Recipient Organization
NEW MEXICO FARMERS MARKETING ASSOCIATION
731 MONTEZ ST
SANTA FE,NM 87501
Performing Department
(N/A)
Non Technical Summary
OVERVIEW: FreshRx for Health New Mexico is a three-year project targeting select communities throughout New Mexico that seeks to demonstrate and evaluate ways to: a) improve dietary health of low-income participants through increased consumption of fruits and vegetables; b) reduce individual and household food insecurity; c) reduce participant healthcare use and associated costs; and, d) support the development of the local food system and economy.THE PROBLEM: New Mexico suffers from high rates of poverty, food insecurity and food deserts, yet it also has a vibrant local food movement supported by a long tradition of small- and mid-sized agriculture, as well as an active and coordinated effort of community health clinics and food security organizations working across the state. The challenge of widespread food deserts combined with 18% poverty (third highest in the nation, behind Louisiana and Mississippi; 2019 US Census data) and 17% food insecurity (highest in the country), leaves many New Mexicans grappling with poor nutrition and associated health issues. Most adults in New Mexico (83%) eat fewer than five servings of produce a day. Strongly correlated to these facts, 15% of youth are obese, while among adults 30% are obese and 10% have been diagnosed with diabetes. Furthermore, poor nutrition, food insecurity and obesity all disproportionately affect Hispanic and Native America populations who together comprise 60% of the state's population. According to New Mexico Dept. of Health 2018 data, 43% of Native Americans and 38% of Hispanics in New Mexico are obese, compared to 26% of whites. And, regardless of race, limited-income individuals are less likely to consume the recommended amount of fruits and vegetables daily. Given the timing of this grant, it's important to note that the COVID-19 pandemic is also taking a significant toll on underserved communities and local farmers. New Mexico is already one of the nation's poorest states; the sudden, widespread spike in unemployment--125,000 new claims filed between mid-March and late April--and subsequent food insecurity due to the COVID-19 crisis is creating a critical demand for affordable, fresh food. Emergency food needs are spiking and in addition to consumers' loss of income, farmers have lost restaurant clients, school sales, and other direct sales. No one knows how long recovery from these events is expected to take, but FreshRx for Health will effectively serve New Mexico's underserved populations and hard-hit farmers alike.THE APPROACH: This project will address these nutritional health and food security issues while simultaneously bolstering New Mexico's local farming and regional economies. The project aims to accomplish this work by partnering with 15 health clinics (located in 11 New Mexico counties) and enrolling 400 rural and urban, food-insecure, nutritionally at-risk individuals into the program to receive weekly incentives for fresh, New Mexico-grown produce, along with supplemental nutrition education, peer-to-peer support, and outreach wrap-around healthy-eating support services. during the 12-20-week growing season. The project builds upon a current foundation of strong community assets including health clinics, farmers' markets, CSAs, and community organizations. The total estimated 1,080 project beneficiaries (400 participants x 2.7 average family members per household) represent low-income, underserved communities, including 37 out of 63 USDA-designated Opportunity Zones located in New Mexico. In addition to evaluations that clinics and food outlets will participate in with the National Training and Evaluation Center, the project includes a rigorous, overarching process analysis to document the process, challenges, and successes of implementation and operations, and an outcome assessment that documents the project's effectiveness in increasing fruit and vegetable purchases and consumption among participants. The project will rely on its Advisory Group for survey instrument and implementation feedback, and the project's "Community of Practice" will review program implementation so that clinic staff can be put into real-time practice.
Animal Health Component
33%
Research Effort Categories
Basic
34%
Applied
33%
Developmental
33%
Goals / Objectives
Project Goals:The goals of the project are to demonstrate and evaluate ways to:1) improve dietary health of participants through increased consumption of fruits and vegetables;2) reduce individual and household food insecurity; c) reduce participant healthcare use and associated costs; and,3) support the development of the local food system and economy.Project Objectives:Outcome #1: Increase consumption of fresh fruits and vegetables among 400 enrolled participants (or 1,080 beneficiaries that include enrolled participants multiplied by 2.7 average family size), with at least 80% (320, or 864 counting family members ) reporting that they have increased the average amount consumed by at least one-cup per day. Justification--This project will work with 15 clinic sites in both rural and urban areas to make produce prescription incentives available to 400 low-income, nutritionally-at-risk individuals per year. Rural clinics with lesser staff capacity will enroll 20 patients each year, while larger clinics will enroll up to 30 patients each year. Most programs will run four months (July-October), concurrent with the local growing season. The incentives will be used specifically for fresh, New Mexico-grown produce, including culturally-appropriate foods such as quelites (wild spinach), pinto beans, chile, and other specialty crops available for purchase at partnering farmers' markets and CSAs. Health clinics will target patients who are food insecure, low-income, and/or have chronic diseases that can be managed with better nutrition. In addition to incentives, clinics will also provide nutrition education and, when possible, connect patients with other community resources to learn about healthy cooking. Each year of the grant more than $86,000 (52%) of federal funds will be directed toward incentives, plus an additional $25,800 each year in match funds for additional incentives, bringing the total to $111,800 (or 67%) per year for produce incentives. Pre- and post-program survey evaluations to determine perceived change in eating behavior will be required for all participants, and will be coordinated with the NTAE Center team. The robust investment in incentives along with nutrition education and clinic follow-up will help ensure increased participant consumption of fruits and vegetables.Outcome #2: Reduce individual or household food insecurity among at least 75% (300) of program participants. Justification--In New Mexico, 21% of the population (1 in 5) participated in SNAP in 2019, compared to 12% (1 in 9) nationwide, according to the Center on Budget and Policy Priorities. Given that the average monthly SNAP benefit for each household member is $127, the added incentives of between $60 and $120 per month ($15-30/week) would play a significant and direct role in reducing food insecurity in New Mexico's underserved communities. Moreover, participants who are SNAP recipients have the added advantage of accessing Double Up Food Bucks incentives, which double the value of their SNAP tokens at the food outlets included in this proposal --farmers' markets and CSAs, thus providing further opportunity for reducing participant food insecurity. In addition to lack of access to sufficient food, the USDA Economic Research Service also defines food insecurity as "reduced quality, variety, or desirability of diet." The NMFMA's FreshRx's explicit focus on New Mexico-grown fruits and vegetables, together with multiple program components (see Section (d)--texting, nutrition classes, etc.) is designed to increase participants' familiarity and comfort with using a large variety of locally grown products, that will help ensure both increased quantity and quality of food in New Mexico low-income households.Outcome #3: Increase healthy eating behavior so that at least 90% (360) of program participants enrolled with a preventable disease report improvement in their ability to manage their health condition(s). Justification--Health clinics will enroll 400 patients who meet targeted criteria including food insecurity, low-income status (such as enrollment in Medicaid or SNAP), and/or are nutritionally-at-risk for chronic disease such as obesity, high blood pressure, diabetes, etc. Recent NMFMA and outside research has shown that cooking classes and clinic-based nutrition education are highly effective tools for communicating nutrition information and for changing eating behaviors (e.g., the DotWell case study, in which 97% of participants in a cooking class designed for low-income individuals in Massachusetts made long-term changes to their eating behaviors as a result of the classes and increased fruit and vegetable consumption by 65%. Source: bestpractices.nokidhungry.org). Especially when paired with incentives, the NMFMA and clinic partners have found nutrition education, peer-to-peer support, and outreach to have a positive impact on health behavior change. During this project, clinic partners will collect a variety of patient outcome data. Some metrics may vary by clinic, but other data collection will be required of all clinic partners. This includes pre- and post-program survey questions on types and quantity of produce participants and their families have consumed, how patients feel about their ability to manage a chronic or underlying condition (if this applies to them), etc. Baseline data will be collected from patients when they enroll in the program at the clinic, and again upon program completion. An analysis of data between pre- and post-program surveys will help determine success in changing participants' behavior. Survey instruments and implementation will be coordinated with the NTAE center team. The long-term goal associated with this outcome is for participants to reduce healthcare and associated costs by learning how to use nutrition to help manage their health.Outcome #4: Increase sales of fresh, locally grown fruits and vegetables at 21 participating NM-grown food outlets by a total of $631,080 by 2023. Justification--Each year, a total of 400 patients will be enrolled in FreshRx for Health at 15 clinic sites. Depending on clinic location, patients will be offered at least one nearby local food outlet for their shopping convenience. Some clinics may be located in an area where patients can visit more than one participating farmers' market or CSA. Patients will receive incentives between $20 and $30 per week, mostly for 16 weeks, depending on the location. Food outlets can expect between $4,960 and $14,880in new sales each year. Total incentive sales for all outlets will increase up to $111,800 each year, or $335,400 over three years. Additional sales will also be realized by these outlets as evaluation data from the NMFMA's previous FreshRx programs has shown that prescription incentives often spur additional sales by the patient (average $6 per visit) plus spending by a friend, neighbor or relative who often accompanies the patient to the market (average $10 per trip), yielding an additional average $16 per market visit. This adds a projected $98,560 per year, or an additional $295,680 over three years, bringing the total new projected sales to $210,360 per year, or $631,080 over three years. Helping to create the habit of shopping for local produce among nutritionally-at-risk individuals, along with the ripple effect of drawing new customers, will help sustain the local food system. The average sales per market is estimated to be $10,000 per year, yet the impact of this program will be especially great on the smaller, more rural markets.
Project Methods
New Mexico's produce prescription program will run as follows:Health clinic partners, the majority of whom are FQHCs that specifically serve low-income populations, will select nutritionally-at-risk program participants who have health issues such as hypertension, diabetes, obesity, and/or food insecurity. They will enroll the participants in 12-16 week FreshRx programs at their health clinic, provide participants with nutrition incentives for fresh, New Mexico grown produce, and will provide nutrition education to their clients. They will also provide clients with information on what food outlets they can use their incentives at. When participants shop at local farmers' markets, they will use an anonymous identification number that will track their redemption of incentives. These aspects of the produce prescription model are fairly standard.Some potentially unique aspects of the New Mexico program are:• An Advisory Group will be set up at the outset with members of health clinics, food outlets, and community partners• Participating clinics will conduct pre-surveys and post-surveys with all program participants (bilingual available)• Some clinics will collect additional health data such as BMI, blood pressure, etc.• Farmers' market managers will collect anonymous patient ID information when the participant shops at the market so that redemption can be tracked. The market manager will share this information with the health clinics so that community health workers can follow up as needed with individuals who require more support services.• Data will be collected on individual patients (anonymously) so that trends can be analyzed.• Some clinics will provide additional patient services such as creating "Sign Up Buddies" and/or facebook groups for their patients.• One clinic, that provides in-home services to its new mothers, will deliver weekly produce boxes to the patients at their homes. This will decrease shopping barriers.• Wrap-around services will be provided included instructional cooking classes and/or virtual cooking videos, plus recipes, to participants.• Additional support includes GoodFoodNM health communications text messages that will be made available to all participants. These text messages provide shopping tips, links to recipes, information about cooking on a budget, etc.• Communities of Practice: Two or three times a year, at least one representative from each clinic, food outlet, and community partner will come together via Zoom to discuss program implementation challenges and successes. The purpose is to have ongoing learning while the program is in progress, rather than solely waiting until year-end data collection is complete.Evaluation:In addition to evaluations that clinics and food outlets will participate in with the NTAE Center, the NMFMA will conduct a rigorous, overarching process analysis to document the process, challenges, and successes of implementation and operations, and an outcome assessment that documents the project's effectiveness in increasing fruit and vegetable purchases and consumption among participants. The project will rely on its Advisory Group for survey instrument and implementation feedback. To create an ongoing feedback loop, the NMFMA will also utilize "Community of Practice" sessions to review program implementation so that clinic staff can be put into real-time practice. The NMFMA has a trained anthropologist on staff skilled in conducting research, including studies that focus on food system interventions among underserved populations. The NMFMA will report annually to NIFA, the NTAE Center, and community partners and interested parties across New Mexico.Process evaluation questions and tools will include the following: Q: Were all accomplished program activities completed during the projected timeline?Tool: Project review by PD, according to the work plan/timelineQ: Were there project activities that were not accomplished?Tool: Project review by PD, according to the work plan/timelineQ: How well did we train/educate clinic personnel, market managers, CSA owners, and other project partners about the program?Tool: Included after workshop training and in end-of-season surveys for all program partners.Q: How well did program outreach and materials serve the participants? Which techniques were most effective?Tool: Measured in: Advisory Group feedback, participant surveys, partner surveys, new text messaging subscriptions, and text messaging cancellation rates.Q: To what extent were people involved in implementing the program a) community-based, and b) representative of the target population?Tool: Records kept by Project Manager about project partners, Advisory Group feedback, partner surveys.Q: How did external factors help or hamper the project?Tool: Project Coordinator/PD assessment, Advisory Group feedback, partner surveys.Q: What progress has been made toward sustainability?Tool: Amount of funds (private or state) committed at project conclusion, level of commitment from project partners for future involvement ascertained via surveys and Advisory Group.Q: Were the Community of Practice sessions useful for partner-wide information exchange during the program implementation timeframe?Tool: Partner Surveys.Outcome evaluations questions and tools include (but not limited to) the following: Q: What was incentive redemption rate?Tool: Outlet record keeping via anonymous Patient ID.Q: What worked for encouraging redemption?Tool: Surveys with clinics staff, market managers, and participants.Q: What didn't help redemption?Tool: Surveys with clinics staff, market managers, & participants.Q: Did FreshRx incentives increase recipients' consumption of fruits and vegetables?Tool: Participant surveys at markets, other data collected by clinics.Q: Did FreshRx reduce food insecurity?Tool: Participant surveys, other clinic data.Q: Did FreshRx help participants with preventable disease feel like they had more control over managing their health condition(s)?Tool: Participant surveys, other data collected by clinics (such as weight, blood pressure, BMI).Q: Did participants and/or clinics feel that FreshRx has or will contribute to reduced healthcare use and associated costs?Tool: Participant surveys, other data collected by clinics.Q: Did cooking classes and nutrition ed. increase recipients' consumption of fresh produce?Tool: Participant surveys, self-reported behavior.Q: How did group activities such as having cooking or check-in partners, a group Facebook page, or community potluck impact participation?Tool: Partner and participant surveys.Q: Did FreshRx create market shopping "habit"?Tool: Part. surveys, market manager observations.Q: Did FreshRx help draw new shoppers, such as friends and family of the participants?Tool: Participant surveys, Market manager observations.Q: Did FreshRx "Learning Community" contribute to project successes and/or sustainability?Tool: Partner surveys, Advisory Group feedback.