Progress 09/01/23 to 08/31/24
Outputs
Target Audience:Out of the 160 participants 98% were recruited from the Langston Center via Health Equity Task Force. Participants needed to be enrolled in SNAP, Medicare or Medicaid in order to qualify for the program. Our baseline enrollment survey reflected that of the 160 participants that enrolled, 79 individuals identified as Black or African American as their ethnic or racial background, 55 individuals stated White, and the remaining were listed as Other. 24% of their origin comes from Hispanic, Latin/a, Spanish. 80% identified as a woman and 18% identified as a man. The highest percentage of the ages the grant serves is 65+ years. Nearly 57% of participants have BMIs that are overweight or class 1 obese. Nearly 50% have elevated blood pressure at the time of enrollment. The survey results for participant onboarding include the following: 154 responses were recorded in our target region and asked within the past month at the time of the survey if their eating activities were as follows: 31% of respondents said they ate fruit 3-4 times per week, 30% ate fruit 1 time per week, and 20% ate fruit 2 times per week. 19% reported eating fruit 5-6 times per week and 1% ate fruit 6 or more times per day. 34% of respondents said they ate green leafy or lettuce salad or vegetables. 2 times per week, 33% ate leafy greens 3-4 times per week and 21% ate leafy greens 1 time per week. 15% ate leafy greens 5-6 times per week and 2% never ate leafy greens. Changes/Problems:Farmers market season was challenging for our farmers and for produce diversity. We had an awful drought and then a historic flooding event from Hurricane Helene which wiped out at least 1,000 farms (crop loss, equipment, soil, etc.) in Northeast Tennessee. We also found that our participants do not have reliable transportation and struggle to get to the markets on the days they are operating. Or they do not go entirely because of the overwhelming environmentand lack of options. What opportunities for training and professional development has the project provided?National PD Meeting for all Program Directors in New Orleans last year. Many conversations with other entities that receive the same funding to troubleshoot how to work with grocers and set up a system without taxing the fruits and vegetables. I was able to attend networking/listening sessions at the Langston Center because of our relationship with them moving forward. I was able to attend the RAFI conference and the Brushy Fork Leadership Summit. ? How have the results been disseminated to communities of interest?We have used the surveys and general feedback to send to our partner grocer, Food City. To assist in training and educational efforts for their staff and essential manager training. We also have prioritized feedback and shifted our schedules to accommodate the availability of most of the participants. We use their feedback to come up with our cooking class topics and what kitchen tools they need to best assist them. We were able to use quotes in many presentations and leverage the program in our conversations moving forward to seek out donors and funds for program sustainability once this grant concludes. ? What do you plan to do during the next reporting period to accomplish the goals?In 2023 the clinics supported by the East TN State University College of Medicine and College of Nursing were experiencing major staff shortages. Because of this, both departments requested to carry out limited recruitment at two clinics in Johnson City, TN. In response to the staffing shortage, ARCD staff continued recruitment and management through Food City and Langston Centre. Food City and the Langston Center only serve as locations to house the distribution and on-boarding. ARCD staff was solely responsible for the recruitment and on-boarding process. The following bullet points have been identified by program staff as priorities for keeping the program on its timeline for meeting the goals outlined in our project narrative. Goals for End of 2024 and 2025 Analyze findings from Year 1 surveys from program participants to determine improvement or behavior change. Evaluation team presents any feedback from participants to program staff and coalition team, and a plan is made to modify any program components that need to be improved. Onboard from waitlist as participants drop off to keep our number around 160 at all times. Year one survey for those onboarded in the middle of the program. Any program modifications are implemented. Training to any new farmers market managers, volunteers or vendors is offered as needed. A new schedule of cooking workshops is compiled. Previous quarter activities continue. Cash Flow analysis and prepare to ask for grant Extension in June of 2025.
Impacts
What was accomplished under these goals?
The Project Goals are to demonstrate and evaluate the impacts of Appalachian Farmacy activities on a) improving participant dietary health through increased consumption of fresh fruits and vegetables; b) reducing the individual and household food insecurity rates of participants; and c) reducing healthcare use and associated cost at the participating community clinics in the Appalachian Highlands. We have partnered with 6 area farmers markets and 11 Food City store locations to provide convenient year-round opportunities for patients to redeem their vouchers on fresh whole or pre-cut fruits and vegetables. Farmers Market vendors are local producers and Food City purchases $5 million in produce from local farmers per year. We successfully recruited 160 participants and their families in the first year from community clinics and the Langston Center. The total number of produce vouchers redeemed at local farmers markets regionally for year two was $13,864.00. The total number of produce vouchers redeemed at Food City so far is $42,667.53 for year two. We have done a great job navigating partnershipsWhile distributing Food City vouchers, we reserved their kitchen and conference space. We planned and successfully implemented morning and evening cooking classes at each monthly distribution day. Once we began farmers market vouchers we reserved space in The Langston Centre,a multicultural facility run by the city of Johnson City that promotes community engagement through arts, education, and leadership activities. Recruitment and onboarding were and will continue to be supported by the Health Equity Task Force and the Langston Centre. The Centre has ample staff and volunteers to help with orientation events and has a computer lab. With the support of volunteers, the computer lab can be used for new program participants to complete surveys. We were able to have the gym space reserved monthly for our distribution. We again provided an AM and PM cooking class and even added pop up farmers markets and chair yoga for program synergy with other grant funding. The Washington County Extension office, Elizabeth Renfro, partnered with Appalachian Farmacy to provide nutrition and cooking education to program participants. We also partnered with ETSU Dietetics Program and Insight Nutrition to host cooking classes in the event that Elizabeth was busy and had other commitments. In total we hosted 16 cooking classes starting with basic knife skills, measuring, seasoning, farmers market pizza, berry popsicles, zoodles, and we will continue classes moving into 2025. Each participant got a new kitchen gadget to use as they practice what they have learned at home. Food City is a family and employee-owned grocery store chain with 123 locations in Georgia, Kentucky, Tennessee and Virginia. Food City cooperates with evaluation and reporting requirements and; provides information to participants about any nutrition education or cooking classes offered at area stores. The program will partner with 7 farmers markets in the project region: Bristol State Street Farmers Market, Boone Street Market, Elizabethton Farmers Market, Erwin Farmers Market, Johnson City Farmers Market, Jonesborough Farmers Market, and the Kingsport Farmers Market. Each farmers market accepts SNAP and provides tokens that can be used to purchase SNAP eligible items. The markets implemented a voucher redemption program at market locations; provided information to participants about any nutrition or cooking classes offered during the market season. We had our focus groups facilitated by ETSU Public Health. Here is the summary: Participants reported that the process and ease of exchanging vouchers differs across Food City locations. Respondents visited locations in Johnson City, Jonesborough, and Kingsport. The State of Franklin location was commonly cited as the most pleasant Food City to use vouchers at. Inconsistencies across sites include cashier knowledge and training concerning the voucher program, whether or not a manager was called to complete the transaction, if Value cards were scanned, and if tax was applied. Despite these difficulties, some participants did mention that knowledgeable employees had been polite or helpful. Participants said that exchanging vouchers with vendors at the farmer's market is an easy process, with the majority of vendors participating with the program, displaying a friendly and welcoming attitude to participants, and working with them to maximize the value of each voucher. Many participants cited voucher denominations as an area for improvement - desiring smaller increments ($5 instead of $15) or the ability to use partial amounts per voucher. Some participants mentioned that they did not need or could not use $15 worth of produce from a single shopping trip or that it was difficult to calculate their shopping total. The most common barriers to attending educational events include transportation limitations (due to distance from home or being driven by someone else who is not part of the program) and work schedules. When asked about topics or skills they would like to see included in educational class offerings, top responses included more recipes, preservation of fresh produce, more detailed nutritional information (macronutrients), and food choices for specific dietary needs. Similar to the barriers to attending educational programs, travel distance, lack of transportation options, and limited time slots were cited as barriers to picking up vouchers. Suggestions included alternate pickup locations or expanded day/time slots for pickup, but no specific locations or times were suggested as alternatives. Those who had participated in at least one educational class reported satisfaction with their involvement and found the knowledge and/or skills learned to be valuable for food preparation habits. Participants experience financial relief from needing to spend less of their personal income on groceries - allowing them to purchase more food for the month than they would have been able to or freeing up income for other expenses. Some participants cited social impacts from the program, including new friendships formed with other participants in educational class offerings and meeting new people at the farmer's market. One participant also mentioned that she shares food with others as another form of social networking. Respondents cited overall health benefits from their participation in the program, including improved diet, management of chronic health conditions, healthy weight gain, and overall better nutrition. Some participants mentioned the emotional and mental health benefits associated with the program, including satisfaction with their healthier choices and bodily health, and relief of some of the stress associating with budgeting for different expenses. Participants reported a change in knowledge, attitude, and beliefs associated with eating behaviors. Participation has led some to making more informed decisions about their diet, including a higher frequency and increased volume of fresh produce intake. Participation in the program improves accessibility and affordability of fruits and vegetables. In addition to the increased intake of fresh produce, participants reported consuming a greater variety of fruits and vegetables - often trying foods for the first time or branching out to different types of fruits and veggies. Many participants mentioned friends or family members they knew who were interested in the program and could also benefit from program expansion. They recognize the positive impacts the program has had for them and wish there was funding for more people, as well as the extension of the program for a longer duration of time. Link here: Interview Results - Appalachian Farmacy.xlsx
Publications
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Progress 09/01/22 to 08/31/23
Outputs
Target Audience:Initially, the project team planned to partner with clinics in the region supported by East Tennessee State University (ETSU) Colleges of Medicine and Nursing to recruit participants for the program. We had partnered with these clinics for our 2017 FINI grant. However, these programs and their clinics were experiencing major staff shortages and staff turnover. Because of this, both departments are requesting to carry out limited recruitment at two clinics in Johnson City, TN. In response to not being able to use the clinic sites as primary recruitment centers, program staff searched for new community partnerships for the recruitment of our target population of participants. We met with theLangston Centre, a Johnson City run community center serving a predominantly minority, low-income population, and were able to carry out program recruitment with this partner. Out of the 160 participants 98% were recruited from the Langston Center. Participants needed to be enrolled in SNAP, Medicare or Medicaid in order to qualify for the program. Our baseline enrollment survey reflected that of the 160 participants that enrolled, 79 individuals identified as Black or African American as their ethnic or racial background, 55 individuals stated White, and the remaining were listed as Other. 24% of their origin comes from Hispanic, Latin/a, Spanish. 80% identified as a woman and 18% identified as a man. The highest percentage of the ages the grant serves is 65+ years old (40%). Nearly 57% of participants have BMIs that are overweight or class 1 obese. Nearly 50% have elevated blood pressure at the time of enrollment.The survey results for participant onboarding are as follows. 154 responses were recorded in our target region and asked within the past month at the time of the survey if their eating activities were as follows. 31% of respondents said they ate fruit 3-4 times per week, 30% ate fruit 1 time per week, and 20% ate fruit 2 times per week. 19% reported eating fruit 5-6 times per week and 1% ate fruit 6 or more times per day. 34% of respondents said they ate green leafy or lettuce salad or vegetables. 2 times per week, 33% ate leafy greens 3-4 times per week and 21% ate leafy greens 1 time per week. 15% ate leafy greens 5-6 times per week and 2% never ate leafy greens. Baseline AF Report https://docs.google.com/document/d/1o6vmoNXYwt3ADKFIJjo6nbb-1HLkIbch/edit Changes/Problems:We are 5 months behind schedule due to turnover of personnel and not having the position filled for 4 months. Ashley Cavender started Oct. 30th. In 2023, the clinics supported by the East TN State University College of Medicine and College of Nursing were experiencing major staff shortages. Because of this, both departments requested to carry out limited recruitment at two clinics in Johnson City, TN. In response to the staffing shortage, ARCD staff continued recruitment through the Langston Centre. After consultation with the East TN State University evaluation team, clinic staff, and the Nutrition Incentive Hub we have determined that the program will better serve 160 families with a higher monthly incentive distribution amount. However, the clinics have reached back out to program staff and are interested in doing increased recruitment for 2024. What opportunities for training and professional development has the project provided?No professional development opportunities have been provided thus far. ? How have the results been disseminated to communities of interest?No dissemination about the project has been done at this time. What do you plan to do during the next reporting period to accomplish the goals?In 2023 the clinics supported by the East TN State University College of Medicine and College of Nursing were experiencing major staff shortages. Because of this, both departments requested to carry out limited recruitment at two clinics in Johnson City, TN. In response to the staffing shortage, ARCD staff continued recruitment through the Langston Centre. After consultation with the East TN State University evaluation team, clinic staff, and the Nutrition Incentive Hub we have determined that the program will better serve 160 families with a higher monthly incentive distribution amount. However, the clinics have reached back out to program staff and are interested in doing increased recruitment for 2024. Program staff will be meeting with the clinics to work out logistics and increase access to the program for their low-income clients. The following bullet points have been identified by program staff as priorities for keeping the program on its timeline for meeting the goals outlined in our project narrative. Goals for End of 2023 and 2024 Research and make connections with partners as the new Program Director. We are 5 months behind schedule due to turnover of personnel and not having the position filled for a few months. Ashley Cavender started Oct. 30th. Meet with ETSU College of Medicine and College of Nursing staff, and outline a plan of onboarding the regional community clinics for the program. Discuss what worked and what did not work in 2023. Meet with managers of the farmers markets to finalize logistics for redeeming the vouchers and vendor reimbursements. Gather information on any planned cooking and nutrition events offered by the markets. Discuss what worked and what did not work in 2023. Meet with executives and accountants from Food City to finalize logistics for redeeming the vouchers and a reimbursement schedule. Gather information on any planned cooking and nutrition events offered by staff nutritionists. Discuss what worked and what did not work in 2023. Meet with County Extension Agents and coordinate a schedule of dates to conduct nutrition and cooking workshops. Discuss what worked and what did not work in 2023. UT Extension Agents will offer nutrition and cooking education workshops. Participants will be encouraged to register in advance and regular emails and information will be sent to them with workshop dates and other opportunities. UT Extension's Farmers Market Fresh program will run for at least 12 weeks, offering cooking and nutrition education to participants and regular Farmers Market customers. Program evaluation and data management continues according to the plan. In January, the evaluation team will begin conducting one on one interviews and focus groups with participants at the farmers markets to capture feedback for the program. Participant usage of vouchers compiled and sent to clinic case managers and/or volunteers by the end of the quarter. Participants who took baseline surveys are contacted and provided with new surveys to track impacts on produce consumption, food insecurity, and health outcomes. This information is compiled for reporting to NIFA. Case managers and program staff identify any families that have failed to participate for two quarters and a new phase of recruitment begins to bring participation rates back up. Previous participants are invited to continue, so long as they still meet eligibility requirements. New baseline surveys are administered as needed to maintain the correct sample size. Evaluation team presents any feedback from participants to program staff and coalition team, and a plan is made to modify any program components that need to be improved. Any program modifications are implemented. Training to any new farmers market managers, volunteers or vendors is offered as needed. The same for any new clinic staff or volunteers. A new schedule of workshops is compiled. Previous quarter activities continue.
Impacts
What was accomplished under these goals?
The Project Goals are to demonstrate and evaluate the impacts of Appalachian Farmacy activities on a) improving participant dietary health through increased consumption of fresh fruits and vegetables; b) reducing the individual and household food insecurity rates of participants; and c) reducing healthcare use and associated cost at the participating community clinics in the Appalachian Highlands. We have partnered with 6 area farmers markets and 11 Food City store locations to provide convenient year-round opportunities for patients to redeem their vouchers on fresh whole or pre-cut fruits and vegetables. Farmers Market vendors are local producers and Food City purchases $5 million in produce from local farmers per year. We successfully recruited 160 participants and their families in the first year from community clinics, and the Langston Center. The total number of produce vouchers redeemed at local farmers markets regionally for year one, within the 3 month period, was $13,601.00. Moving forward our goal is to have at least 80% of participants report visiting participating Farmers Markets and Food City grocery store locations and redeeming their vouchers monthly over the course of the 3 year program. Because of program director turnover, we do not have other data to report at this time. The next report will include data from focus groups and educational activities scheduled for 2024. We will continue these partnerships moving into 2024. The Langston Centre is a multicultural facility run by the city of Johnson City that promotes community engagement through arts, education, and leadership activities. Recruitment and onboarding was and will continue to be was will be supported by the Health Equity Task Force and the Langston Centre. The Centre has ample staff and volunteers to help with orientation events and has a computer lab. With the support of volunteers, the computer lab can be used for new program participants to complete surveys. Additionally, the Centre will provides in-kind space for new participant orientation and educational classes to be held in 2024. The Extension Eastern Regional office is partnering with Appalachian Farmacy to provide nutrition and cooking education to program participants. These will be online and in-person when it is safe to do so. Many county offices also participate in the Farmers Market Fresh program, which provides free samples and healthy recipes using local, in-season produce at area farmers markets. The Extension provided expert instruction for nutrition and cooking workshops; Shared information and resources through the Farmers Market Fresh program at participating markets; Shared information about other educational opportunities provided by each county office; And cooperate in any necessary evaluation and reporting requirements. Food City is a family and employee-owned grocery store chain with 123 locations in Georgia, Kentucky, Tennessee and Virginia. Food City will cooperates with evaluation and reporting requirements and ; provides information to participants about any nutrition education or cooking classes offered at area stores. The program will partner with 65 farmers markets in the project region: Bristol State Street Farmers Market, Boone Street Market, Elizabethton Farmers Market, Erwin Farmers Market, Johnson City Farmers Market, Jonesborough Farmers Market, and the Kingsport Farmers Market. Each farmers market accepts SNAP and provides tokens that can be used to purchase SNAP eligible items. The markets implemented a voucher redemption program at market locations; provided information to participants about any nutrition or cooking classes offered during the market season.
Publications
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