Source: FEEDING FLORIDA, INC. submitted to NRP
HEALTHIER TOGETHER: FORTIFYING FLORIDA FOOD BANK HEALTHYRX PROGRAMS WITH FRESH FRUITS AND VEGETABLES.
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
ACTIVE
Funding Source
Reporting Frequency
Annual
Accession No.
1028869
Grant No.
2022-70422-37751
Cumulative Award Amt.
$499,999.00
Proposal No.
2022-06166
Multistate No.
(N/A)
Project Start Date
Sep 15, 2022
Project End Date
Sep 14, 2026
Grant Year
2022
Program Code
[PPR]- Produce Prescription
Recipient Organization
FEEDING FLORIDA, INC.
1489 MARKET ST
TALLAHASSEE,FL 32312
Performing Department
(N/A)
Non Technical Summary
Feeding Florida, Inc. (FF), the state affiliate of Feeding America, is requesting support for the Healthier Together Produce Prescription Program (HTFVRx) to improve health outcomes for food insecure Floridians by expanding access to fresh fruits and vegetables at food bank sites and farm-direct locations in three Florida regions. Specific objectives will include fortifying the food bank (FB) healthy food prescription program impact through technical assistance with sourcing, logistics and funding for fresh produce. This initiative will expand access points to community farm-direct locations with fruit and vegetable vouchers, strengthen digital nutrition education opportunities and establish collaborative program milestones across a spectrum of healthcare providers and food access stakeholders in three Florida regions. HTFVRx will create a replicable model design for FB fruit and vegetable prescriptions (FVRx), which will significantly increase the realization of future programs.
Animal Health Component
60%
Research Effort Categories
Basic
10%
Applied
60%
Developmental
30%
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
70460990001100%
Goals / Objectives
FF will improve health outcomes for food insecure Floridians by expanding access to fresh fruits and vegetables through increased produce availability and vouchers redeemable for produce at FB program sites and farm direct locations across three Florida regions. Along with Healthier Together FVRx vouchers FF will develop and share their nutrition education online platform with FBs and farm direct locations. The program will generate diet related interventions for 1,500 participants, and will create the infrastructure for continued, sustainable program expansion. This proposal will also bring together program impacts and client metrics from distinct produce prescription programs at participating FBs to better understand the variables of successful program elements.Goal 1: Design and implement FVRx vouchers to expand Healthy Rx programs at three FBs to increase fruit and vegetable consumption for 1500 food insecure eligible clients.Expand access to fresh fruits and vegetables with HTFVRx vouchers at 29 farm direct locations and 18 partner FB Healthy Rx program locations.Provide 1,500 clients with 50 vouchers valued at $5 per voucher for incentives that will pay for fresh fruits and vegetables.Share FF's online nutrition education platform with 1,500 participating clients and verify the use of the online nutrition content with all participating clients.Work with HCPs and clients to achieve 80% voucher redemption rate.Goal 2: Build a collaborative cohort to support FVRx operations and integrate the program into strategies for assisting low-income, food insecure families on SNAP or Medicare.Converge a strategic, collaborative network of FBs, food access practitioners, and HCPs to create a written strategy for working together to maximize access to fresh fruits and vegetables for eligible populations and expand opportunities to engage additional healthcare providers and community assets.Collaborate with program partners to design and implement metrics to establish shared program milestones that will track associated outcomes and measures across distinct projects and systemize approach of interventions and activities.Monitor outcomes and generate a best practices roadmap that will aid expansion of programs throughout the FF network FBs and beyond.Goal 3: Evaluate Healthier Together FVRx Progress and Outcomes.In partnership with program operators, conduct process evaluation to document and assess the process, challenges and success of implementation, operations and achievement of Goals 1 and 2.Conduct an outcomes evaluation to assess the project's effectiveness in improving health outcomes and household food security by increasing fruit and vegetable consumption among eligible participants.Create and conduct an outcomes evaluation assessing the project's effectiveness in communicating impact.
Project Methods
Expand Healthy Rx programs at three FBsProduce Expansion: FF will leverage its logistics infrastructure and farm partnerships to increase sourcing and availability of fresh produce at participating FB program sites. FBs currently have programs that provide shelf stable items or medically tailored packaged meals. However, logistics, cost and perishability affect the ability of FBs to consistently provide fresh produce to clients. FF's work will ensure a baseline level of fresh produce available to all HTFVRx participants. Prior to the HTFVRx implementation, FBs will report current produce availability in order for locations to have tailored opportunities to improve availability of produce for clients. FF will provide funding and TA to ensure that all vouchers distributed to clients can be redeemed on fresh produce. Vouchers will be designed and distributed for use at farm direct outlets (Table 2) as well as FB program sites (Table 1) to pay for fresh fruits and vegetables. Including farm direct outlets will expand opportunities to access fresh produce, increase community engagement and further nourish self-efficacy. Each client will receive 50 vouchers valued at $5 each. Vouchers will be available for use by the client for 25 weeks from issue date, with the intention of the client using an equivalent of $10 incentive vouchers per week for fresh fruits and vegetables. Vouchers will include a unique ID so that redemption rates, locations, and frequency can be tracked to the client. All locations that accept HTFVRx vouchers will participate in a preliminary training, feedback sessions, and have TA available from FF.Informative promotion: FF will create innovative materials to spread program awareness and details among eligible populations, leveraging partners' community connections while creating a robust suite of informative materials. The resulting promotional campaign will be adaptable to HCP programs and their unique environments. Materials will include flyers, posters, brochures, in English and Spanish. This grant will also support design work for online nutrition education components such as recipe cards and seasonal harvest calendars to be incorporated in resources and the digital nutrition education platform.Nutrition Education: FF's robust online nutrition education platform will be extended for use with partner FB and farm direct outlet locations, matching Florida's unique growing season to help improve the dietary health and nutrition status of 1,500 participating clients. Materials will consist of video and downloadable course content, working through a variety of SNAP-Ed topics, broken down into lessons and modules, which will include interactive features. as well as other additional content types to ensure cultural and diet appropriateness. The platform will be mobile-phone friendly with flexibility to tailor approaches to local needs and opportunities. FBs may conduct telephone outreach to inform clients about this nutrition education opportunity or include printed materials in HTFVRx distributions, containing nutrition education messaging and information about the website and courses or implement other creative engagements such as diet related nudges and unique links to courses based on health concerns.Build a collaborative cohort to support HTFVRx operations Collaborative evaluation: FBs collect data on their distinct Healthy Rx projects, but outcomes, metrics and impact are siloed and currently only convey program specific results. FF will work with FBs, HCPs, clients and farm direct locations to build common program metrics and reporting procedures. Quarterly stakeholder meetings will be convened to ensure protocol adoption and effectiveness. Practitioners will have the opportunity to provide relevant feedback on implementation and opportunities to streamline and improve program procedures, data collection activities, and client engagement. An online portal will be made available for all HCP and HTFVRx redemption sites to easily input required data sets on a monthly or quarterly basis, as required. FF will provide the needed training and TA to ensure all stakeholders have access and understand evaluation requirements.Client Evaluation: FF will include the NTAE baseline metrics along with the CDC Health Related Quality of Life (HRQOL) Healthy Days Measure in the intake and post materials to align distinct programs with a common core of outcome data. Inclusion of HRQOL will help FBs and HCPs better understand client perception of well being while participating in the HTFVRx program. Client evaluations will be conducted at baseline, and at the end of the 25 week participation window. Evaluations will be available in paper at HCP locations and redemption sites as well as online through a web link or QR code that can be used through a smartphone or tablet device on site at redemption locations. FF staff will regularly monitor the evaluations to ensure that participants are completing the required intake and post evaluations and to troubleshoot any issues in completion as problems arise.Biometric Data: Current Healthy Rx programs at partner HCP locations may track: A1c, blood pressure, weight, and/or BMI, respectively. These metrics are tracked in addition to the HTFVRx program, but will be shared with FF in a secure manner to help increase the evidence pool and understanding of fresh produce impact on health outcomes. Dates of biometrics will be shared on a quarterly or annual basis per HCP capacity.Evaluate Healthier Together FVRx Progress and Outcomes.Outcomes and Program Realization: In partnership with program operators FF will conduct a process evaluation to document and assess the process, challenges, and success of implementation, operations, and achievement of HTFVRx as it relates to client recruitment, client redemption rates, and client metrics data. An outcomes evaluation will be created to assess the project's effectiveness in improving health outcomes by increasing fruit and vegetable consumption among eligible participants. These outcomes will be measured by client metric data, redemption rates collected from FB and farm direct locations, as well as HCP and FB surveys. Finally, the project's effectiveness in communicating the program will be evaluated to better understand how clients understand and engage in the HTFVRx program on a larger scale, with greater participation rate. These evaluations will be conducted using surveys, phone interviews, and group feedback meetings.

Progress 09/15/23 to 09/14/24

Outputs
Target Audience: Nothing Reported Changes/Problems:As outlined in last year's progress report, significant changes were planned for this project due to Feeding Florida's substantial expansion in community programming after receiving GusNIP PPR grant funds.The primary factor driving these changes was Feeding Florida's new role as a SNAP-Ed implementing agency across all 67 counties in Florida, which created additional demands on resources and timelines. Further challenges arose from capacity constraints at partner food banks and evolving healthcare partnerships, increasing the need for project modifications. The process of navigating appropriate channels within the NTAE for program adjustments, submitting a project change request to NIFA, were essential steps before our project could move forward. Additionally, time required for the IRB process influenced the timeline. Despite these challenges, the project has reached the implementation stage and is on track to launch during 2025. What opportunities for training and professional development has the project provided?Training: All Feeding Florida and network food bank staff involved in the study components of the Healthier Together Program completed CITI training, either though the University of South Florida, or the University of Nebraska Medical Center of Nutrition. Professional Development: On April 9th, 2024, Feeding Florida delivered a presentation on the Healthier Together Produce Prescription Program at the Florida Nutrition Education Statewide Conference. The presentation highlighted various aspects of the program and detailed plans for integrating the PPR program with SNAP-Ed to amplify support for food insecure Floridians.On April 13th 2024, the VP of Nutrition of Feeding Northeast Florida, who also serves as a regional coordinator for the Healthier Together Program, presented at the Florida Nutrition and Dietetics Conference in Orlando, Florida. The session focused on collaborative strategies to address nutrition security and included discussions about PPR initiatives and partnerships between food banks and healthcare providers. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?Currently, final preparations are underway, with the project set to launch in two food bank regionsin January 2025. Goal 1:(Expand Healthy Rx Programs) In the next reporting year, we plan to enroll 650participants in the Healthier Together Program across two food bank regions. This initiative will enhance access to fresh fruits and vegetables in these areas, directly addressing food insecurity and promoting healthier dietary habits for those with, or at risk or, diet related chronic illnesses. Goal 2: (Strengthen Collaboration) We will implement our strategies to foster collaboration within the food bank network and with healthcare provider partners, while recruiting additional stakeholders to support program expansion. Over the next year, we plan to onboard at least one new healthcare partner, collect partner feedback, and track the impact of supportive programming efforts to refine and improve our PPR programs. Goal 3: (Evalution)We will collect data from 75-100 matched baseline and post program surveys from particpants to assess the program's effectiveness.

Impacts
What was accomplished under these goals? Feeding Florida regularly collaborated with the project's NTAE advisor and other NTAE departments to appropriately adjust the project in response to significant changes within Feeding Florida. Notably, these changes included the Feeding Florida network's new role as a SNAP-Ed implementing agency and shifts in partner food bank programming and capacity. To address these developments, a project change proposal was submitted to NIFA for review on January 29, 2024, and subsequently approved. Feeding Florida received an amended Award Face Sheet from NIFA confirming the project change approval on February 10, 2024.In the months following, efforts were focused on finalizing the study protocol and preparing the submission to the Institutional Review Board (IRB). The application was submitted to the University of South Florida's IRB on May 31, 2024, and the protocol received "exempt" status approval on September 10, 2024. Additional accomplishments: A written program protocol and processes was finalized, and staff responsible for implementation have been trained. A system for data collection and tracking was established, and a strategy for integration of PPR into other Feeding Florida programming was created. Recruitment materials for healthcare partnerships, as well as marketing materials for programming were created. A strategic, collaborative network of food banks and healthcare providers was developed,and is continuing to grow. Final preparations underway to launch program in the next reporting year.

Publications


    Progress 09/15/22 to 09/14/23

    Outputs
    Target Audience: Nothing Reported Changes/Problems:Major changes have been proposed for this project due to Feeding Florida's drastic increase in community programming since being awarded GusNIP PPR grant funds. Feeding Florida became a SNAP-Ed implementing agency in all 67 counties of Florida which has impacted this project's timeline. The steep learning curve of launching a new statewide nutrition education program has created a barrier to focusing efforts on this project. As Feeding Florida's SNAP-Ed nutrition program has entered it's second year of implementation, substantial progress on the PPR project has been made. Adjustment to the project's goals andmethods have been necessary to bridge Feeding Florida's nutrition education program with this PPR project. Additional modifications were necessary due to changes in food bank operations and their community partnerships. As advised by this project's NTAE program advisor,a rewritten narrative, budget and formal project change justification have been submitted for review to the Fair Food Network. Once appropriate, the project change materials will be submitted to NIFA for review. What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?As of October 1st 2023, Feeding Florida has had weekly planning meetingswith the regional coordinators from the partner food banks. Additionally, meetings with the project's NTAE program advisor occur more frequently, currently on a weekly basis. As of November 2023, the project has been rewritten to incorporate SNAP-Ed and adjust to current food bank operations and capacity. The rewritten narrative, justification for change, and adjusted budget have been submitted to The Fair Food Network team for assistance and review. Pending review and approval by NIFA, the IRB review process will commence. Once this process concludes, client recruitment through partner HCP's will begin. Over the next reporting year, progress will be made in towards allthree project goals, however most of the progress will focus on goal one: Increase access to fruits and vegetables for Floridians in two partner food bank regions through providing and redeeming FVRx prescriptions. Expand Feeding Florida'snutrition education website and sharing this with clients of the HTFVRx program. Create and disseminate nutrition education and HTFVRx marketing materials. As the project moves forward over the next reporting period, regular meetings will take place with partner food banks and HCP's to developbest practices and strategies for future food bank PPR activities.

    Impacts
    What was accomplished under these goals? Feeding Florida has met on a regular basis with the project's NTAE program advisor to discuss the project status andbarriers to accomplishing statedgoals. A partnership wascreated with a professor from the University of South Floridafor support with the IRB as well as data collection/analysis, and planning meetings have occurred. Internal discussions within the Feeding Florida team have occurred on how to adjust the project to incorporateSNAP-Education into the PPR project and thereforeincreasing nutrition education opportunities for community members. Discussions have taken place with regional coordinators from the partner food banks to realign the project based on their current food bank's operations, goalsand capacity.

    Publications