Progress 09/01/23 to 08/31/24
Outputs
Target Audience:Target audience Our target audience remains women who are in their first or second trimester of pregnancy, Latina, 18 years of age or older, living in the Hartford CTConnecticut area, and are experiencing low income. During this reporting period, the Hispanic Health Council (HHC) screened a total of 81 participants and enrolled 44 into the Food4Moms produce prescription program. Of those screened, 61.7% were referred from the WIC program located in the Hispanic Health Council (HHC) building in Hartford, 17.3% were referred from the HHC Comadrona program for pregnant and postpartum mothers, or from other colleagues at HHC. Additionally 9.9% were referred by their friends and family members and 11.1% were referred from other sources or had an unknown referral source. Most (75.3%) of the screenings were conducted in Spanish (96.3%) on the phone in lieu of in person. The main reasons participants were ineligible was either that they were in their 3rd trimester of pregnancy or they were not Latina. Baseline Demographics The participants enrolled during this period were primarily born in either the USA (17.2%) or Peru (17.2%), as well as Puerto Rico (15.6%) and Mexico (9.4%). Other birth places included Guatemala, El Salvador, Venezuela, Honduras, and Columbia. In the baseline surveys, 37% of the moms were between 18 and 25 years old, 34% were between 26 and 30 years old, 26% were between 31 and 40 years old, and 3% were over 40 years old. In regards to racial demographics, 17.2% selected White, 9.4% selected Black/African American, 1.6% selected American Indian or Alaska Native, 26.6% preferred not to answer the question, 25% selected don't know/not sure, and 21.9% selected other race. Participants were able to select more than one category for race. About half (53%) of women reported having only a high school education or GED, 13% had less than a high school education and 19% reported having some college education. More than half (62.9%) of participants had 1-2 adults living in the household and 66.1% reported having 1 to 2 children. 71% reported that they rent their homes. Over 40% of participants reported household income as less than $1000 per month, 37.5% reported $1,000 to $1,999 per month and 21.9% reported $2,000 to $3,000 per month as their income range. When asked to reflect over the past 12 months, 37.5% reported receiving SNAP benefits, 68.6% reported being on WIC and 18.8% reported receiving no benefits. In terms of self-reported pregnancy complications, 17.2% of participants reported having anemia, 4.7% gestational diabetes, 3.1% high blood pressure, 1.6% Type 1 or 2 Diabetes, 1.6% gestational hypertension and 1.6% preeclampsia. When asked about food security, 56.3% of participants reported a high level of food security, 12.5% marginal food security, 21.9% low and 9.4% very low food security. Changes/Problems:Delay in recruiting/enrolling Cohort 1: Due to delays in the recruitment of our pilot participants, our timeline was delayed in recruitment and enrollment of cohort 1 participants. We were able to catch up and meet the projected recruitment numbers. Halfway, Month 9, and Month 10 phone calls: Due to the duration of the study, it is possible that our participants change their phone number or experience a change of address during the 10 months. To address this challenge, we added three additional phone calls to our protocols to be made at important landmarks in the study. The goal of each phone call is to 1) let the participant know what month they are in the program, 2) find out about any changes in phone number or address and 3) inform them of the upcoming post survey. In addition, if participants are still not reachable by phone, we have implemented home visits as a final attempt to reach them. Fresh Connect: In June 2024, Fresh Connect changed how they handled card support and their policy regarding lost cards. As a result, participants who lost or never received their cards needed to complete reorder phone calls on their own. Fresh Connect's call center can be difficult to navigate particularly for participants who do not speak English, so the Food4Moms Research Associate at HHC, worked with participants to complete three-way calls between the participant and Fresh Connect to help with card replacements. However, some participants were unable to order replacement cards due to difficulties during these calls. One problem was if they had changed their address between the time of enrollment and the time of the call and another was if their address failed a fraud check that the Fresh Connect contractor for new cards implemented. Those participants were required to provide Proof of Address (POA) which was not always possible. Those that did not have POA had to be switched over to our InstaCart incentive option. Gift Card Incentive: To thank participants for completing the post survey, they have the option to accept a $25 amazon gift card. Since this was not an option available to the pilot group, those that completed the post survey were contacted and offered a $25 amazon gift card. We were able to contact 15/16 participants and provide them with gift cards. Challenges with produce delivery redemption option: The produce box company that we originally worked with, Umoja Produce Boxes, could only fulfill orders for produce box delivery if there were 20 or more participants who selected the boxes. Since we only had three participants initially select the Umoja box option, it was no longer feasible to use. We therefore had to remove this option and worked quickly to try and find a replacement delivery option. Our program is based on the Fidelity, Equity and Dignity Principle and choice is an important part of that. The three participants who initially chose this option, were instead given the Fresh Connect card initially. The solution we found to replace the Umoja box was Instacart produce delivery ordered from a local, culturally appropriate, Key Foods supermarket. We created a Wholesome Wave Business Instacart account with the Instacart Plus option for $10 per month. This allows us to order the same standard order of $50 in fresh fruits and vegetables for delivery to any participants who choose this option. The produce is ordered directly by Wholesome Wave and not by the participant. With the Instacart Plus account, delivery is free for orders over $35 and the service fees are reduced. In addition, we can place the orders to be delivered within a 3 hour window and participants can change the delivery date and time to one that is convenient for them via text. What opportunities for training and professional development has the project provided?There have been a variety of development opportunities provided by the Food4Moms program, benefiting various staff and partners of the program. Both the nutrition educator and the nutritionist at the Hispanic Health Council completed the CIRT training: Community Involvement in Research Training as part of their involvement in the research study. This training increases their knowledge or research and improves their skill level. In addition, the outgoing Research Associate, Andrea Tristan, and Sofia Segura Perez, the Chief ProgramExecutive Officer at HHC trained the incoming Research Associate for Food4Moms, Sara Rodonis. Sara was taught how to navigate communication with participants through phone calls, text messaging, and emails. , She learned how to work with the community by actively listening with an emphasis on understanding their perspective as well as empathizing with their situation. Sofia has also instilled in Sara the importance of the community perspective in the research study. While Sara was not present for the co-design, she has a deep appreciation for how impactful the co-design has been on the implementation of the study. Sara is also learning from the Food4Moms team skills forediting the client satisfaction and post survey by keeping in mind the participant and the purpose of the question in relation to data analysis. Sara is very eager to be trained, soon, in data analysis by collaborating with Wholesome Wave and Yale School of Public Health Food4Moms team members. The Wholesome Wave Programs and Data Manager Katina Gionteris attended both the October 2023 Produce Prescription Mini-Convening held by the Nutrition Incentive Hub in Chicago Illinois and the December 2023 Project Directors meeting in New Orleans held by USDA-NIFA. While in Chicago, Katina was able to interact and learn from other PRx program operators around the country. Most valuable was an exercise with these other GusNIP fundees when everyone shared the different aspects of the GusNIP programs by putting sticky notes under different questions posted on the walls of the conference room. It made it so clear that there is both a broad range as well as various types of programs being funded. In addition, enhanced learning the details of how programs can be implemented in all populations, geographies, firm types and redemption methods. The incredible learning continued in visits to the Chicago Botanic Garden VeggieRx program and Farm at Ogden, which demonstrated strong program implementation as well as new activitiesincluding test kitchens plus eating and meeting spaces and how they are integratedn within the city's farmers markets and health centers. In New Orleans, Katina experienced the bigger picture of the USDA, including it's many areas of work and many new people working in different areas of Food and Agriculture. In addition, Katina Gionteris served as a GusNIP grant panel member in May of 2024. This opportunity allowed her to learn specifically about the grant application process at USDA-NIFA, broaden her knowledge on the types of programs offered, understand what it takes to submit a GusNIP grant, and what is included in those applications. In January 2024, the FED Partners, a collaboration between Wholesome Wave, DAISA, Yale-Griffin Prevention Research Centers and Upstream Impact Solutions, held a webinar on The FED Principle: A deep dive into Fidelity, Equity & Dignity in Produce Prescriptions. Nearly 500 people registered for the webinar. Hispanic Health Center Research Associate, Andrea Tristan, presented the Food4Moms program in a the webinar . Andrea presented on 'The FED Community Workbook in Action" to a varied audience of program operators, funders, vendors, researchers, healthcare providers and others. She spoke about the application of the FED Community Workbook to the Food4Moms program during various phases 1) recruitment and eligibility, 2) prescription redemption, 3) nutrition education, 4) data collection and evaluation and 5) program management. She was able to illustrate to the audience how the FED principle was applied to our Food4Moms program. How have the results been disseminated to communities of interest?Through broad outreach, we have been successful in enhancing public understanding and increasing interest in learning as it relates to Food As Medicine (FAM); produce prescriptions; and, more specifically, the Food4Moms program. This includes a press release distributed in January 2024. Also included were features in a variety of publications, such as articles in Patch.com and CT News Junkie, both published in January 2024, as well as newsletters for Nutrition Incentive Hub and the Center for Nutrition: National Women's History Month, both of which were published in March 2024. What do you plan to do during the next reporting period to accomplish the goals?As Wholesome Wave together will our partners have now entered into a no cost extension period for this grant, 1) all participants who are still in the program will complete their 10 months in the program, 2) post program listening sessions will be held, 3) all qualitative will be coded and analyzed, 4) quantitative data will be cleaned and merged into analysis datasets, 4) statistical analysis will be completed and 4) dissemination plans will be documented and executed. Completion of program: All 63 participants will be completing their 10 month produce prescription beginning in November 2024 through February 2025. Our post program survey will be sent to all participants who complete the program via a text link to take the Qualtrics survey. We have a schedule of reminder texts and calls that will be executed to help ensure the maximum completion rate of the post surveys. Participants who do not complete the survey after 3 reminder texts will receive reminder calls and will be offered the option to be administered the survey over the phone by a research staff at the Hispanic Health Council. All participants will receive a $25 gift card as compensation for completion of the post survey Post Program Listening Session: Our evaluation partners at YSPH will develop a post program listening session guide which will serve as a script to follow while holding the listening sessions. Participants will be contacted by staff at the HHC and invited to participate in the listening sessions, informed that there will be a consent to sign and an incentive amount paid for their participation and their time. Listening sessions will be moderated by bi-lingual research staff as most participants identify Spanish as their preferred language. Participants attending the listening sessions will be asked about topics such as their satisfaction with specific aspects of the program, inclusion of FED principles, impacts of the program on their health and that of their families, and changes they experienced in their fruits and vegetables consumption during the program. Listening sessions will betranslated and transcribed and results will be analyzed. These results will also be analyzed together with quantitative data and contribute to report and manuscript development. Quantitative Data: The screening, survey (pre, post and satisfaction) and redemption data will be cleaned and merged by Wholesome Wave with help from HHC and YSPH. In the surveys we will have pre and post measures of fruit and vegetable intake, food security, self efficacy, health status and barriers. The post survey also has self reported pregnancy and birth outcomes, measures of respect and satisfaction. The Satisfaction survey will provide insight into client experiences. Redemption data from the Fresh Connect systems will supply monthly amounts spent for each participant and will be used to create metrics of redemption rate, utilization and engagement. Once all datasets have been cleaned and merged together, de-identified analysis datasets will be created to allow analysis on specific metrics and topics. Data Analysis: An analysis plan will be developed jointly by Wholesome Wave and our evaluation team at the Yale-Griffin Prevention Research Center to ensure that all relevant analyses will be conducted in a systematic and thorough manner. The analysis plan will take into account the need to: a) document participant characteristics for the whole sample, b) document any differences in participant characteristic differences for those that completed the post survey and those that didn't, c) identify initial barriers to fresh fruit and vegetable consumption, d) document changes in barriers and study outcomes before and after program participation, e) examine racial/ethnic differences in participant characteristics as well as program outcomes. Additional multivariate analyses will be conducted if initial findings warrant further analyses. Weekly team meetings will be held review and discuss analyses, results, and interpretation of findings. Dissemination In looking ahead to next year, our team anticipates disseminating findings through various methods including conferences, publication of articles in peer reviewed journals, and community reports. There are several conferences that would be good matches for us to share findings with others in the field: GusNIP Convening May 2025 in Minneapolis American Society for Nutrition, May 31 - June 3, 2025 Society for Nutrition Education and Behavior, July 8-11 American Public Health Association, Oct 27-30 Indeed, our team has already prepared a manuscript on the co-design phase of the Food4Moms program and will be submitting it soon to a peer-reviewed journal titled "Community Engaged Co-design and Piloting of the FOOD4MOMS Produce Prescription program for Pregnant Latina Women"
Impacts
What was accomplished under these goals?
Enrollment: in this grant year, we finished enrolling all of our participants for a total of 64 into the Food4Moms produce prescription program including 20 pilot participants (enrolled in the previous grant year) and 44 cohort 1 participants. We had 3 participants withdraw from the program this year either for not activating or not using their Fresh Connect card (n=2) and one mom who experienced a miscarriage (n=1) rendering her no longer eligible. SNAP-ED Nutrition Education Sessions (NES): As part of the enrollment requirements, all 64 moms attended the first nutrition education session, "Prenatal Nutrition Guide." The major objectives were that participants would be able to: 1) identify 2 benefits of healthy eating during the first 1000 days of life, 2) recognize 2 of the main impacts of body weight during pregnancy, 3) recognize 2 criteria to build a healthy meal during pregnancy, and 4) describe 2 benefits of exercise during pregnancy. Objectives and themes for each class were determined based on input received from listening sessions during the development phase of the program. The HHC nutrition team utilized pre-existing material and created new material adapted from these findings. The four additional classes offered were optional and consisted of the following themes: "Pregnancy Related Complications" (n=26 participants), "Food Labels" (n=19), "Food Safety" (n=19), and "Maternal & Infant Feeding Recommendations" (n=18). These educational classes enhanced the cohort's existing knowledge of good nutrition particularly as it relates to pregnancy. Classes included Pre- and Post-KAP tests to assess knowledge and confidence levels, and, if in-person, a food demonstration. Due to scheduling conflicts, some classes were held hybrid or only virtually. In addition to nutrition education through classes, participants are sent three weekly texts including nutrition tips, recommendations, and recipes. The entire nutrition team responsible for the NES are people of Latino heritage, fluent in both English and Spanish. This team is an integral part of the HHC, an organization explicitly dedicated to serving and representing the Latino community. The presentation materials took into careful consideration elements that resonate with the Latino community ensuring that they were culturally relevant and aligned with their audience. All handouts and documents were thoughtfully prepared to accommodate language preferences. Redemption: Participants in the Food4Moms program are provided $100 per month for purchase of fresh fruits and vegetables. They have the option of selecting either the Fresh Connect debit cards or a produce delivery option. Almost all of the 64 participants chose the Fresh Connect debit cards at enrollment which they received in the mail. Three participants chose the produce delivery option. After three months of enrollment, participants were asked in a satisfaction survey if they would like to change their redemption option. One participant who initially chose the Fresh Connect card reported that she would like to change her redemption option to produce delivery due to transportation challenges. Of the participants using the Fresh Connect card, the monthly redemption rates ranged from a low of $70.13 in Dec 2023 and a high of $83.96 in Feb 2024. The total amount of money spent using the Fresh Connect card during this grant period was $34,473 and for Instacart was $108.33 for produce only. Both redemption options included additional fees: $2988 in Fresh Connect administrative fees and $27.08 in fees to Instacart. In February 2024, the team instituted balance reminder texts. Twice a month participants received a text with their card balance and a reminder message to use their remaining funds before the end of the month. These texts were sent 10 days before the end of the month and 4 days before the end of the month. Once these were instituted, we saw a rise in redemption rates for participants and these texts remain part of our team protocol. Cohort Maintenance: For our pilot cohort of 20 moms, one participants were withdrawn from the study. Two participants were withdrawn after 4 months of no card use. A second participant was withdrawn at 2 months when she experienced a miscarriage. Her experience enabled us to include a protocol that provides use of the Fresh Connect card for 2 months if a participant is withdrawn due to a miscarriage. Of the remaining 18 pilot participants, 77.8% completed the satisfaction survey and 16 (82%) completed their post program survey. For our 44 cohort 1 participants, one mother withdrew after 4 months of not using her card. Of the 43 participants, 36 (83.7%) completed the satisfaction survey distributed via text. They are scheduled to complete the Food4Moms program in November of 2024 through February of 2025. Listening Sessions Results Integrated: Pilot feasibility study listening sessions were conducted at the HHC together with our evaluation partners at Yale School of Public Health (YSPH) to understand participants' experiences with F4M as part of the co-design approach, which is highly responsive to the needs and wants of the program participants. A few of the major themes from moms include that they 1) were drawn to the financial support of the program, 2) expressed interest in joining due to the nutrition education sessions, 3) recognized the significance in maintaining their and their baby's health, 4) expressed appreciation for learning about their baby's growth and brain development, and 5) believed this assistance would enable them to provide better nutrition for their babies. In addition, the participants found the overall communication to be prompt and appreciated the concise duration of the consent calls, found the healthy recipes shared by the program to be helpful and educational including regarding nutrition, diverse meal preparations with produce and food safety. They felt better informed, more cautious when making dietary choices, and more empowered to prepare new, healthy meals. Participants expressed deep gratitude for the study, stating that it allowed them to prioritize nourishing themselves and their babies more effectively. Satisfaction Survey Results: Eighty-two percent of the 61 participants fully enrolled in the program completed the satisfaction survey after they had been enrolled in the program for approximately 3 months. The satisfaction surveys were administered during the program to a) assess if improvements in program administration and implementation needed to be made and 2) provide participants with the choice to change their benefit selection (i.e. FreshConnect or produce delivery). A high degree of satisfaction was found in the preliminary analysis of satisfaction surveys. Almost all participants (94%) reported being completely or very satisfied with the program overall , 97% said they would strongly recommend the program to other women in their community , and 91% reported that the produce prescription program was very helpful in improving their and their family's diet . Almost 80% of participants said that it was very easy to use the Fresh Connect card and 59% said it was very easy to check their card balance. Overall, participants reported positive program experiences with staff . Sixty-five percent of participants felt that staff responded in a timely manner when they requested assistance , 79% felt the staff treated them in a kind/friendly way , 71% felt their customs and culture were valued by program staff , and 82% reported that they were spoken to using language and words they could understand . Some difficulties were reported with card useage (17.6%), attending classes (32.4%), and taking surveys (32.4%) but participants did not shared details about these difficulties. When asked about the incentive amount, 41.2% felt that the $100 per month was more than enough, 41.2% felt it was just enough, and 14.7% felt that it was not enough.
Publications
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2024
Citation:
Segura-Perez, S., Trist�n, A.G., Gionteris, K., Duffany, K., Hromi-fiedler, A., Gald�mez, G., P�rez-Escamilla, R., (2024) Abstract of Distinction: FOOD4MOMS: Community Co-Design and Pilot Implementation of a Produce Prescription Program for Pregnant Latinas, Society for Prevention Research Annual Meeting, Washington DC.
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Progress 09/01/22 to 08/31/23
Outputs
Target Audience:Based on our screening and recruitment data, we have screened a total of 39 women to date. Our target audience are women who are in their first or second trimester of pregnancy, Latina, over 18, living in the Hartford Connecticut area and are low income. Most of our participants were referred from the WIC program located in the Hispanic Health Council (HHC) building in Hartford, from the HHC Comadrona program for pregnant mothers, or from other employees/reception at the HHC. Of our resulting 20 woman cohort, 57.9% completed either high school or their GED, 75% had a month income of less than $2,000, 35% worked either full or part time, 75% rent their home and the mean age is 27.1 years old. Changes/Problems:
Nothing Reported
What opportunities for training and professional development has the project provided?In June, the 2023 National Convening of GusNIP programs was held for three days in Washington DC. Wholesome Wave Program Manager, Katina Gionteris, attended the convening which included colleagues from hundreds of nutrition incentive programs funded through the GusNIP funding mechanism, of the United State Department of Agriculture (USDA) - National Institute of Food and Agriculture (NIFA), redemption option vendors, funders, policymakers and technology providers. Mrs. Gionteris attended multiple sessions focused on numerous PRx and FAM-related topics. Prior to this convening, her PRx program experience was limited to Wholesome Wave administered initiatives. This large-scale introduction to the broad range of FAM and FINI provided a rich and fruitful learning experience. Also valuable experience while at the convening in Washington DC was the opportunity to prepare, research and attend meetings with staff from Connecticut Senators Blumenthal and Murphy's offices, as well as Congressman Larson's office in the House of Representatives. Participating in these meetings alongside Brent Ling, Director of External Affairs at Wholesome Wave, provided a great education to the legislators staff on the farm bill, the translation of programs to policy with support from the federal government. Professional development has been facilitated through mentoring by Sofia Segura-Pérez, Chief Program Officer at HHC, and Dr. Rafael Pérez-Escamilla, Professor and Director of the Maternal Child Health Promotion Program at the Yale School of Public Health. Mrs. Segura-Pérez has been pivotal in training Ms. Andrea Tristan, the research associate working on the Food4Moms program at HHC, on various facets of the Hartford Latino community through strong supportive supervision. This includes important project management considerations and quality control such as the necessity for reminders and follow-up, their specific needs, and their level of comprehension. She has also shared valuable insights on how to engage and collaborate with partners, including hospitals, local health departments, and maternal and child health programs, based on equity and respect principles. Furthermore, Mrs. Segura-Pérez has advised on solid strategies on addressing the Latino population through text messages, crafting the pre- and post-KAP tests for the nutrition education sessions (NES), and specifying the content within the NES. Dr. Rafael Pérez-Escamilla has been instrumental in Andrea's professional growth, focusing on sound program implementation science practices. He has guided Andrea in the development of the Program Impact Pathways (PIP) for Food4Moms, a tool designed to identify bottlenecks and assess necessary adjustments in order to achieve our overarching goals with a high degree of quality. He has offered mentorship and valuable feedback during the development of a listening session guide and the qualitative data analysis of the co-design listening sessions. Moreover, his expertise has extended to overseeing the quantitative data analysis of the NES pre- and post-KAP tests, serving a role in maintaining quality control for the sessions. How have the results been disseminated to communities of interest?At the Washington DC GusNIP convening, Wholesome Wave was invited to present on the Food4Moms program. Entitled "Fidelity, Equity, Dignity in PPR," the session provided the opportunity to introduce the FED Principle and illustrate how its framework is being incorporated into the Food4Moms program. There were 63 attendees in the Zoom, including fellow GusNIP fundees, funders and redemption providers. What do you plan to do during the next reporting period to accomplish the goals?The Food4Moms program will continue to be fully engaged in the 2023-2024 grant year, with the pilot cohort fully enrolled, followed closely by the addition of cohorts 1 and 2. We will be using an iterative process based on the FED Principle, incorporating input and lessons learned from program participants in the pilot phase into subsequent phases of the program. To do this, listening sessions will be held following two full months of program enrollment and satisfaction surveys administered at the three-month mark. Participants will be asked for feedback on material covered in NES, their experiences with redemption options, and the recruitment and enrollment processes. This valuable input will be integrated to refine the program before recruitment and enrollment of the 40 participants in cohort 1. An NES focusing on maternal and infant feeding recommendations is currently being developed, with a goal of educating and assisting moms with care and feeding of their infants during the period immediately following birth and the introduction of complementary feeding. We are also adding additional biometric data collection to our surveys as well as maternal mental health measures. During the 2023-2024 grant year, cohorts 1 and 2 will be recruited and enrolled. Once all baseline surveys are collected, we will clean our baseline survey data and begin analysis to examine how our program is performing and learn what improvements can be made. We will continue to collect redemption data and monitoring utilization of the benefit over the course of the program. Participants will be given the opportunity to change their redemption option when they are three months into the program. This will be in keeping with the FED principle of dignity because it provides participants with the ability to choose what is best for them. Dissemination Continued dissemination of program information and learnings in the coming year include the following: Attendance at the GusNIP mini convening in Chicago in October 2024 as well as the Program Director meeting in New Orleans in December 2024. Abstract submission - titled "FOOD4MOMS: Community Co-Design and Pilot Implementation of a Produce Prescription Program for Pregnant Latinas" to the Society for Prevention Research Conference in Washington DC in May 2024 Program feature in Wholesome Wave FED webinar, highlighting the application and effectiveness of the framework and embedded principles Press release distributed in both English and Spanish to local and national media focusing on the program progress to date. Create a co-design booklet on how to conduct community listening sessions while incorporating the FED principles. Expansion Funding requests will be submitted to one or more foundations and potentially to the GusNIP funding mechanism of the USDA-NIFA. One potential area of expansion includes extending prescription intervention up to 12 months after birth, i.e. the first 1,000 days of life or even the first 2000 days of life focusing on growth and development outcomes for infants, understanding the complementary feeding experiences of the mother-child dyad, and evaluating maternal biometric and mental health outcomes. For the infant, data collection would focus on child growth and developmental cognitive measures; detailed eating habits; and anemia indicators. Maternal mental health measures will be collected at multiple points in the program, extending beyond the traditional 6 to 8 week postpartum period. An enhanced component of an extended program might also include collection of biometric data for the mother-child dyad through medical record extraction at Hartford Hospital, allowing us to gather information on the mother's pregnancy and delivery outcomes, as well as infant's health indicator, assisting us in better understanding how produce PRx programs could help reduce or eliminate adverse maternal outcomes such as preterm birth rate, and severe maternal morbidity/mortality.
Impacts
What was accomplished under these goals?
Wholesome Wave and our partners at Hispanic Health Council (HHC) and the Yale Griffin CDC Prevention Research Center (YG-PRC) have taken steps towards helping improve food security as well as fruit and vegetable intake for our program participants by integrating feedback from listening sessions during the co-design phase and baseline surveys to improve implementation. HHC's Chief Program Officer, Sofia Segura-Perez, and her team recruited members of the Latina community who were either pregnant or mothers to small children. Of the three listening sessions held, two were in Spanish and one was a bilingual session in both English and Spanish. All were facilitated by Rafael Pérez-Escamilla, PhD of the YG-PRC. Participants were asked to provide input on topics such as where and how they like to shop; what types of foods they consider culturally appropriate, which topics should be covered in the nutrition education session(s) (NES) and in what format should they be delivered. Program Co-Design - Listening Sessions Feedback on redemption options during the listening sessions included debit cards to be used at local retailers and / or biweekly box delivery service to their homes. While the latter garnered less enthusiasm, participants did highlight it's potential benefits to their peers who may have limited transportation, as well as its importance as a remote alternative in emergency situations. They also appreciated the opportunity to support local community-based organizations via this option. Overall feedback from participants included a strong interest in using the redemption cards, stating they valued the freedom and convenience to select their own produce. Current WIC enrollees were familiar with and preferred card redemption as the primary program option. Participants provided feedback and options during the pre-program listening sessions. A range of store choices for redemption including Walmart and Stop & Shop and other more local stores were discussed with preferences based on lower prices and a wider selection of fruits and vegetables. Participants also valued the inclusion of nutrition education sessions which encouraged optimal eating habits and increased fruit and vegetable consumption which are a vital aspect of maternal health and babies' well-being. The resulting program offers interactive in-person group classes, online attendance in case of emergencies, recipe discussions and food tastings and are facilitated through the HHC SNAP program. Participants also endorsed the use of text messages containing reminders about redeeming the rest of their monthly produce card balance as well as links to healthy tasty recipes and nutrition tips. These information- based communications have been seamlessly integrated into the program's structure with participants anticipating the receipt of nutrition tips and recipes every Monday, Wednesday, and Friday, and balance spend down reminders once a month. Program Co-Design - Redemption Options Logistics research was done to provide a broad range of potential redemption options to Food4Moms participants. We considered multiple local stores, multiple box providers, vouchers, farmers markets and delivery options like Instacart. Given our population, it was important that the redemption options included access to culturally relevant foods. We developed a check list, for potential redemption options, of positives and negatives including administrative fees, whether store/company owners were BIPOC, the variety of culturally appropriate foods available, quality of produce, how long before the options could be initiated. We examined local options, even trying to develop shopping options with the local Key Foods market which is owned and operated by Latinx community members with a large variety of Latinx foods. However, challenges such as limitations with obtaining data through their POS system did not make this a viable option. The final options resulted in the Fresh Connect card, which offers participants the opportunity to shop at multiple stores which have at least some culturally relevant foods available to them, and the Umoja box delivery option. We worked with Umoja to develop a list of culturally relevant fruits and vegetables to include in the box. Program Implementation There were 39 women screened over the phone (with the exception of 1) between 7/14/2023 and 8/10/2023 for participation in the program. Of those 69% (n=25) satisfied the inclusion criteria below and were invited to participate. Latina race/ethnicity 18 years of age or older Live in the greater Hartford Connecticut area Low income: eligible or participating in WIC, SNAP or Medicaid (state-based healthcare) as defined by the state of Connecticut Speak English or Spanish In their first or second trimester of pregnancy Of the 25 potential participants, 1 declined to participate, 2 did not complete the consent call and 2 did not complete the baseline survey or attend a nutrition education session. For the remaining 20 participants, verbal consent was administered over the phone after a summary of the program was read to each participant. Women were then texted or emailed a link to the baseline Qualtrics survey and scheduled to attend the first required Nutrition Education Session titled "Prenatal Nutrition Guide". Once all these activities were completed, participants were considered fully enrolled. For those 20 women who were fully enrolled, we conducted an initial analysis at the survey data and found that 57.9% had completed their high school diploma or GED, 75% had a monthly income under $2,000, 35% worked either full or part time and 75% rent their home and they had a mean age of 27.1 years. When asked about specific health conditions that they were informed about by their doctor, 20% affirmed anemia, 10% gestational diabetes, 5% hypertension before pregnancy, 10% gestational hypertension or pre-eclampsia and 70% of moms affirmed that they had not been told they had any of these conditions by a doctor. At the end of the initial NES, both the redemption options (the Fresh Connect Card and the Umoja box) were presented to moms and any questions that came up were addressed. The Fresh Connect (FC) Card is a debit card loaded with $100 per month with the funds expiring on the last of the month. The FC can only be used to purchase fresh fruits and vegetables at Stop and Shop and Walmart stores and allows moms to select their own produce and pay for them the same way they would with any other card, thus avoiding any potential stigma. The Umoja option is a box delivery twice monthly that includes culturally appropriate fruits and vegetables. They have the option of selecting from three box options: a box with more fruits, a box with more vegetables or a balanced box with equal amounts of fruits and vegetables. A handout was provided with detailed information about each of the redemption options and moms were asked to select one of the options. All 20 moms selected the FC card option. As of 8/31/2023, there were 12 participants who had used their cards and a total of $927 had been spent by all participants. As of August 2023, there were five NES held covering the first topic, "Prenatal Nutrition," with 10 virtual and 10 in-person attendees. The second NES which was optional focused on "Food Labeling and Food Safety,"- two sessions were held resulting in six virtual and eight in-person attendees. The third NES (also optional), entitled "Problems & Complications During Pregnancy" - two sessions were held including six virtual and seven in-person attendees. Per participants' feedback, these NES offered valuable information and are complemented by text messages, which serve as an additional educational tool reinforcing the session topic and providing recipes incorporating fruits and veggies.
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