Source: COMMUNICARE HEALTH CENTERS submitted to NRP
PRODUCE RX: HEALTH CENTERS LEVERAGING LOCAL PRODUCE FOR WELLNESS
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
COMPLETE
Funding Source
OTHER GRANTS
Reporting Frequency
Annual
Accession No.
1028893
Grant No.
2022-70422-37763
Cumulative Award Amt.
$499,986.00
Proposal No.
2022-06164
Multistate No.
(N/A)
Project Start Date
Sep 15, 2022
Project End Date
Oct 1, 2023
Grant Year
2022
Program Code
[PPR]- Produce Prescription
Recipient Organization
COMMUNICARE HEALTH CENTERS
1590 DREW AVE STE 210
DAVIS,CA 956187848
Performing Department
(N/A)
Non Technical Summary
CommuniCare Health Centers (CCHC) is a designated Migrant Health Center and Federally Qualified Health Center (FQHC) that provides high-quality care to low-income residents of Yolo County, California. CCHC will implement Produce Rx, a patient-centered initiative to connect connect low-income individuals with elevated blood sugar to the agricultural bounty of Yolo County. Produce Rx will leverage CCHC's Healthy Living with Diabetes, Sweet Success and Food Programs activities to provide patients with high-quality nutrition education and produce prescriptions.Over the project period, 580 CCHC patients will participate in regular education activities and receive produce grown by local small and beginning farmers. The project will increase participants' comsumption of locally-grown fruits and vegetables, expand their food literacy, reduce food insecurity, improve health outcomes including reduced A1C, and boost sales opportunities for small and beginning farmers.Participants will be assigned to one of four produce prescription intervention models based on the site at which they receive health care services and/or their access to transportation, each differing in duration and/or frequency. UC Berkeley evaluators will use mixed methods to conduct process and outcome evaluation. Findings will elucidate the comparative advantages and drawbacks of each model and will inform future CCHC efforts.Produce Rx will provide both the health care and agricultural sectors with a blueprint for optimizing the health of low-income patients while stimulating economic opportunities for local farms. The project team will disseminate findings across multisectoral networks to facilitate adoption of the model by FQHCs serving low-income populations in locations with strong agricultural economies.
Animal Health Component
100%
Research Effort Categories
Basic
(N/A)
Applied
100%
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
70460991010100%
Knowledge Area
704 - Nutrition and Hunger in the Population;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
1010 - Nutrition and metabolism;
Goals / Objectives
The primary goal of Produce Rx is to improve the health and food security status of patients with prediabetes and diabetes by increasing their consumption of fruits and vegetables. A secondary program goal is to develop market opportunities for beginning and small-scale farmers. Produce Rx will demonstrate and evaluate project impact related to produce consumption, food insecurity, clinical outcomes, diet-related knowledge and skills, and sales of locally-grown produce. Participants will be encouraged to continue participating in educational activities past the duration of their produce prescriptions and will complete annual surveys to assess the degree to which changes persist past the intervention period. Clinical data will be abstracted from patient records both during and following active participation in Produce Rx. Outcome 1: Produce Rx participation will be associated with improvements in diet-related knowledge, self-efficacy, and skills. Produce Rx will provide an additive layer to ongoing HLWD, Sweet Success and Cooking Matters educational activities. Pre- and post-intervention surveys will collect information regarding nutrition-related knowledge, self-efficacy and skills related to topics including label reading, food resource management, and cooking.Outcome 2: Produce Rx participants will significantly increase their consumption of fruits and vegetables. Eligible participants will have elevated blood sugar (A1C >5.7%). Produce Rx will provide 580 unduplicated participants with nutrition education and improved access to fruits and vegetables over the project period. Consumption will be measured using the Hub's survey. The VeggieMeter (described in the Equipment attachment) will be used to assess skin carotenoid status, a more objective measure of fruit and vegetable consumption.Outcome 3: Levels of household food insecurity will decline among Produce Rx participants over the period during which they receive Produce Prescriptions. UCB will administer the food security screening at baseline and endline.Outcome 4: Produce Rx participants will experience reductions in body mass index (BMI) and A1C. Clinical outcomes are captured in the Electronic Health Record (CCHC utilizes eCW).Outcome 5: By September 2024, small and beginning farmers will expand their sales among low-income community members by selling fruits and vegetables valued at $258,600 to project participants. Reimbursements to farm-direct firms for redeemed prescriptions and produce boxes will enable monitoring of this outcome.
Project Methods
Produce Rx will partner with farm direct firms to connect patients with elevated blood sugar to produce prescriptions. All firmsare SNAP authorized vendors that also participate in GusNIP-funded Market Match;Produce Rx participants will learn about options for redeeming SNAP benefits.Produce prescriptions will be fulfilled as described below:Fiery Ginger home delivery: Saturdays, January 1, 2022-September 30, 2024.Spork Food Hub produce box distribution: biweekly over a multi-hour window on Fridays from March 1-November 30 in 2022-2023, and March 1-September 30, 2024, pausing during the winter months due to inclement weather and early nightfall.Davis Farmers Market (DFM) participants will be able to redeem vouchers at two year-round Wednesday markets, one Saturday market, and one May-November market next to DCC.Produce prescriptions will only include GusNIP-eligible produce items in fresh form. Examples include tomatoes, stone fruit, squash, cucumbers, basil, and melons in the spring and summer; and leafy greens, brassicas, onions, lettuce, citrus and peas in fall and winter.Prescription duration will vary based on the intervention model as previously described. All prescriptions will be valued at $60/month. Vouchers can be redeemed for the full value at one or multiple visits to acquire $60 of produce. Home deliveries will consist of boxes valued at $15 and containing approximately three different varieties (e.g., one head of broccoli, a 1/2 lb bag of spinach, and a bunch of 5 carrots).Vouchers, distributed to CCHC patients by CCHC staff, will serve as the financial instrument used for incentive delivery for DFMclients. CCHC staff will use a checklist to monitor produce box pick-up from the Garden. An existing electronic tracking system will confirm home deliveries.Participation will be tracked by lists and vouchers, depending on participants' assigned method of filling prescriptions. Vouchers will include numerical data associating them with the participant to whom it was prescribed. CLBL and DFM will scan redeemed vouchers to create invoices for reimbursement and provide CCHC with a record of redemption by participant.Participants will participate in at least one education session each month.They may choose to meet the education requirement by participating in GMVs (HLWD) or CenteringPregnancy (perinatal) visits;Cooking Matters classes; one-on-one visits; or virtual appointments and classes. Woodland distribution will concur with food demonstrations and taste tests featuring items included produce boxes.Evaluation will assess whether the effect of the Produce Rx on the outcomes of interest differs by intervention model (effect modification testing). Findings will be disseminated through conference and seminar presentations and publications in peer-review journals. Qualitative semi-structured interviews will assess participants' satisfaction with Produce Rx, barriers to participation, and program impact on their familiarity with the local food system. Semi-structured qualitative interviews will also be conducted among Produce Rx collaborators to elicit feedback on the project, benefits of participation to farm direct firms, and challenges encountered. Farm direct firm quantitative outcomes will be measured using voucher redemption data. Data will be contributed to Federal Agencies and the Nutrition Incentive Hub.

Progress 09/15/22 to 10/23/23

Outputs
Target Audience:112 CommuniCare Health Centers patients with elevated blood sugar were enrolled in Produce Rx. Participants are all lowincome, participating in Medicaid, Medicare or a similar state-run insurance program. Approximately 60% of participants are best served in Spanish, and the remaining 40% prefer to communicate in English. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Two graduate students conducted practicums related to Produce Rx during this reporting period. An additional seven undergraduate students supported project operations as a component of service learning placements with CommuniCare Health Centers. Staff professional development included regular participation in communities of practice offered by the NTAE and attendance at the in-person Nutrition Incentive Convening in June 2023 How have the results been disseminated to communities of interest?While results are not yet available, program awareness has been disseminated among potential participants. Program staff worked tirelessly to create awareness among community partners via word of mouth and social media. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? Produce Rx staff and partner organizations established systems for enrolling participants, distributing and redeeming produce prescription vouchers or boxes, and evaluating project impact. Staff worked with clinicians and support staff to raise program awareness and promote patient participation. Non-federal funds were used to host staff engagement activities in each intervention community that allowed staff (e.g., Medical Doctors, Medical Assistants, Enrollments Specialists, Case Managers, administrators, etc.) to experience and better understand the program, enabling them to better represent and promote the opportunity among the patients with whom they interact. 112 individuals with elevated blood glucose levels were enrolled in the project during this reporting period. Given the timing of the intervention, participants had not concluded the six month "prescription" period at the close of project year 1. 52 individuals completed baseline surveys. Participants have regularly participated in diabetes and food education activities, and have successfully accessed produce from the Center for Land-Based Learning's Mobile Farmers Market, the Davis Farmers Market, and pre-packed produce boxes at Hansen Family Health Center.

Publications


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

    Outputs
    Target Audience:112 CommuniCare Health Centers patients with elevated blood sugar were enrolled in Produce Rx. Participants are all low-income, participating in Medicaid, Medicare or a similar state-run insurance program. Approximately 60% of participants are best served in Spanish, and the remaining 40% prefer to communicate in English. Changes/Problems:Voucher redemption and produce box pick-up rates have hovered around 25% of total enrolled individuals. Partnering witha brick and mortar grocery partner is anticipated to alleviate participant barriers to accessing produce prescriptions. What opportunities for training and professional development has the project provided?Two graduate students conducted practicums related to Produce Rx during this reporting period. An additional seven undergraduate students supported project operations as a component of service learning placements with CommuniCare Health Centers. Staff professional development included regular participationin communities of practiceoffered by the NTAE and attendance at the in-person Nutrition Incentive Convening in June 2023. How have the results been disseminated to communities of interest?While results are not yet available, program awareness has been disseminated among potential participants. Program staff worked tirelessly to create awareness among community partners via word of mouth andsocial media. What do you plan to do during the next reporting period to accomplish the goals?In this initial year of programming it became clear that while patient interest in the program is high, access and utilization has been a challenge. The farmers markets with whom we collaborate operate withlimited hours, and the window for box pick-ups is also quite limited. This makes it challenging forpatients to "fill" their produce prescriptions,and is particularly challenging for those individuals who are working during business hours and/or face transportation barriers. To address these challenges, we exploring a brick and mortar option for produce prescription access in collaboration with Nugget andFood4Less Markets. We anticipate that this may significantly expand program utilization. We will continue and expandprogrampromotion among clinic staff, conduct baseline and endline surveys in collaboration with our evaluation partners at UC Berkeley, and engage patients in diabetes and food education activities.

    Impacts
    What was accomplished under these goals? Produce Rx staff and partner organizations established systems for enrolling participants, distributing and redeeming produce prescription vouchers or boxes, and evaluating project impact. Staff worked with clinicians and support staff to raise program awareness and promote patient participation. Non-federal funds were used to hoststaff engagement activitiesin each intervention community that allowed staff (e.g., Medical Doctors, Medical Assistants, Enrollments Specialists, Case Managers, administrators, etc.) to experience and better understand the program, enabling them to better represent and promote the opportunity among the patients with whom they interact. 112 individuals with elevated blood glucose levels were enrolled in the project during this reporting period. Given the timing of the intervention, participants had not concluded the six month"prescription" period at the close of project year 1. 52 individuals completed baseline surveys. Participants have regularly participated in diabetes and food education activities, and have successfully accessed produce from the Center for Land-Based Learning's Mobile Farmers Market, the Davis Farmers Market, and pre-packed produce boxes at Hansen Family Health Center.

    Publications