming as it was not worth it. Until...KDD started the market was just scraping by. KDD saved the season for more than one of my farmers." - Clay County Farmers Market. According to customer impact surveys, the program continues to be impactful on eating habits and health. From 2020 to 2022, 134 participants in the KDD program completed an impact survey. Overall, participants found this program to have wide-ranging impacts. All respondents except 2 (99%) noticed positive changes in at least 1 of the 7 food-related behaviors that were measured. 95% reported that they had positive changes in five or more of the behaviors measured. 49% reported positive changes in all 7 behaviors. Additional details can be found in the attached report compiled by CEDIK. In short, participants observed the following changes in the order of frequency: 1) Less consumption of processed foods: 91% 2) Greater awareness of food sources and farming: 89% 3) Better digestive health: 82% 4) Increased physical activity: 81% 5) Greater nutritional awareness: 80% 6) Better food preparation skills: 74% 7) Weight loss: 64%. KDD contributed to increased household consumption of fresh fruits and vegetables. 88% of respondents agreed or strongly agreed that KDD increased their vegetable intake. 82% agreed that KDD increased their fruit consumption. GOAL 3: Kentucky farmers and local food systems have been positively impacted by the implementation of this project. KDD increased sales and income for Kentucky farmers, increased access to fresh and local food for low-income populations, and leveraged multiple funding streams. During this grant period, KDD has shown significant success in creating substantial on-farm and market-based impacts for Kentucky's food systems. Kentucky Double Dollars has proven to be essential to the stability and sustainability of many of Kentucky's farmers markets and their associated farmers. Of the farmers surveyed who accepted KDD, 76% agreed that participation in KDD increased their farm income overall, 50% indicated that they increased the number and type of products offered at the markets because of KDD sales, and 36% of farmers increased employment due to the KDD program. In short, Kentucky Double Dollars had diverse, positive impacts on farms. While these impacts were experienced primarily by smaller producers, all size classes noted benefits. Farmers identify that KDD has increased their on-farm income, with 80% of farmers surveyed identifying an increase in their sales since their market began participation in KDD. Additional details of the economic impact of the program can be found in the attached report published by the University of Kentucky's Community and Economic Development Institute of Kentucky (CEDIK). CFA anticipates that most, if not all, current participating locations will continue the program after the conclusion of the grant period - provided that CFA is able to secure funding to support the incentive component of the program. Many farmers markets have the financial capacity to offer individual matching incentive programs, however, the majority of Kentucky's farmers markets do not have this capacity, and as a result, rely on CFA for funding the incentive component of Kentucky Double Dollars. Though KDD has seen large increases in usage, there has been a slow uptake in broad public awareness of the program, partly due to the media producing conflicting reports of what organization administers the program, what is available, and who is eligible. However, the recent White House Conference on Hunger, Nutrition, and Health has led to a growing interest in "food as medicine". Numerous Kentucky media also provided coverage of CFA's Executive Director's testimony to the US Senate Agriculture Subcommittee on Food and Nutrition.
Publications
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Progress 07/01/20 to 06/30/21
Outputs
Target Audience: Kentucky consistently ranks in the bottom ten states nationally for diet-related health outcomes and is 45th in the nation for overall health. With around 22% of Kentucky's children living in poverty, and more than 17% of Kentuckians living beneath the poverty line (45th in the country) - many of Kentucky's households struggle to afford a nutritionally adequate diet. The average adult Kentuckian consumes only 1.9 and 1.3 servings of vegetables and fruit respectively, per day. These dietary factors significantly contribute to Kentucky's poor health outcomes and many health conditions can be positively impacted by a diet high in fruit and vegetable consumption. However, low-income individuals are often unable to locate affordable, healthy foods. With 527,256 Kentuckians participating in SNAP, it and the other Federal Nutrition Programs have been instrumental in improving access to fresh food among low-income individuals and have the potential to both increase access to fresh produce while supporting Kentucky farmers and stimulating economic development. Changes/Problems: With additional support from a USDA NTAE grant, CFA transitioned the program's data collection from FM Tracks to Smartsheet beginning in the 2021 season. CFA worked with consultants at Smartsheet to design a custom solution to KDD's data collection and evaluation needs. This includes customized monthly surveys and a personalized dashboard for each market, as well as a backend database that allows for quick budget and outcome evaluation. Data collection and evaluation have been a consistent challenge with this program, largely due to difficulties with capturing consistent, reliable data from markets, vendors and customers. Some of our rural markets in particular struggle with computer literacy, so an intuitive and simple reporting system is crucial to their success in the program. The new Smartsheet data collection system was designed with ease of use in mind and it has already been successful in collecting higher quality data with less frustrations from users. As mentioned throughout this report, the COVID-19 pandemic has added challenges to many aspects of the program. One such challenge has been the rapid rise in food insecurity since its onset. In Kentucky, the number of SNAP recipients increased by 30% during 2020. Though farmers markets and KDD have been able to scale and meet the new demand, it has required a sustained increase in capacity to administer this program. As previously mentioned, capacity issues have then led to a decrease in non-essential project activities, such as outreach. With CFA's newly awarded supplemental funding from USDA NIFA, the Project Team will be able to increase capacity and overcome some of these hurdles. What opportunities for training and professional development has the project provided? KDD Program Training was presented to 55 participating markets and 4 retail stores during this progress period. A presentation about the program was also given at the Kentucky Fruit and Vegetable Conference, the SNAPEd/ Nutrition Education Program Staff Professional Development Conference and the Nutrition Incentive Hub Grantee Conference. The Program Coordinator participated in a variety of professional development opportunities including participation in the Food Research & Action Center Annual Conference, USDA SNAP Online Purchasing Listening Session, National Grocers Association Retail Incentives Working Group, and GusNIP/FINI Project Directors Meeting. How have the results been disseminated to communities of interest? Community Farm Alliance and community partners are currently campaigning for the Healthy Food and Farm Incentive Fund. This fund would legislatively allocate a portion of Kentucky's Tobacco Master Settlement Funds to local produce incentive programs, such as Kentucky Double Dollars. As part of these campaign efforts, CFA staff have presented about KDD to multiple committees in Kentucky's Congress. Additionally, in an effort to engage priority populations, CFA staff have created a variety of educational materials about KDD and shared them with stakeholders, including farmers and food-insecure community members. Beyond this and the training sessions and conference presentations mentioned in the previous question, other program outreach has mostly been put on pause due to the COVID-19 pandemic. What do you plan to do during the next reporting period to accomplish the goals? The Project Team has the following goals for the next reporting period: Maintain and grow SNAP participation at current markets and retail sites. The program is entering a maintenance phase in which the goal is not to expand to many new sites, but to increase participation, incentive redemption and program effectiveness at current sites. Hire a KDD Retail & Marketing Coordinator who will bolster retail partnerships through increased outreach and technical assistance, and will draft and implement an annual KDD Communications and Outreach Plan, including creating marketing materials for all KDD sales outlets. Work with CFA's evaluation partner, CEDIK, to increase the response rate of both customer and farmer surveys, and begin to deeply evaluate the program in anticipation of the final report.
Impacts
What was accomplished under these goals?
GOAL 1 - During this progress period, Kentucky Double Dollars (KDD) exceeded all projected goals for increasing the accessibility and affordability of Kentucky grown fruits and vegetables among low-income customers participating in SNAP. Despite the pandemic continuing to present challenges to marketing and outreach, the program expanded across all market types in both number of locations and total sales. 1. KDD expanded in 2021 to partner with 51 farmers markets in 44 counties, doubling the program's goal geographical reach. Over 1,000 farmers vended at these markets in 2020. 2. KDD met its goal of partnering with five retail locations, including maintaining its partnership with a large, urban cooperative grocery. In 2021, three new IGA partnerships were also developed across rural, Appalachian Kentucky, after a pilot program at one IGA store in 2020. Retail sites are crucial to providing consistent access to local produce, especially in rural communities that do not have a robust farmers market. 3. KDD met its goal of partnering with 19 Fresh Stop Markets (FSMs) in the 2021 market season. Fresh Stop Markets provide pre-ordered shares of local produce to community pick-up points using a sliding scale price model. 4. Participating farmers markets, Fresh Stop Markets and retail stores served approximately 10,167 SNAP customers through the KDD Program within the last progress period. Though this is significantly lower than CFA's proposed target of 20,000 customers per year, since running the program for 4 years, CFA has realized this goal was unrealistic. Program use has tended to include fewer total customers with higher incentive spending per transaction. This suggests that there may be a barrier to trying out the program but once SNAP users begin utilizing KDD, they are routinely shopping at farmers markets and relying on the program to increase the value of their SNAP dollars. Further, this customer data has been especially difficult to collect from markets which has resulted in low quality data. After reanalyzing past customer data to better account for data quality, total customer counts per year appear lower than previously reported. The previous reporting period served about 5,000 customers, meaning the program doubled customers served this progress period. This growth can be attributed to a variety of factors including program expansion and thus greater reach, as well as the pandemic and P-EBT creating more food-insecure and SNAP-eligible users. 5. During this performance period, $84,813 in SNAP F&V Kentucky Double Dollars were redeemed at participating markets. This is an astonishing 250% increase in incentive redemption from the previous progress period and record redemption for the program. Operating KDD through the pandemic made it clear that direct to consumer market channels, such as farmers markets, were much quicker to adapt to the pandemic as far as offering online ordering, contactless pickup options and increased production to match demand for local food. Additionally, these markets were more resilient to pandemic-related market instability and supply chain issues and tended to maintain a supply of food, at the same time that grocery stores had shortages and empty shelves. Further, many SNAP users also expressed that they felt safer shopping at an outdoor market with fewer hands on their produce between the farm and their plate. This is a testament to the vital role that both farmers markets and nutrition incentive programs play in food security and community resilience, as participants are relying on them even more heavily during a global pandemic. GOAL 2 - SNAP sales at participating KDD sites far exceeded program goals for the second year in a row with a 250% increase in SNAP Fruit and Vegetable incentive redemption. To understand the downstream impacts of this on customer shopping habits and health, customer surveys were designed and distributed to willing participants starting in 2020 and preliminary results are presented below. 1. Participating farmers markets and fresh stop markets experienced 282% and 210% increases, respectively, in SNAP F&V sales in this progress period compared to the previous period. Retail SNAP F&V KDD redemption increased by 224%. Increases in all market types are due to both program expansion and an increase in SNAP sales at each individual site. Because KDD doubles SNAP dollars when spent locally, the program effectively brought in almost $170,000 in local produce sales for Kentucky farmers during this progress period. After the start of the pandemic, the program immediately saw an increase in usage likely due to increased food insecurity and the safety and accessibility of shopping directly from farmers. Many farmers reported that they had to increase their production to meet the new demand and there has been some worry that this increased interest in local food purchasing would quickly dissipate. Though the pandemic continues, farmers market sales are still climbing, suggesting that the recent enthusiasm for these programs is here to stay. 2. According to customer impact surveys, the program continues to be broadly impactful on eating habits and health. All but one respondent noticed positive changes in at least one food-related behavior and 85% experienced positive changes in three of more. For example, 89% of participants reported greater nutritional awareness and 82% consumed less processed food. These behaviors translated to meaningful health impacts, in which 65% of participants reported better digestive health and 30% even reported losing weight since participating in the program. Though we expect these trends will remain true with more data, to date only 19 surveys have been collected. Even with paid survey incentives, it has been difficult to get customers to complete surveys. This remains to be a major challenge of the evaluation side of this project. 3. KDD clearly contributes to increased household consumption of fresh fruits and vegetables. 84% of respondents said they increased vegetable intake, while 78% increased fruit consumption. 85% of respondents spent all $12 of their incentives and 78% visited their farmers markets over 9 times a year, suggesting that KDD improves the affordability of increased local fruit and vegetable consumption. GOAL 3 - Farmer vendor surveys clearly show that the KDD Program has a significant impact on farmers market sales and total farm income. 1. 68 farmer vendors have completed impact surveys to date. 85% of surveyed farms reported increased sales that they attributed to KDD participation. This demonstrates that the program is bringing in additional customers and sales and not just replacing sales. On average, farmers market sales saw an 11% increase after participating in KDD, with 10% of farmers reporting increases over 20%. 2. CFA expects most, if not all, current participating markets to continue with the program after the conclusion of the grant period. 0% of surveyed farmers expressed dissatisfaction with the program and market manager feedback is consistently positive. 3. Though KDD has seen large increases in usage, broad public awareness of the program continues to be a challenge. KDD admin and implementation require tremendous amounts of capacity and advertising typically is not prioritized above the tasks necessary to keep things running smoothly. Decreased capacity from markets and community partners due to the pandemic has also minimized outreach efforts.
Publications
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Progress 07/01/19 to 06/30/20
Outputs
Target Audience:Kentucky consistently ranks in the bottom ten states nationally for diet-related health outcomes and is 45th in the nation for overall health. With around 22% of Kentucky's children living in poverty, and more than 17% of Kentuckians living beneath the poverty line (45th in the country) - many of Kentucky's households struggle to afford a nutritionally adequate diet. The average adult Kentuckian consumes only 1.9 and 1.3 servings of vegetables and fruit respectively, per day. These dietary factors significantly contribute to Kentucky's poor health outcomes and many health conditions can be positively impacted by a diet high in fruit and vegetable consumption. However, low-income individuals are often unable to locate affordable, healthy foods. With 527,256 Kentuckians participating in SNAP, it and the other Federal Nutrition Programs have been instrumental in improving access to fresh food among low-income individuals and have the potential to both increase access to fresh produce while supporting Kentucky farmers and stimulating economic development. Changes/Problems:As mentioned throughout this report, the COVID-19 pandemic has added challenges to every aspect of the program. Because we already had two full seasons to establish KDD, we have been able to run the program and retain the vast majority of market participants through the pandemic. The biggest challenge has been in having less capacity and ability to provide outreach and advertise the program to new markets or SNAP participants. Participating market managers continue to face challenges related to learning to use and collecting data regularly through FM Tracks. FM Tracks has proven to be far from user-friendly, resulting in many markets struggling to maintain required data collection and reporting requirements. Moving forward, CFA is planning to transition to a more intuitive system, that is accessible for those with little technological experience, that does not require a Wi-Fi or cellular data connection, and that is tailored to collect data specific to the needs of the KDD program. This system will be developed in the coming months, with anticipated market use during the next market season. Evaluation partner Wholesome Wave has experienced significant employee turnover since the beginning of this grant, which has had a substantial impact on their ability to accurately collect and track data, and conduct evaluation activities. CFA's partnership with Wholesome Wave ended in June of 2020, and moving forward CEDIK will take over as the project's evaluation lead. What opportunities for training and professional development has the project provided?In the winter of 2019, a variety of training sessions were provided by the Food Access Program Director to other members of the Project Team and participating market and retail staff. A refresher training was provided to Community Farm Alliance's Farmers Market Support Program staff on program specifics, reporting and FM Tracks. 10-15 markets received additional training on reporting and program management due to staff turnover and difficulties using FM Tracks. Two trainings were provided to staff at a KDD retail site (Good Foods Co-op), each attended by 10-15 employees, and a training session also took place for members of a newer Fresh Stop organization that only recently became able to process incentives. The Food Access Program Director also attended a training for the FreshLink Ambassador Program in preparation for future outreach efforts. How have the results been disseminated to communities of interest?The following outreach activities all occurred in the first half of the progress period, and these activities have been on hold since the beginning of the COVID-19 pandemic. At the end of 2019, the Food Access Program Coordinator spoke extensively about the program at two University of Kentucky Extension Farmers Market Toolkit meetings, each attended by 20-25 Extension staff. The biggest outreach event for this progress period was a series of press events held in collaboration with the Farmers Market Support Program to celebrate National Farmers Market Week. Events were held at farmers markets in Lexington, Whitesburg, and Louisville, and were attended by numerous representatives from the state government and local press outlets. The Food Access Program Director also spoke at a number of local classes and events, including a staff event at a domestic violence center and a Community Action Council nutrition class. The Coordinator has been present on behalf of the program at a number of local and regional events, including the Regional Community Health Forum in Bowling Green, multiple Bluegrass Farm to Table meetings, a Public Assistance Reform Taskforce meeting, and the Kentucky Health Exchange Stakeholder meeting. Outreach materials were also distributed to a handful of local organizations that serve SNAP-eligible populations in Lexington. Beyond the public presentations and outreach by the Project Coordinator, the KDD Advisory Council convened twice during this progress period, where they were updated on the program. Council members take this information and shares it with their own communities and working groups, further disseminating our results to communities of interest. What do you plan to do during the next reporting period to accomplish the goals?Unfortunately, the pandemic situation is ever-evolving, making it difficult to plan for a specific future. The Project Team will continue to meet weekly to assess the situation and plan how to best move forward. Thus, the following goals are subject to change based on current events. Customer surveys will be distributed at select farmers markets and CEDIK will produce a final report on the impacts of KDD on SNAP customer's fruit and vegetable purchasing and healthy eating habits. Vendor surveys will be distributed for a second year and CEDIK will produce a final report on the impacts of KDD on farm income, business growth, and provide insight on the overall economic impact of the program. Participating farmers markets will continue to log their sales data in FM Tracks and this will be used to analyze the impacts of KDD on total markets sales and number of SNAP customers served. The Food Access Program Director will continue to provide technical support to the third retail partner, FoodChain, in order to launch their SNAP-eligible meal kits by the end of the next reporting period. The Project Team will consult with participating farmers markets on their desire and ability to continue offering the KDD program after the grant progress period. Strategic planning will occur to inform the growth and expansion of the Kentucky Double Dollars Program, with special attention paid to a statewide retail expansion, and piloting innovative SNAP incentive models (such as FoodChain's food boxes). The strategic plan will provide the Project Team with a clear roadmap, timeline, and implementation and evaluation methodology that will support a successful 2021 GusNIP large-scale project application.
Impacts
What was accomplished under these goals?
GOAL 1 - During this progress period, Kentucky Double Dollars met or exceeded most of our projected goals for increasing the accessibility and affordability of Kentucky grown fruits and vegetables among low-income customers participating in SNAP. The COVID-19 pandemic brought many challenges to the program, especially outreach and recruiting new market participants, yet it also brought many new SNAP-eligible participants who participated in KDD for the first time. 1. The Kentucky Double Dollars Program is currently partnered with 41 farmers markets, impacting 37 counties, and hosting a total of 1111 farmer vendors. While more markets anticipated participating in KDD in 2020, the onset of the pandemic caused them to struggle with adequate management capacity, and resulted in more than a few markets closing for the season. Though the total number of participating markets did not increase during this period, CFA considers maintaining the program through the COVID-19 pandemic with 41 markets a great success. 2. KDD met its goal of partnering with three retail locations, including maintaining its partnership with a large, urban cooperative grocery, and developing a new partnership with a small IGA in rural, Appalachian Kentucky. The program incentivizes the IGA to purchase local produce, while making fresh fruit and vegetables more accessible to a large population of rural SNAP participants. IGA's are often the only full-size grocery stores in the rural communities of Appalachian Kentucky and they typically stock little local produce. CFA is excited about the potential of expanding KDD to more IGA's and helping to facilitate better access to affordable, fresh produce, while creating opportunities for local farmers to sell their products. Through implementation of KDD at this IGA, CFA forged a partnership with a representative from the National Grocers Association (NGA). NGA assisted the IGA with developing a digital redemption model that was easily integrated into IGA's existing point-of-sale. This is an important development that will prove useful in further expasions of the program, as the other KDD retail locations have been unable to implement a digital redemption system to date. The third retail partner, FoodChain, is preparing SNAP-eligible meal kits with minimally-processed, gleaned produce which will first become available later this fall. 3. KDD is just shy of meeting our goal to partner with 13 Fresh Stop Markets (FSMs), with 12 FSMs participating in the 2020 farmers market season. FSMs are pop-up markets at churches, businesses and community centers in food-insecure neighborhoods, that act as a pickup point for pre-paid shares of fresh, local foods. This model has shown great success in making fresh produce more accessible in these neighborhoods, especially for transportation-limited populations like seniors. 4. Participating farmers markets and Fresh Stop Markets served 11,423 SNAP customers. In the previous year, we saw a marked decline in KDD participation, along with overall SNAP participation in Kentucky. The program saw many new participants this year, due to the P-EBT program and statewide increases in SNAP eligibility resulting from pandemic-related unemployment. 5. During this performance period, $33,492 in SNAP F&V were redeemed at markets participating in the KDD Program. During the same period last year, $29,892 in KDD SNAP FV incentives were redeemed at participating markets. This is slightly below the baseline $33,231 redeemed in 2018 and significantly below our target goal of $41,500 in 2019. Though overall participation has been lower than anticipated, the increase in redemption rate through the pandemic is quite a success. This is a testament to the vital role that both farmers markets and nutrition incentive programs play in food security, as participants are relying on them even more heavily during a global pandemic. GOAL 2 - Data collected in FM Tracks reveal growth in total SNAP sales at participating KDD sites that far exceeded our goals, with a 46% increase compared to last year. To understand the downstream impacts of this on customer shopping habits and health, customer surveys have been designed and are currently awaiting IRB-approval, with plans to distribute them in late fall. 1. Participating farmers markets experienced a 26% increase in total SNAP sales in this progress period compared to the previous period. Fresh Stop Markets had much high increases with a 52% increase in SNAP sales. A retail location that has participated in the program since 2017 experienced a 34% increase in SNAP sales. Between all participating KDD sites, there was a 46% increase in SNAP sales, far exceeding our goal of a 25% increase at the end of the grant performance period. This steep increase is largely due to a crisis creating more SNAP-eligible customers, but it also means that even in a difficult time, SNAP and KDD is working as it's meant to by being immediately responsive to community needs. It also illustrates that markets have been able to quickly adapt to increase food access and provide for those customers inways that many other businesses can't. 2. Our research partner, Community and Economic Development Initiative of Kentucky (CEDIK), designed a survey for customers using KDD that is currently awaiting IRB-approval and will be distributed at the end of the 2020 farmers market season. The survey will collect data on changes in fruit and vegetable consumption and healthy eating habits with participation in KDD. 3. The customer survey will also collect data on changes in produce purchasing habits. We expect to have this data collected and analyzed by the end of the grant performance period. GOAL 3 - Data collected during this reporting period clearly shows the KDD Program has a significant impact on farmers market sales and total farm income. 1. CEDIK designed and distributed surveys to 203 vendors at 42 farmers markets across the state, to understand the effect of the Program on sales and business growth. 82% of surveyed vendors reported an increase in 2019 sales due to KDD. Importantly, 68% of respondents reported increases in total farm income due to the program, demonstrating that KDD is bringing in additional customers and sales and not just replacing sales. The total economic impact of the program in 2019 is estimated at $436,918, based on a conservative vendor-reported estimate of a 5% increase in sales due to the program. Further, 24% of respondents reported 10% and higher increases in sales. Vendor surveys will be distributed again at the end of the 2020 farmers market season. 2. We expect most of the current participating markets to continue with the program after the conclusion of the grant period. We have generally received very positive feedback from market managers and vendors. Many vendors left notes like, "Thank you for providing Double Dollars", "Please continue the program", and "This program really helps us," in the comments section of the vendor survey. The main complaint for the program is that not all items are eligible, including honey and value-added products. 3. Though the program saw many new participants in 2020, public awareness of the program is a hurdle that prevents its maximum potential impact. The Project Team planned to launch a major outreach campaign in 2020, but the pandemic put this on pause. Programs like this require a lot of energy to be successful and the capacity of the Project Team has been fully utilized in program maintenance and providing technical support to markets and retailers. Due to the pandemic, markets have required much more technical assistance to keep their markets open and compliant with ever-changing safety regulations. Increased SNAP usage at participating markets has also demanded more capacity from the. Project Team.
Publications
- Type:
Other
Status:
Other
Year Published:
2020
Citation:
Community Farm Alliance and Bluegrass Farm to Table. (2020) "Kentucky Double Dollars 2019 Annual Report."
- Type:
Theses/Dissertations
Status:
Other
Year Published:
2020
Citation:
Davis, Alison. (2020) "The Economic Impact of the Kentucky Double Dollars Program."
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Progress 07/01/18 to 06/30/19
Outputs
Target Audience:Kentucky consistently ranks in the bottom ten nationally for diet-related health outcomes. With around 22% of Kentucky's children living in poverty, and more than 17% of Kentuckians living beneath the poverty line (45th in the country) - many of Kentucky's households struggle to afford a nutritionally adequate diet. The average adult Kentuckian consumes only 1.9 vegetables and 1.3 servings of fruit per day. These dietary factors significantly contribute to Kentucky's poor health outcomes: Kentucky ranks 45th in the nation for overall health. All of these conditions can positively impacted by a healthy diet, high in fruit and vegetable consumption. Increasing consumption of fruits and vegetables is a proven strategy to help reduce a host of chronic diseases. However, low-income individuals are often unable to locate affordable healthy foods. With 527,256 Kentuckians participating in SNAP, it and the other Federal Nutrition Programs have been instrumental in improving access to fresh food among low-income individuals and have the potential to both increase low-income access to fresh produce while supporting Kentucky farmers and stimulating economic development. Changes/Problems:The retail partnership has proven to be challenging in quite a few ways. Many challenges that our retail partners have experienced have been at the point-of-sale level, as administration of the program requires item numbers that separate the incentive eligible produce from other store items. This process is time-consuming, and many small retail establishments lack the necessary capacity and administrative oversight to complete the process. Additionally, retail locations are unable to use FM Tracks - which adds even further complications to retail data tracking and collection. Other challenges include retail location's inability to consistently access and sell locally grown produce throughout the year, as well as, general staff turnover and capacity issues. Implementing KDD requires substantial administrative and employee oversight, which many retail locations lack. Individual markets participating in the program have consistently had issues with learning to use, utilizing, and collecting data in FM Tracks. The quality of the data recorded in FM Tracks reflect the ability of the market managers to successfully and consistently report on their experiences at the market on a given day. Many markets lack consistent access to Wi-Fi or cellular data, leaving the market manager responsible for inputting data at a later time, sometimes keeping up with datasets on paper. The program was designed around using digital technology to collect and track data, and many markets have been unable to use technology in the way this project requires. However, CFA's KDD Coordinator and Technical Assistants have continuously dedicated time to assisting markets with data collection, program management, and reporting requirements. Moving forward, they will continue this assistance and work alongside markets to figure out methods that work around the challenges that have been identified. The annual grant period has consistently been a challenge, for both participating markets and project partners, as it occurs during midseason of the farmers market. This has a negative impact on data collection and evaluation efforts, and adds challenges to the reporting process. What opportunities for training and professional development has the project provided?CFA's Kentucky Double Dollars Coordinator facilitated six in person trainings focused upon training participating markets on the fundamentals of program implementation, general management of the program, and in-depth explanations of how to track and collect data through FM Tracks. The KDD Coordinator also worked one-to-one with individuals who required additional technical assistance to understand and navigate FM Tracks. During this reporting period, the KDD Coordinator attended a FreshLink Ambassador Program training where she learned about the importance of outreach in implementation of Nutrition Incentive Programs. The FreshLink model utilizes community level outreach to increase participation in the program and redemption of incentives. During the next year, CFA will work to incorporate what she learned into the implementation of the KDD program. How have the results been disseminated to communities of interest?During the coming months CFA will draft an Annual Report for Kentucky Double Dollars, for Year 2, which spanned July 1, 2018 - June 30, 2019. Once finalized, this publication will be made available to all program partners and participants. What do you plan to do during the next reporting period to accomplish the goals?CFA will build upon current efforts, and continue to add new market participants at a similar rate. It is anticipated that we will surpass our projected goals for number of participating markets during the next project period. With SNAP KDD participation and redemption rates declining, CFA will focus upon reaching new SNAP participants. CFA will work to identify barriers that are preventing low-income residents from participating in the program, while working alongside low-income community members to identify and implement solutions. CFA will continue to work to increase varied, targeted outreach to participants, NGOs, state agencies, retailers, and other stakeholders with the goal of increasing participation. During the next year, evaluation partner Wholesome Wave will continue to explore the baseline data to identify strengths as well as gaps and barriers, in order to direct our technical assistance and training efforts. Wholesome Wave will explore market day trends, markets with stronger SNAP sales and those markets who lag behind the others in customer surveys, in order to learn more about effective and scalable program components. In order to better quantify the impacts KDD has made upon low-income participants, individual markets, and individual farmers, during the next progress period distribution of surveys will begin, and through evaluation CFA will be able to quantify the impact this program has had on each of the groups.
Impacts
What was accomplished under these goals?
What was accomplished under these goals? GOAL 1 - During this progress period, Kentucky Double Dollars has met or exceeded our projected goals for increasing the accessibility and affordability of Kentucky grown fruits and vegetables, among low-income customers participating in SNAP. 1. The Kentucky Double Dollar Program (KDD) is currently partnered with 42 farmers markets across 34 counties in Kentucky. KDD is close to meeting and likely to exceed our projected goals of partnering with 47 farmers markets during the grant period. 2. KDD is currently partnered with one retail location, and has identified and is working closely with three retail locations across the state, and working to prepare for a 2020 launch. Retail locations are instrumental in providing low-income residents with consistent access to healthy, locally grown fruits and vegetables. 3. KDD has partnered with 10 Fresh Stop Markets, through four organizations across the state. The Fresh Stop Market is a farm-fresh food market that pops-up at local churches, businesses, and community centers in fresh food insecure neighborhoods. The food has been paid for in advance so that farmers don't face the same degree of risk as they do with a standard farmers market. This alternate model has shown substantial growth during the first two years of this grant, and has positively impacted both farmers and participants. 4. During this performance period, participating farmers markets and Fresh Stop Markets served close to 4000 SNAP customers. When comparing current participation numbers to data from the previous year, there is a clear decline in participation. Mirroring KDD's decline in SNAP participation, is SNAP participation overall within Kentucky. During May 2018, Kentucky's SNAP enrollment dropped sharply with the reinstatement of a three-month time limit for some adults. Overall SNAP enrollment for the state dropped by 16% from June 2018 to June 2019, and this decline was felt throughout KDD participating markets. During this reporting period, KDD has felt this decline through significant decreases in both customers and the amount of incentives distributed. 5.During this progress period $29,892 in SNAP F&V has been redeemed. This number is well behind our anticipated redemption rate of $100,000 per year, and is likely tied to multiple external factors. The decline in Kentucky's overall SNAP enrollment is likely one of the primary causes of this reduction in redemption. During the next grant period, KDD will employ robust outreach strategies that work to connect SNAP participants to the KDD program, and that connect participants to resources such as SNAP-ed. GOAL 2 - Participant evaluations were not implemented during this progress period, due to a variety of factors. Both Wholesome Wave and CFA experienced significant staff turnover during this period, which caused the participant evaluation timeline to be pushed back, as new staff focused upon onboarding and getting acclimated to their work. The participant evaluations have been drafted and select markets have distributed a small number of sample surveys. Feedback from the sample surveys has prompted CFA to revise our approach. Surveys are currently being reviewed and edited by project partners Wholesome Wave and Community Economic and Development Initiative of Kentucky (CEDIK). Distribution is scheduled to begin during the next month. 1. During the past reporting period baseline metrics were established to begin measuring change in SNAP fruit and vegetable market sales. Data collected through FM Tracks shows that participating markets have shown a 20% decrease in sales during year two of the grant. This decrease is likely tied to the overall decrease in SNAP participants in Kentucky during the progress period. 2. While participant surveys have not yet been distributed widely, some data was able to be collected from the sample group who completed the first round of surveys. Of the 18 customers that responded to the question about whether coming to this market increased their consumption of fresh fruit and vegetables, 83% responded yes. 3. While participant surveys have not yet been distributed widely, from the sample survey group we learned that of those who completed the survey, 62% had shopped at that particular farmers market previously. This leads us to believe that those surveyed are more regularly purchasing locally grown fruits and vegetables at participating farmers markets. Additionally, 90% of those surveyed reported that fruits and vegetables are more affordable for them now, which would enable participants to increase their fruit and vegetable purchasing potential. GOAL 3 - Data collected during this reporting period helps to illustrate that the Kentucky Double Dollars Program is impacting farmers while helping to expand and sustain the market for Kentucky's local fruit and vegetable producers. 1. During the previous progress period, baseline average per-vendor sales were established. During this progress period, average per vendor sales were calculated and compared to previous year's datasets. Currently, KDD participants are showing an average increase in per-vendor sales of 25%. 2. Based upon the response from current participants, we foresee a large percentage of markets continuing participation in KDD after the conclusion of this grant. CFA staff have worked closely with markets to better educate about the importance of community fundraising for sustaining incentive programs. A number of markets this season have exhausted their Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Seniors Farmers Market Nutrition Program (SFMNP) incentives early in the market season, and worked within their communities to independently fund these programs. This is a trend we anticipate will continue during the remainder of this grant, which will help to ensure markets are able to independently fund their incentive programs in the future. 3. Public awareness is something that can always be expanded upon, and CFA is attempting to do this through the distribution of our Kentucky Double Dollars publications, targeted outreach to organizations and community members, and through presentations at various workshops, conferences, and meetings. These publications and presentation provide an outline of the program, eligibility requirements, and identify where and how the incentives can be used. Through implementation of this project, the KDD Advisory Council was formed. The KDD Advisory Council is a coalition of healthy local food access stakeholders composed of NGOs, state agencies, farmers markets and retailers, low-income stakeholders, and funders with an interest in building common knowledge and best practices for increasing access to Kentucky grown healthy food, developing a statewide food access incentive program, and supporting outreach to low-income populations to increase participation in healthy food access. This coalition has been and will continue to be an instrumental piece to increasing public awareness of the KDD program.
Publications
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Progress 07/01/17 to 06/30/18
Outputs
Target Audience:Kentucky consistently ranks in the bottom 10 nationally for diet related health outcomes. One in six Kentuckians do not know where their next meal will come from. With over 25% of Kentucky's children living in poverty, more than 17% of Kentucky households struggle to afford a nutritionally adequate diet. The average Kentuckian consumes only 1.7 vegetables and 1.2 servings of fruit per day. These dietary factors significantly contribute to Kentucky's poor health outcomes. With 1.1 billion in Kentucky benefits and 769,000 Kentuckians participating in SNAP, it and the other Federal Nutrition Programs have been instrumental in improving access to fresh food among low-income individuals and have the potential to both increase low-income access to fresh produce and support Kentucky farmers and stimulate economic development. Changes/Problems:Community Farm Alliance has been offering a Double Dollars Program for farmers markets since 2014. With the FINI award CFA and Bluegrass Double Dollars merged to form Kentucky Double Dollars in 2017 to include farmers markets, Fresh Stops and select retail outlets. However since the FINI grant did not begin until July 1, 2017 we did not rollout the merged program until was essentially mid season. Because of that we regarded 2017 as a "pilot" of the new program, including requiring the new usage of FM Tracks as the data collection system. Overall this significantly impacted our ability to collect comprehensive data for the entire 2017 marketing season. The retail partnership has proven to be challenging in quite a few ways. Many of the challenges are at the point-of-sale level, as the KDD program has to have separate item numbers to keep the incentives and the rest of the store items separate, which requires quite a bit of administrative efforts on the retail location's end. In addition, retail locations are unable to use FM tracks, which adds further difficulty to data collection. Additionally, one of the retail partners has had a change in management and as a result, has had trouble securing a consistent supply of Kentucky-grown produce which has made program implementation challenging. We are re-evaluating their participation for next year. Another challenge that has surfaced during this progress period is individual markets inability to successfully utilize FM Tracks and general data collection. There have been a wide range of issues related to data collection, and the KDD Coordinator and Technical Assistants are prepared to conduct more one-on-one trainings to remedy these issues. What opportunities for training and professional development has the project provided?CFA's Kentucky Double Dollar Coordinator facilitated three regional group training opportunities and one webinar, which trained participants on the fundamentals of implementing the Kentucky Double Dollar Program at their market, as well as an in-depth explanation of how to use FM Tracks. During these trainings there was also a focus upon volunteer recruitment and retention - essential components to the success of implementing the Kentucky Double Dollar Program at farmers markets and Fresh Stop locations. Additionally, multiple one-on-one trainings with our technical assistants have been held across the region to assist individuals with navigating FM Tracks. How have the results been disseminated to communities of interest?We have drafted an Annual Report for our first year of Kentucky Double Dollar, which spanned July 1 - December 31, 2017. Once finalized, this publication will be made available to all program partners and participants. What do you plan to do during the next reporting period to accomplish the goals?The current plan of action is working, and if we continue to add new market participants at a similar rate, there will be no problem reaching projected goals before the end of the grant cycle. In order to quantify the positive impact that has been made upon low-income participants, individual markets, and individual farmers, we will complete the drafting of our evaluation forms for each group, and begin implementation of the distribution plan this fall. Once the distribution process has been completed, we will easily be able to quantify the impact this program has had on each of the groups. Our hypothesis is that we have reached, or are close to reaching, the projected goals related to each specific group. KDD will continue to expand across the state, with a focus upon reaching new participants - both market and individuals utilizing the incentives.
Impacts
What was accomplished under these goals?
GOAL 1 - During this progress period, KDD has met or exceed our projected goals for increasing the accessibility and affordability of Kentucky grown fruits and vegetables, among low-income customers participating in SNAP. The Kentucky Double Dollar Incentive Program is currently partnered with 34 Farmers Markets, across 27 counties in Kentucky. During this progress period the program has spread geographically further than anticipated by 5 counties. KDD is on track for partnering with the projected number of markets, and only need to add 15 markets over the course of the next 3 years, in order to reach our project goals. KDD has partnerships with two retail locations, and has identified two more as working to prepare them for 2019. This retail partnership is essential for providing consistent access to local fruits and vegetables, especially to targeted low-income consumers. KDD has partnered with 15 Fresh Stop Markets, which are a new model focused upon increasing the accessibility of healthy, local foods by providing mobile markets which deliver bi-weekly to set locations in food-insecure neighborhoods. This model utilizes an income-based sliding scale fee as well as provides matching SNAP incentives to ensure consistent accessibility for those who need it most. During this performance period, participating markets have served over 18,000 SNAP customers. While that is close to meeting the anticipated goal, it is still a bit behind on engaging low-income consumers who are new to the program. KDD anticipates meeting our project goal of reaching at least 20,000 SNAP customers during each remaining performance period, by continuing to seek out partnerships with state and local agencies and community organizations which focus upon serving low-income consumers to share the benefits of the program. During this progress period $45,000 in SNAP FV has been redeemed. This is a little behind the anticipated redemption rate of $100,000 per year and is directly tied to initial rollout challenges and scaling up outreach. While a substantial number of participants have been recorded utilizing the program, their initial spending power was over estimated. We hypothesize that by employing outreach strategies such as connecting participants to resources like SNAP-Ed, we will increase not only the number of SNAP FV redeemed, but the amount of healthy, local foods consumed by those with low-income. GOAL 2 - Participant evaluations were not implemented in 2017 to due the mid-season rollout to effectively gauge behavioral and consumer changes in SNAP recipients' Kentucky-grown produce consumption. 2018 will be the first complete year of the program. These evaluations are currently being drafted and will be distributed during the fall of 2018. During this progress period technical assistance has been provided to market participants to ensure that accurate and consistent records of their SNAP sales are being recorded using FM Tracks, so as to create an established baseline of SNAP sales which will be referenced at the end of the next performance period, in order to accurately calculate increase. By pairing outreach strategies, such as distributing information about SNAP-Ed. and other nutrition education publications alongside distribution of these surveys, it is anticipated that there will be an increase in healthier eating habits. Current data suggests that increased access to fresh fruits and vegetables, will increase the regularity of SNAP participants purchasing and consuming fresh produce. By connecting participants to outreach activities, such as cooking demonstrations, in addition to KDD incentives, KDD will further assist SNAP participants in regularly purchasing and consuming locally-grown produce. GOAL 3 - While we can look at the amount of SNAP FV redeemed at our markets, and conclude that clearly there has been an increase in sales, and therefore our efforts have expanded and are helping to sustain the market for Kentucky's locally grown fruits and vegetables. However, until we have collected data from the vendors and markets participating during subsequent complete years of sales, we won't be able to accurately track this increase. During this progress period, technical assistance has been provided to market participants in order to ensure that accurate and consistent records are being collected using FM tracks, and to establish a baseline of produce gross sales. Establishing this baseline of information will guarantee accurate calculation of the increase of sales. The Kentucky Double Dollar Program has a positive impact on not only the food-insecure of the region, but on the farmers participating in the markets as well. KDD is in the process of collecting this data, and will be able to address this intended outcome at the conclusion of each calendar year and a cumulative total for this grant. Based upon the response from our current participants, we foresee a large percentage of markets continuing participation in this program after this grant period has ended. CFA's staff helps to educate participating markets on community fundraising methods to ensure that they can continue to offer incentive programs in the future if further grant funding is not available. Under this FINI grant the previous program was rebranded to Kentucky Double Dollars. Each year 6-8 farmers markets are provided with KDD tents as well as printed materials. In 2018 CFA worked with SNAP ED to produce a YouTube video to promote KDD and explain how the program works. Public awareness is something that can always be expanded upon, and one way CFA is attempting to do this is through distribution of our Kentucky Double Dollars pamphlets and booklets. These outline the program, eligibility requirements, and where and how the incentives can be used. Outreach is an important component to the success of this project, and something that requires continued collaboration with participants in order to identify needs and implement measures to improve project outcomes.
Publications
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