Progress 09/01/23 to 08/31/24
Outputs
Target Audience:Our target audience includes Ceres' partner networks, such as the California Food is Medicine Coalition, that advocate for Medicaid and other healthcare coverage of medically supportive food interventions. Changes/Problems:
Nothing Reported
What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?We are in the process of analyzing the impact our program has had on long-term eating behaviors, and we are sharing some of this data for the first time in this report. We will be meeting with staff from the two health centers to share this data with them. In addition, our CEO will be sharing this data wtih the Associate Medical Director for Quality at Partnership HealthPlan, the MMCO for 24 counties in Northern California as one of our key goals is to have the MMCO cover this intervention for their members. What do you plan to do during the next reporting period to accomplish the goals?Goal 1: During the next reporting period, we plan to serve an additional 80 pregnant women. We will continue to meet with our clinic partners, sharing enrollment files back and forth to maintain an ongoing referral pipeline. We plan to continue our progress toward our goal of serving 240 total women through this program. We are on target to meet this goal,and need to serve 97 more women to achieve it. We are meeting with health centers before the end of the year to disseminate preliminary data and collaboratively plan for the next year. Goal 2: We are responding to the initial participant survey feedback regarding their interest in participating in our nutrition support classes. Our RDN is developing a toolkit with nutritional resources that will be distributed via mail, email, and text. We will continue surveying participants to learn which topics they are most interested in and their preferences for engaging. Our clinic partners have also been advising us on best practices to engage with this population of women, who are usually working moms with limited free time. Our primary year 2 goal is to distribute our finalized nutrition tool kit, which is approximately 50% complete. We expect to have this tool kit published and disseminated to clients by the end of Q1 2025. Goal 3: As we enter our second year, we will continue collecting pre- and post-survey data to add to the evidence supporting the need for long term healthcare coverage of nutritional support for low-income, pregnant women. By the end of our second year, we will have enough data to start demonstrating impact. We see pre- and post-survey data as invaluable to program evaluation, particularly in determining whether our meal intervention was successful in improving long-term healthy eating habits for our clients and healthy birth outcomes. Our main goal for year 3 will be to share our preliminary results more broadly. We will begin this process at the GusNIP Annual Convening in May 2025, where our Contracts and Business Development Manager will have the opportunity to share preliminary findings based on client data. Our sample size is currently limited to the 41 participants who completed both pre- and post-surveys, so we will continue to encourage clients to complete both surveys as well as consider other ways to promote survey completion.
Impacts
What was accomplished under these goals?
Reporting Period: 9/1/2023 - 8/31/2024 Goal 1) Provide incentives to interrupt chronic food insecurity for low-income pregnant women. eres has served 144 participants; this is about 60% of our goal (240 total). We're lower than anticipated for two reasons: 1) we had a delay in the start of our contract, 2) we have had some challenges recruiting through our two healthcare partners. Both health centers transitioned to a new EHR, which impacted clinic productivity, and one had turnover in a key staff role. To address this, we implemented several strategies: Attended meetings with clinic providers to promote program engagement. Amended brochures/recruitment materials. Joined a coffee hour with the NTAE to learn from other grantees. Met with clinic leadership to brainstorm recruitment strategies. Sent regular enrollment and status reports to clinic leads. We received an uptick in referrals in May and July, and referrals have been steady since that point. We plan to apply for a no-cost extension, and at the current steady rate of enrollment we are confident we can meet our enrollment targets within that extended time frame. To date, we have provided 8,069 meals and 1,852 produce bags as incentives spanning two grant periods. All participants of this program are considered low-income at <138% of the Federal Poverty Level. Sixty-five percent (65%) are Hispanic/Latinx; 26% are White; and the remaining identify as Asian, Black or African American, Native American or Native Pacific Islander. Approximately 16% of IRB-enrolled participants screened as food insecure; we do not have substantive data to show improvements in this area at this time. Goal 2: Improve the health status of low-income pregnant women and their infants by changing household eating behaviors. Early results suggest that Ceres' Perinatal Produce Prescription Program is making progress in promoting healthy dietary habits and improved well-being. To date, the program has demonstrated a positive impact on fruit consumption frequency, with the percentage of participants who consumed fruit 2 or more times per day increasing from 58.5% at pre-survey to 78% at post-survey. These results suggest that the program was effective in encouraging more frequent and consistent fruit intake among participants. The program also had a positive influence on 100% pure fruit juice consumption, with 53.7% of participants reporting increased consumption of 100% fruit juice post-program participation. In terms of non-fried vegetable consumption, the GusNIP program had a moderate impact. The percentage of participants consuming these vegetables at least once a day increased slightly from 36.6% at pre-survey to 43.9% at post-survey, and the program effectively reduced the percentage rarely consuming any vegetables that were not fried from 14.6% to 4.8%. Last, the program positively influenced participants' self-reported health status, with 41.5% reporting an improvement from pre- to post-survey. The most notable shift was from "Good" to "Very Good" health; and the number of participants reporting "Fair" or "Poor" health decreased from 13 to 5, suggesting the program benefited those with the greatest health needs. To improve the health status of our clients and their family members, each client receives our Nourishing Connections cookbook created collaboratively by Ceres' CEO, Nutrition Director and Chefs. The cookbook includes recipes that are simple to make, delicious and allow for variation and improvisation based on preferences and ingredients available. The focus is on healthy, plant-forward salads, soups, vegetable-rich entrees and side dishes. The cookbook aims to help clients discover, or rediscover, the joy and satisfaction of cooking for health. 'Nutrition Bites' are 1-page handouts in English and Spanish that are included in each client's weekly produce bag. These informative handouts were created by our RDN to provide nutrition information and benefits of key ingredients with an accompanying recipe. Other topics include nutrition and inflammation, eating on a budget, and eating the rainbow. Our planned nutrition education tool kit is still under development, with a target distribution date of December 2024. The goal of our tool kit is to provide general, accessible information on diet and pregnancy to increase our clients' confidence in purchasing and preparing fresh fruits and vegetables. Ultimately, we hope that our educational materials and nutrition resources will help these clients incorporate healthier, whole food ingredients into their daily eating patterns. Goal 3: Contribute important missing data to the body of research supporting the need for long-term healthcare coverage of food interventions for low-income populations. All women enrolled in our project are asked whether they would like to participate in our IRB-approved study that evaluates how medically tailored meals, produce prescriptions and nutrition support can improve eating behaviors to support healthy pregnancies among low-income women. Those who agree to participate complete pre- and post-surveys that measure their consumption of fruits, vegetables, starches, sugars, etc., in addition to food insecurity and SNAP benefits utilization. To date, 99 clients have consented to participating in the IRB study. Of those clients, 41 have completed more than 12 weeks of services and have completed a post-survey. Preliminary data based on our limited sample of 41 participants reveals promising trends in fruit and vegetable consumption and self-reported health status. A promising trend is that 80% of all participants opt in to the study and complete a pre-survey. Overall, our rate of post survey completion (excluding early terminations) is 57%. However, we made a change in Q2 to our survey administration workflow,and have since increased our rate to 86% completion. All participants of this program are considered low-income at <138% of the federal poverty level. 65% are Hispanic/Latinx, 26% are White, and the remaining are a mix of Asian, Black or African American, Native American or Native Pacific Islander.
Publications
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Progress 09/01/22 to 08/31/23
Outputs
Target Audience:Our target audience includes Ceres' partner networks, such as the California Food is Medicine Coalition, that advocate for Medicaid and other healthcare coverage of medically supportive food interventions. Changes/Problems:We originally planned to offer bi-monthly nutrition classes to help support our participants in changing their eating habits to improve outcomes for them and their babies. In a response to their feedback, we are now developing toolkits with educational material and recipes that will help bring the information to them in a way they prefer to receive it. We will continue to survey and pivot as needed, with the ultimate goal of supporting nutritional wellness for all participants of this project. What opportunities for training and professional development has the project provided?NA How have the results been disseminated to communities of interest?We are just beginning to collect post-survey data for women who have completed at least 12 weeks of service and have agreed to share their personal information. The data is still preliminary and has yet to be shared outside of our organization and the NTAE. Results will be shared extensively through Ceres' partner networks and coalitions involved in advocating for Medicaid and other healthcare coverage of medically supportive food interventions. What do you plan to do during the next reporting period to accomplish the goals?Goal 1: During the next reporting period, we plan to serve an additional 80 pregnant women. We will continue to meet with our clinic partners, sharing enrollment files back and forth to maintain an ongoing referral pipeline. Goal 2: We are responding to the initial participant survey feedback regarding their interest in participating in our nutrition support classes. Our RDN is developing a toolkit with nutritional resources that will be distributed via mail, email, and text. We will continue surveying participants to learn which topics they are most interested in and their preferences for engaging. Our clinic partners have also been advising us on best practices to engage with this population of women, who are usually working moms with limited free time. Goal 3: As we enter our second year, we will continue collecting pre- and post-survey data to add to the evidence supporting the need for long term healthcare coverage of nutritional support for low-income, pregnant women. By the end of our second year, we will have enough data to start demonstrating impact. ?
Impacts
What was accomplished under these goals?
Goal 1: Provide incentives to interrupt chronic food insecurity for low-income pregnant women. Our intended goal for Year 1 of this project was to provide incentives in the form of medically tailored meals and produce bags, to 80 low-income pregnant women. Between a delay in contracting and getting the IRB process completed, we were unable to launch our project until January 1, 2023, three months past the original start date. During the last 9 months of our reporting period, we were able to serve 74 women a total of 3,339 meals and 704 produce bags, 92% of goal. We worked with two clinic partners to recruit patients receiving CPSP services - a program for pregnant Medi-Cal beneficiaries that helps improve the health of low-income pregnant women and their babies. We set target enrollment goals for each clinic and meet with them regularly to maintain a steady flow of participants enrolled in the project. We share enrollment files back and forth, where the clinics also share pre- and post-partum biometric data such as hemoglobin A1Cs, blood pressure, birth term and birth weight. We also survey participants on their food insecurity before and after their participation and so far, we have seen a decline in food insecurity among the women receiving the incentives. One of the women enrolled in this project was a stay-at-home Mom of 5 children, pregnant with her 6th. Her family of 7 survive on her husband's income alone, putting them below <138% of the federal poverty guidelines. Not only did the meals help alleviate food insecurity for her, but they also helped teach her family about proper nutrition since her daughter struggles with health issues due to an unhealthy diet as well. Goal 2: Improve the health status of low-income pregnant women and their infants by changing household eating behaviors. In addition to receiving a Ceres cookbook, and weekly nutrition bites with recipes, our Registered Dietician Nutritionist and Nutrition Educator developed our first pilot of nutrition classes to support long-term changes in household eating habits. The classes were developed as a 3-class series with the aim to provide information on produce, healthy eating patterns and recipes/cooking demonstrations. The style of the class is a combination of lecture, demonstration, and interactive conversations to promote information sharing among participants. Class content included the following topics: Eating the Rainbow, Affordable Nutrition, and Perinatal Nutrition. Each class highlighted 2-3 produce items, with nutrition information and health benefits of each, followed by a cooking demonstration. The classes were offered every other month in both English and Spanish. The class instructors included our RDN and Nutrition Educator. Prior to launching the classes, we sent surveys to participants to determine the preferred time for classes and to gauge interest. The response rate was very low, but we chose the class times that were preferred by those who did respond. We also created a website landing page that provided the zoom link, recipes, and other information about the nutrition class series - trying to get the word out as much as possible. In the weeks preceding the class series, we reminded all participants by sending texts and emails, and sent flyers with their weekly deliveries. Although we were successful in developing the series and despite our outreach efforts, we had no participation in our first pilot round of classes. We called 16 participants to gain information on the best way to engage with them, what topics they were interested in learning about, and their preference between in-person and virtual classes or written material. We also inquired as to what barriers they have in accessing classes, and the majority indicated that time is the biggest barrier. In response to this feedback, we are developing a nutrition education tool kit to be provided via hard copy, text, and email to participants. We also recorded the first 3 classes in both English and Spanish, and this will be made available to participants to access. Goal 3: Contribute important missing data to the body of research supporting the need for long-term healthcare coverage of food interventions for low-income populations. All women enrolled in our project are asked whether they would like to participate in our IRB-approved study that evaluates how medically tailored meals, produce prescriptions and nutrition support can improve eating behaviors to support healthy pregnancies among low-income women. Those who agree to participate complete pre- and post-surveys that measure their consumption of fruits, vegetables, starches, sugars, etc., in addition to food insecurity and SNAP benefits utilization. To date, 50 women have agreed to participate in the study, 13 of which have completed at least 12 weeks of services, and we have post survey data for. The data is still preliminary, but we look forward to seeing an improvement in eating behaviors as we continue to collect post-surveys.
Publications
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