CHATHAM COUNTY, GA PRODUCE PRESCRIPTION PROGRAM

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: COMPLETE
• Funding Source: OTHER GRANTS
• Reporting Frequency: Annual
• Accession No.: 1020821
• Grant No.: 2019-70030-30410
• Cumulative Award Amt.: $455,772.00
• Proposal No.: 2019-04700
• Project Start Date: Sep 1, 2019
• Project End Date: Aug 31, 2023
• Grant Year: 2019
• Program Code: [PPR]- Produce Prescription

Recipient Organization
FORSYTH FARMERS MARKET
11 W PARK AVE
SAVANNAH,GA 31401

Performing Department
(N/A)

Non Technical Summary
The Forsyth Farmers Market's (FFM) plans to introduce the Chatham County Produce for Health project with GusNIP Produce Prescription funding. Currently, FFM's Farm Truck 912 is a mobile farmers' market that brings locally sourced produce to Chatham County's primarily African-American, low income, low food access neighborhoods. Farm Truck 912 owes it success to its five-year track record of working with neighborhood institutions offering cooking classes, health screenings, and other programs.To implement the program, FFM will partner with four health care clinics for the project. The program will serve 200 participants and their families each year. Annually, the program will run from March to September so that the participants will be able to see, taste and use almost all produce grown in this region. Each month, participants will be required to come in for a brief health screening that will include weight and blood pressure measurements along with other self-reported statistics and attend an hour-long interactive nutrition class led by the dietician. This will include a cooking demo with nutrition information and tips for having a healthy dialogue around food in the home. The cooking demo will feature seasonal produce that can be purchased from the farmers' market that month. Participants will receive their prescription vouchers after attending each class session. The dietitian will teach participants to read nutrition labels and to identify serving sizes. The classes will conclude with an open discussion where participants can express concerns or offer observations. Farm Truck 912 will make stops at each clinic after the monthly class so patients and their families can shop immediately. During the rest of the month, patients can shop at the Saturday FFM Market and at any of the Farm Truck 912's daily stops. Patients will be screened for food insecurity and, if needed, aided with SNAP and other social services enrollment, and referred to community food resources.This project is designed to meet the GusNIP PPR objectives; 1) the improvement of dietary health through increased consumption of fruits and vegetables; 2) the reduction of individual and household food insecurity; and 3) the reduction in healthcare utilization and costs. The project will perform a rigorous evaluation with participant, partner, and community input. It will participate in all GusNIP PPR evaluation activities. The project will serve 600 participants and 840 family members.

Animal Health Component

(N/A)

Research Effort Categories

Basic

100%

Applied

(N/A)

Developmental

(N/A)

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
703	6099	3080	100%

Knowledge Area
703 - Nutrition Education and Behavior;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
3080 - Sociology;

Keywords

farmers markets

fruits and vegetables

georiga

prescription

produce

produce prescription

Goals / Objectives
This project has two main objectives: 1) to reduce the prevalence and impact of obesity related chronic diseases by increasing healthy eating habits among at risk populations; and 2) to increase healthy mealtime habits among families by making healthy food options more accessible and increasing knowledge of healthy eating.The program has six defined outcomes to measure success. By the end of the grant period:1. At least 75% of the patients' households (450) will report an increased monthly consumption of fruits and vegetables on the annual patient survey and measured in stops at the Saturday FFM and Farm Truck 912.2. At least 70% of patients' households (450) will report increased knowledge of the components necessary for a healthy diet as measured on the annual patient survey.3. At least 75% of patients' households (450) will be purchasing fresh fruits and vegetables weekly from Farm Truck 912, the Saturday FFM, or other local source.4. At least half of the participating farmers (16) will report higher income based on the sales through farmers markets in the local area.5. At least 75% of the families (450) will report improved food access and food security.6. At least 80% of patients and their families (480) will have a better understanding of how to access locally grown fruits and vegetables as reported on the annual patient survey and assessed through shopping patterns at Farm Truck 912 and the Saturday FFM.

Project Methods
Enrollment, health screenings, and classes will begin in March of 2020. Each clinic will select a start date, and the program at the individual clinic will run for six months from that date. Each month, participants will be required to come in for a brief health screening that will include weight and blood pressure measurements along with other self-reported statistics and attend an hour-long interactive nutrition class led by the dietician. This will include a cooking demo with nutrition information and tips for having a healthy dialogue around food in the home. The cooking demo will feature seasonal produce that can be purchased from the farmers' market that month. Participants will receive their prescription vouchers after attending each class session. The program will run from March to September so that the participants will be able to see, taste and use almost all produce grown in this region. The dietitian will teach participants to read nutrition labels and to identify serving sizes. The classes will conclude with an open discussion where participants can express concerns or offer observations. FFM nutrition education programs have shown that cooking demonstrations are successful at encouraging participants to increase produce consumption.Key Evaluation QuestionsProcess Evaluation:Was the program implemented as planned?How many individuals were reached with the program?What were the demographics of those who were served?How much fresh fruits and vegetables were provided per month?How many farmers were engaged in the project?How many vouchers are utilized at the Farm Truck 012 and at the Farmers Market?What challenges were encountered with implementation?How many voucher users (and non-voucher users) participate in the educational components?Are there any variations in participation by clinic location?Outcome Evaluation:Was there an increase in participants reported use of fresh fruits and vegetables?Is there an increase in the use of vouchers at the Farmers Market and Farm Truck 912?Was there a decrease in health-related issues among voucher users?Did participating individuals and families see a decrease in health care utilization and costs?Did families who participated in the voucher program report increased food access and food security? Over time and compared to non-voucher users?Are voucher users who also participate in educational components more knowledgeable about healthy eating?Do the farmers who participate in the program reporting increased sales and income?Are there any variations in outcomes by clinic location?Data Sources Administrative data from key stakeholders including sales records, employee and staff records, partnership documentation, marketing materials, number of individuals enrolled and participating, class materials, number of pounds of fruits and vegetables served, number of sites served, number of classes held (and attendees).Direct measurement data including physical information from participants (height, weight, blood pressure, other clinical characteristics)Observational measures of purchasing behavior and class participationFocus group and interview data collected from staff, farmers, and participants about how programs are marketed, key needs for program components, and impact of the program after implementation.Surveys of participants to monitor changes in knowledge and behaviors regarding purchasing and eating healthy fruits and vegetables.Health care utilization and cost data for participating individuals for 3 months at the beginning of the program (prior to class participation) and 3 months after completion of the classes and after at least 6 months of voucher usage.Project Specific Data Primary data Demographic characteristics of the program participantsKey documents developed as part of program developmentKey stakeholder and community feedback gathered via interviews and focus groupsSales data from the Farm Truck 912 and Farmers MarketSales and profit reports from partner farmersUsage reports from partner clinicsNumber of Farm Truck 912 stops, demographics of usage, and food provided through target food distribution sources (food pantries and FarmTruck912)Pre and post-test changes in knowledge, skills, and behaviors of participantsLong term behavioral changes as assessed by an annual survey of target populationsOrganizational level changes in policies and practices of participating organizationsSecondary data Neighborhood obesity ratesAdministrative program data from partner organizations and farmersHealth and utilization data collected from the participants and health care partners

Progress 09/01/19 to 08/31/23

Outputs
Target Audience:FFM has partnered with five clinics who primarily serve low-wealth communities. These clinics are Memorial Health's Children's Clinic, St. Joseph's St. Mary's Clinic, St. Joseph's African American Health Information and Research Center, St. Joseph's Good Samaritian Clinic & Chatham County Health Department. Our clinic partners have increaded over the years. The overwhelming majority of our participants have been Afrcican-American. This demographic makes up 66% of current participants. The Hispanic community makes up 15%, which has grown from 5%. The rest of our participants have been caucasian. Each participant represents one family and they are able to enroll in consecutive cohorts. Participants are screened for food insecurity and are referred to the program by recommendation of their health clinic. Of the participants, roughly half are current SNAP users. Changes/Problems:Due to COVID-19 our first two cohorst did not host in-person cooking demonstartions. We used a blend of recorded videos uploaded to YouTube and Zoom meetings to increase participation/participant feedback. This was a true hybrid model. During our thrid year we were finally able to move toin-person demonstrations. We did those monthly at each of theclinic sites. Our most recent cohort was much larger than any of the previous ones. This made communication a bit more challenging. We also heavily increased our efforts within the Hispanic community and had to work hard to build trust and understanding of our program. We are exploring adding WhatsApp as a form of communication to better serve this population. We also added a fifth clinic site where all communication is in Spanish. What opportunities for training and professional development has the project provided?I, and previous project directors, have been very active with the GusNIPI NTAC community of practice through the Grethen Swanson Institute. This gave me the opportunity to connect with many other project leaders. I also completed the GUSNip PELC cohort which provided training on equity driven projects. How have the results been disseminated to communities of interest?Data has been shared with all of the partners as well as the GusNIP NTAC What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? In cohort #1, we had 92 participants and it ran from May-October 2020. In cohort #2, we had 146 participants and it ran from March-August 2021. In cohort #3 we had 246 and it ran from March-October 2022. In cohort #4 we had 402 total users. The reported results are based on that count. 100% of families reported an increase in monthly consumption of fruits and vegetables 100% of families reported an increased knowledge of parts of a healthy diet. 100% of participants purchased fresh produce from Farm Truck 912 or at the Saturday market. 13 out of 16 farmers report higher income due to the program. 100% of families reported improved food access and food security. 100% of families reported having a better understanding of how to access locally grown fruits and vegetables

Publications

Progress 09/01/21 to 08/31/22

Outputs
Target Audience:FFM has partnered with four clinics who primarily serve low-wealth communities. These clinics are Memorial Health's Children's Clinic, St. Joseph's St. Mary's Clinic, St. Joseph's African American Health Information and Research Center, & Chatham County Health Department. The overwhelming majority of our participants have been Afrcican-American 62%, with a few members of the Hispanic community (5%)and the rest being Caucasion. Each participant represents one family. Participants are screened for food insecurity and are referred to the program by recommendation of their health clinic. Of the participants, 49%are enrolled in SNAP benefits. Changes/Problems:Our third cohort was much larger than either of the previous cohorts. We were also able to meet in person rather than doing demos via Zoom. In the fourth cohort we are considering adding additional clinics to increase our outreach and add participants. We also intend to explorenew educational avenues like food preservation methods & financial literacy. What opportunities for training and professional development has the project provided?Our program manager, Lew Pettes was very active with the GusNIPI NTAC community of practice through the Grethen Swanson Institute. This gave them the opportunity to develop their public speaking skills and communication abilities. How have the results been disseminated to communities of interest?Data has been shared with all of the partners as well as the GusNIP NTAC. What do you plan to do during the next reporting period to accomplish the goals?With the guidance of surveys and focus groups we've been able to adapt the program year after year, working against the challenges of COVID-19 to reach our goals. We plan to do the same going into the fourth cohort. We will continue to partner with other non-profits to broaden our reach and grow the number of participants.

Impacts
What was accomplished under these goals? In cohort #1, we had 92 participants and it ran from May-October 2020. In cohort #2, we had 146 participants and it ran from March-August 2021. Cohort #3 ran from March-October 2022. We had 246 participants. The reported results are based on that count. 100% or 239 families reported an increase in monthly consumption of fruits and vegetables 100% or 239 families reported an increased knowledge of parts of a healthy diet 100% or 239 participants purchased fresh produce from Farm Truck 912 or at the Saturday market 53% of participating farms (19 farms total) reported an increase of sales due to the program 100% or 239 families reported improved food access and food security 100% or 239 families reported having a better understanding of how to access locally grown fruits and vegetables

Publications

Progress 09/01/20 to 08/31/21

Outputs
Target Audience:FFM has partnered with four clinics who primarialy serve low-income communitites. These clinics are Memorial Health's Children's Clinic, St. Joseph's St. Mary's Clinic, Gateway Behavioral Health Center, and Chatham County Health Department. The overwhelming majority of our participants have been African American (76%), with a few members of the Hispanic Community (3%) and the rest being caucasion. Each particpant represents one family. Participants are screened for food insecure and come to us through recomendation of their health clinic. 98% of participants are SNAP participants. Changes/Problems:COVID 19 is the major reason for all of our changes. Our clinical partners were not able to recruit for the first cohort like they should have. Our second cohort is much bigger but still smaller than we had originally hoped for. We were not able to offer large group cooking demonstrations. Instead, our nutirition educator has continued as she did last year of offering mini-demos and tastings as part of the education. Also, last year we did videos and posted them to YouTube for the participants. This year, we moved these videos to zoom so partipants could follow along at home and ask questions of the educator while she was doing the demonstration. . What opportunities for training and professional development has the project provided?Our program manager, Ashleigh Floyd Clark has been very active with the GusNIP NTAC community of practice through Gretchen Swanson Institute. This has given her the opportunity to develop her public speaking skills and communication abilities. How have the results been disseminated to communities of interest?Data has been shared with all of the partners as well at the GusNIP NTAC. What do you plan to do during the next reporting period to accomplish the goals?The first cohort saw a dramatically different program than one we first envisioned. However, we took a lot of the feedback from our surveys and focus groups and were able to bring it in to the second cohort. We expect the same going into the third cohort. WE do have new marketing strategies and are partnering with other non-profits to send their participants to the program to hopefully enhance the number of participants. How the program will be run next year really depends on how we are doing with Covid.

Impacts
What was accomplished under these goals? In cohort #1, we had 92 participants and it ran from May-October 2020. In cohort #2 we had 146 participants and it began in March 2021 and will complete at the end of August 2021. The data used for reporting today is from Cohort #1 as we won't have the survey data from cohort #2 till later in the fall. 56 People completed the program. The reported results are based on that count. 100% or 56 number of families reported an increase in monthly consumption of fruits and vegetables 100% or56 number of families reported an increased knowledge or parts of a healthy diet. 98% of particpants purchased fresh produce from Farm Truck 912 or at the Saturday market. 81% of participating farms (13 farms total) reported an increase of sales due to the program. 55 % of farmilies or ___34__number reported improved food access and food security 100% of __56___number have a better understanding of how to access locally grown fruits and vegetables.

Publications

Progress 09/01/19 to 08/31/20

Outputs
Target Audience:Our target audiance islow wealth individuals who were currently being treated by one of our clinical partners for a diet related chronic disease. Changes/Problems:In our application, we mentioned that we would have in-person education programs during the cohort. Our education programs were not as robust as we had once hoped them to be due to COVID. We had expected to do everything in person and had to do a lot virtually. We did have a small in person component each month. Also each month, we did YouTube video for our participants to view that included nutrition education, a cooking demo, and journal entry prompts. This was a true hybrid model.While we are still waiting on the final data to know how many participants watched the films, conversations have led us to believe over half completed both the in person and virtual lessons. All members had internet access through either their home or a family member's home. The conversations also lead us to believe, and we will see when all the survey results are complete, that participants truly enjoyed. We are hoping that COVID will subside in 2021 so that we can return to an all in-person class, but if we can't, we know that we have created a great option with which to move forward. What opportunities for training and professional development has the project provided?Each month, participants received nutritional advice and recipes to cook with produce that was in season during this time. This was done through a combination of in-person activities as well as film. How have the results been disseminated to communities of interest?As we are waiting for results from the survey, no results have been disseminated yet. What do you plan to do during the next reporting period to accomplish the goals?Covid 19 put a halt to our recruitment, Now that we have a better idea of how to recruit in a pandemic, we will continue with this new strategy. We also feel that our hybrid education programs were a success, we just wish we could have done more in person.

Impacts
What was accomplished under these goals? We served 92 people in this period. Unfortunately, our end of year surveys had to be pushed back and were done in September so the results are not ready for distribution. 1. Results to come 2. Results to come. 3. Results to come 4. Seven farms reported higher sales during the period. Our program added more than $20,000 in total sales to these seven farmers. These farmers have estimated their increases over the same time period to be close to 25%. However, looking at what sales data we have, we estimate that the program was only responsible for 6% of their growth. 5. results to come 6. results to come.

Publications