Source: FARMSHARE AUSTIN submitted to NRP
FRESH FOR LESS MOBILE MARKETS AND CURBSIDE DELIVERY PRODUCE PRESCRIPTION: INCREASING INCENTIVES AND EQUITY FOR LOCAL FRUITS AND VEGETABLES
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
COMPLETE
Funding Source
Reporting Frequency
Annual
Accession No.
1028996
Grant No.
2022-70422-37834
Cumulative Award Amt.
$80,839.00
Proposal No.
2022-06597
Multistate No.
(N/A)
Project Start Date
Sep 15, 2022
Project End Date
Sep 14, 2025
Grant Year
2022
Program Code
[PPR]- Produce Prescription
Recipient Organization
FARMSHARE AUSTIN
3608 RIVER RD
CEDAR CREEK,TX 786123079
Performing Department
(N/A)
Non Technical Summary
Austin is often ranked as one of the country's most segregated large metropolitan areas. Food insecurity and lack of food access are concentrated in an area called "The Eastern Crescent," comprising a crescent shape extending from Northeast Austin to Eastern Travis County to South Austin. This same geographic region is also predominantly non-White and has a median annual household income below $70,000. A 2017 Austin and Travis County Food Environment Analysis identified four barriers that contribute to food access challenges: 1) Low Proximity; 2) Lower Household Income; 3) Fewer Mobility Options; and 4) Less Healthy Food Availability. Eastern Crescent residents experience more of these barriers compared to residents in other parts of Austin and Travis County. Healthy food retail is scarce or non-existent. Eastern Crescent residents consistently express in public forums that they would like better access to affordable high quality grocery items, including fresh produce.Most residents of Travis County (80%) do not eat the daily recommended number of fruits & vegetables, and 60% of adults are overweight or obese. Major health disparities exist for chronic diseases by income and race/ethnicity, such as diabetes. The diabetes rate for all Travis County adults is 8.3%. Diabetes rates among Blacks and Hispanics/Latinos are 13% and 12%, respectively. Chronic diseases such as diabetes are the most preventable of all health problems. Research shows that a healthy lifestyle, including consumption of a wide variety of fresh vegetables and fruit, can prevent many chronic diseases. Lack of access to fresh, affordable produce, and particularly culturally relevant fresh local produce, can contribute to poor nutrition.Farmshare Austin will run this pilot project at People's Community Clinic, a federally qualified health center (FQHC) in the Eastern Crescent of Austin and Travis County, an area with strong local demand for increased healthy food and medical resources. People's is a site host of a weekly Fresh for Less Mobile Market. According to the 2020 People's Community Clinic Annual Report, 88% of patients are below 200% of the Federal Poverty Level, and 85% of all patients reside in Travis County. Patients have higher prevalence for several chronic health conditions: asthma, COPD, diabetes, heart failure, hypertension, and renal failure. People's Community Clinic patients are 84% Latino and 5.4% Black. The City of Austin has identified four barriers to healthy food access: 1) Low Proximity; 2) Lower Household Income; 3) Fewer Mobility Options; and 4) Less Healthy Food Availability. Patients experience many of these barriers, making People's Community Clinic a target location for a PPR pilot project. People's Community Clinic will verify participants in the Produce Prescription Program (PPR) by using electronic health records to identify diabetic patients, selecting up to 50 participants with the highest HbA1c levels.The goal of this pilot project is to improve health outcomes among low-income diabetes patients by increasing their consumption of fresh local produce through a pilot PPR project using Farmshare's successful FFL program in partnership with People's Community Clinic FQHC and assessing its feasibility for a larger scale project.Project participants will have access to a diverse range of fresh, seasonal, local fruits and vegetables. Farmshare's FFL Mobile Markets and Curbside Delivery offer a wide selection of culturally appropriate produce staples as well as seasonally changing local produce items, all at reduced cost. An important aspect of Farmshare's proposed PPR program is client choice: participants are able to select and shop for the items and quantities that work best for them.The City of Austin's FFL food access initiative, which funds about 50% of Farmshare's Mobile Markets and Curbside Delivery, also funds outreach and education led by Farmshare partners Sustainable Food Center. Through this partnership, Farmshare provides all FFL customers with weekly nutrition education packets that contain healthy, seasonal recipes, tips for eating a healthy diet and links to virtual cooking videos. These resources are provided in both English and Spanish and will be provided to all PPR project participants.Project outcomes for Farmshare Austin's proposed PPR pilot project are to:Increase consumption and variety of fruits and vegetables by 25% from baseline measures among 100 low-income diabetes patients at designated People's Community Clinic (PCC) locations.Reduce individual and household food insecurity among low-income and SNAP recipient PCC patients by providing information about and access to reduced cost FFL grocery options, including free home delivery for qualifying participants and PPR vouchers to redeem at markets or online.Reduce healthcare use and associated costs among project participants by $250 during the 6 month incentive redemption period via increased consumption of fruits and vegetables.Reduce HbA1c levels among participating diabetes patients by at least one point.` Based on past evaluations, FFL successfully increases the consumption and variety of fruits and vegetables among customers. Nearly 80% of FFL Mobile Market customers surveyed in 2019 reported they and their families ate more fruits and vegetables as a result of shopping at the Mobile Market, and 82% reported the variety of fruits and vegetables consumed also increased. PPR project participants will benefit from the demonstrated success of these existing programs while also reducing their need for healthcare use and costs by $250 per participant. This figure is based on the National Committee for Quality Assurance (NCQA) findings that reducing A1C levels by one percentage point (10% to 9%) demonstrated a 3-year cost savings of $1,200-$4,100 per patient. All participants will be diabetic. By increasing consumption of fresh produce, we anticipate participant reduction of HbA1c levels by at least one point. This metric was developed with the assistance of People's Community Clinic.
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
70360991010100%
Goals / Objectives
The goal of this pilot project is to improve health outcomes among low-income diabetes patients by increasing their consumption of fresh local produce through a pilot PPR project using Farmshare's successful FFL program in partnership with People's Community Clinic (PCC) FQHC sites and assessing its feasibility for a larger scale project.Project participants will have access to a diverse range of fresh, seasonal, local fruits and vegetables. Farmshare's FFL Mobile Markets and Curbside Delivery offer a wide selection of culturally appropriate produce staples as well as seasonally changing local produce items, all at reduced cost. An important aspect of Farmshare's proposed PPR program is client choice: participants are able to select and shop for the items and quantities that work best for them.The City of Austin's FFL food access initiative, which funds about 50% of Farmshare's Mobile Markets and Curbside Delivery, also funds outreach and education led by Farmshare partners Sustainable Food Center. Through this partnership, Farmshare provides all FFL customers with weekly nutrition education packets that contain healthy, seasonal recipes, tips for eating a healthy diet and links to virtual cooking videos. These resources are provided in both English and Spanish and will be provided to all PPR project participants.Project outcomes for Farmshare Austin's proposed PPR pilot project are to:Increase consumption and variety of fruits and vegetables by 25% from baseline measures among 50 low-income diabetes patients at designated People's Community Clinic locations.Reduce individual and household food insecurity among low-income and SNAP recipient PCC patients by providing information about and access to reduced cost FFL grocery options, including free home delivery for qualifying participants and PPR vouchers to redeem at markets or online.Reduce healthcare use and associated costs among project participants by $250 during the 6 month incentive redemption period via increased consumption of fruits and vegetables.Reduce HbA1c levels among participating diabetes patients by at least one point.` Based on past evaluations, FFL successfully increases the consumption and variety of fruits and vegetables among customers. Nearly 80% of FFL Mobile Market customers surveyed in 2019 reported they and their families ate more fruits and vegetables as a result of shopping at the Mobile Market, and 82% reported the variety of fruits and vegetables consumed also increased. PPR project participants will benefit from the demonstrated success of these existing programs while also reducing their need for healthcare use and costs by $250 per participant. This figure is based on the National Committee for Quality Assurance (NCQA) findings that reducing A1C levels by one percentage point (10% to 9%) demonstrated a 3-year cost savings of $1,200-$4,100 per patient. All participants will be diabetic. By increasing consumption of fresh produce, we anticipate participant reduction of HbA1c levels by at least one point. This metric was developed with the assistance of CH's Clinical Nutrition Manager.
Project Methods
Farmshare's PPR pilot will operate for one year. Participant recruitment, baseline surveys and incentive distribution will occur October-December. Participant incentive redemption will be January-June. Post surveys and other project evaluation will be July-September.The PPR dosage will be $390 per participant, available during a 6 month period. There will be no restrictions on how quickly a customer can redeem their coupons. Part of the data gained will be the rate at which participants choose to use incentives. The PPR incentive will be provided as a book of 26 tear-out $15 coupons. Incentives can be used in person or online. Each coupon will have a unique online redemption code. No additional purchase is required to redeem the incentive. All fresh fruits and vegetables sold through FFL will be eligible to be received at the point of incentive redemption. The produce items typically include 20 or more options.Incentive redemption will be tracked in-person and online. If redeemed in-person at a Mobile Market, a staff member will record redemption information. If redeemed online, the webstore will record the redemption. All incentive coupons and their corresponding online codes will possess a unique identifier indicating which participant the incentive was associated with and which number coupon the participant redeemed. Each participant will self-report SNAP household usage via project surveys. This information will be cross-referenced with incentive redemption records and shared during evaluation. The proposed PPR project is a new incentive program for FFL. Currently, SNAP customers can use DUFBs when they shop with FFL. However, there is no PPR program available to FFL shoppers in Travis County.Farmshare partners with SFC to offer weekly nutrition education resources, such as bilingual healthy and seasonal recipes, online discussion groups and access to bilingual cooking videos. These resources will be provided to PPR participants. CH has chronic disease management and nutrition education/cooking programs to help their patients build and sustain healthy lifestyles. PPR participants will be recruited to these programs to enhance outcomes.The primary clinic location for this pilot project will be People's Community Clinic (PCC). All participants will be able to redeem their incentives in person at the PCC FFL weekly Mobile Market or any FFL Mobile Market. Farmshare anticipates having a minimum of 5-7 weekly Mobile Markets by the time the proposed PPR launches. The new FFL program will combine Curbside Delivery with longer Mobile Market hours.

Progress 09/15/22 to 01/24/25

Outputs
Target Audience:Low-income pre-diabetic and diabetic patients at Lone Star Circle of Care (FQHC) Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Farmshare's project manager completed The Collaborative Institutional Training Initiative's course to train individual learners in research, ethics, regulatory oversight, responsible conduct of research, and research administration. This has opened up future collaborative opportunities for Farmshare to explore clinical, and research based nutrition intervention and incentive programs. Farmshare's food access director attended the project director's conference in New Orleans. Although this was mandatory training it was beneficial in understanding other approaches to nutrition incentive programs. The conference was useful in developing a vision for future Veggie Rx projects. How have the results been disseminated to communities of interest?Finalized results are still being compiled and will be shared with relevant communities as soon as possible. Notices to participants regarding any future opportunities for Veggie Rx participation has been sent out. This message also contained some preliminary data as shared above. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? Farmshare, in collaboration with Lone Star Circle of Care (FQHC) and UT Dell Med has completed the Veggie Rx program with 100 participants with high A1C levels who identify as food insecure. Farmshare's Fresh for Less provided healthy food access through Mobile Markets and Home Delivery for the duration of the program to all participants who were actively engaged. Thirty-nine thousand dollars of incentives were distributed between May - August 2024. Of this total, $18,797 was used by participants during the 6-month period to purchase fruits and vegetables. Participants were given a $390 lump sum card to use at FFL Mobile Markets and Home Delivery. This approach allowed for participants to select the variety and quantity of food they prefer to suit their nutrition needs as best possible. Program Participation 100 participants consented into the program from Nov 2023 - February 2024. Of those 98 picked up their veggie RX card and received their educational material (handout from our community health worker). During the 6 month program period, 81/98(83%) used their card at least one time (46 from the mobile market, 17, home delivery, 18 both). 72 participants completed the posttest survey, with 64 using their card at least once and completing baseline and post-test assessments. This sample is what we will report for our outcome analyses in the final report. In our pilot project, participants reported an increased consumption of vegetables of about 1 serving per week. Variety of produce increase After completing the program, we asked participants to rate the following question on a scale of 1-5 (1=strongly disagree, 5= strongly agree): "As a result of shopping at the Fresh for Less Mobile Market or Home Delivery, the VARIETY of fresh fruits and vegetables my family eats has increased." On a scale of 1-5, program participants reported on average a 4.1 (standard deviation 1.3) to the statement "As a result of shopping at the Fresh for Less Mobile Market or Home Delivery, the VARIETY of fresh fruits and vegetables my family eats has increased." A Household food insecurity We administered the USDA 6-item household food insecurity screener at baseline and posttest, and 33% participants showed a decrease in household food insecurity (48% maintained, 19% increased). A1C Level Data Among card users with A1c values, Baseline HbA1c (n=54) was meanSD = 7.3(1.8) and Post HbA1c(n=31) was meanSD = 6.8(1.4). When looking at the subset of 19 individuals with both a pretest and post-test value, baseline A1c mean SD = 6.7(1.0) and post test A1c mean SD 6.7(1.4).

Publications


    Progress 09/15/22 to 01/15/25

    Outputs
    Target Audience:Low-income pre-diabetic and diabetic patients at Lone Star Circle of Care (FQHC) Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Farmshare's project manager completed The Collaborative Institutional Training Initiative's course to train individual learners in research, ethics, regulatory oversight, responsible conduct of research, and research administration. This has opened up future collaborative opportunities for Farmshare to explore clinical, and research based nutrition intervention and incentive programs. Farmshare's food access director attended the project director's conference in New Orleans. Although this was mandatory training it was beneficial in understanding other approaches to nutrition incentive programs. The conference was useful in developing a vision for future Veggie Rx projects. How have the results been disseminated to communities of interest?Finalized results are still being compiled and will be shared with relevant communities as soon as possible. Notices to participants regarding any future opportunities for Veggie Rx participation has been sent out. This message also contained some preliminary data as shared above. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

    Impacts
    What was accomplished under these goals? Farmshare, in collaboration with Lone Star Circle of Care (FQHC) and UT Dell Med has completed the Veggie Rx program with 100 participants with high A1C levels who identify as food insecure. Farmshare's Fresh for Less provided healthy food access through Mobile Markets and Home Delivery for the duration of the program to all participants who were actively engaged. Thirty-nine thousand dollars of incentives were distributed between May - August 2024. Of this total, $18,797 was used by participants during the 6-month period to purchase fruits and vegetables. Participants were given a $390 lump sum card to use at FFL Mobile Markets and Home Delivery. This approach allowed for participants to select the variety and quantity of food they prefer to suit their nutrition needs as best possible. Program Participation 100 participants consented into the program from Nov 2023 - February 2024. Of those 98 picked up their veggie RX card and received their educational material (handout from our community health worker). During the 6 month program period, 81/98(83%) used their card at least one time (46 from the mobile market, 17, home delivery, 18 both). 72 participants completed the posttest survey, with 64 using their card at least once and completing baseline and post-test assessments. This sample is what we will report for our outcome analyses in the final report. In our pilot project, participants reported an increased consumption of vegetables of about 1 serving per week. Variety of produce increase After completing the program, we asked participants to rate the following question on a scale of 1-5 (1=strongly disagree, 5= strongly agree): "As a result of shopping at the Fresh for Less Mobile Market or Home Delivery, the VARIETY of fresh fruits and vegetables my family eats has increased." On a scale of 1-5, program participants reported on average a 4.1 (standard deviation 1.3) to the statement "As a result of shopping at the Fresh for Less Mobile Market or Home Delivery, the VARIETY of fresh fruits and vegetables my family eats has increased." A Household food insecurity We administered the USDA 6-item household food insecurity screener at baseline and posttest, and 33% participants showed a decrease in household food insecurity (48% maintained, 19% increased). A1C Level Data Among card users with A1c values, Baseline HbA1c (n=54) was meanSD = 7.3(1.8) and Post HbA1c(n=31) was meanSD = 6.8(1.4). When looking at the subset of 19 individuals with both a pretest and post-test value, baseline A1c mean SD = 6.7(1.0) and post test A1c mean SD 6.7(1.4).

    Publications


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

      Outputs
      Target Audience:Low-incomepre-diabetic and diabetic patients at Lone Star Circle of Care (FQHC) Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Farmshare's project manager completed The Collaborative Institutional Training Initiative's course to train individual learners in research, ethics, regulatory oversight, responsible conduct of research, and research administration. This has opened up future collaborative opportunities for Farmshare to explore clinical, and research based nutrition intervention and incentive programs. Farmshare's food access director attended the project director's conference in New Orleans. Although this was mandatory training it was beneficial in understanding other approaches to nutrition incentive programs. The conference was useful in developing a vision for future Veggie Rx projects. How have the results been disseminated to communities of interest?Finalized results are still being compiled and will be shared with relevant communities as soon as possible. Notices to participants regarding any future opportunities for Veggie Rx participation has been sent out. This message also contained some preliminary data as shared above. What do you plan to do during the next reporting period to accomplish the goals?During the month of December data will be finalized, and results will be shared.This is the final progress report for this program.

      Impacts
      What was accomplished under these goals? Farmshare, in collaboration with Lone Star Circle of Care (FQHC) and UT Dell Med has completed the Veggie Rx program with 100 participants with high A1C levels who identify as food insecure. Farmshare's Fresh for Less provided healthy food access through Mobile Markets and Home Delivery for the duration of the program to all participants who were actively engaged. Thirty-nine thousand dollars of incentives were distributed between May - August 2024. Of this total, $18,797 was used by participants during the 6-month period to purchase fruits and vegetables. Participants were given a $390 lump sum card to use at FFL Mobile Markets and Home Delivery. This approach allowed for participants to select the variety and quantity of food they prefer to suit their nutrition needs as best possible. Program Participation 100 participants consented into the program from Nov 2023 - February 2024. Of those 98 picked up their veggie RX card and received their educational material (handout from our community health worker). During the 6 month program period, 81/98(83%) used their card at least one time (46 from the mobile market, 17, home delivery, 18 both). 72 participants completed the posttest survey, with 64 using their card at least once and completing baseline and post-test assessments. This sample is what we will report for our outcome analyses in the final report. In our pilot project, participants reported an increased consumption of vegetables of about 1 serving per week. Variety of produce increase After completing the program, we asked participants to rate the following question on a scale of 1-5 (1=strongly disagree, 5= strongly agree): "As a result of shopping at the Fresh for Less Mobile Market or Home Delivery, the VARIETY of fresh fruits and vegetables my family eats has increased." On a scale of 1-5, program participants reported on average a 4.1 (standard deviation 1.3) to the statement "As a result of shopping at the Fresh for Less Mobile Market or Home Delivery, the VARIETY of fresh fruits and vegetables my family eats has increased." A Household food insecurity We administered the USDA 6-item household food insecurity screener at baseline and posttest, and 33% participants showed a decrease in household food insecurity (48% maintained, 19% increased).

      Publications


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

        Outputs
        Target Audience: Nothing Reported Changes/Problems:IRB and contract document approval between our clinical and evaluation partners took an extremely long time, thus pushing back our implementation start date.Farmshare has been granted a one year no-cost extension for the Veggie Rx. 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?Farmshare Austin has been able to secure a clinical partner, Lone Star Circle of Care, a Federally Qualified Health Center, along with an evaluation partner, The University of Texas Dell Medical to move forward with implementaiton of the Veggie Rx. IRB and other contract documents have been completed and we are prepared to move forward with our project.In subsequent reporting periods we anticipate recruiting, enrolling and distributing incentives to patients. At the time of this report, December 12, 2023, these efforts are underway.

        Impacts
        What was accomplished under these goals? N/A

        Publications


          Progress 09/15/22 to 08/22/23

          Outputs
          Target Audience: Nothing Reported Changes/Problems:Farmshare Austin formally requested a no cost extension on August 11, 2023. We are currently awaiting a response to continue our work with Lone Star Circle of Care, a Federally Qualified Health Center (FQHC) to participate as our clinical partner. After our initial clinical partner expressed that they were unable to participale Farmshare was met with considerable difficulty in finding a new clinical partner that was able to meet the requirements for this project. The process to establish a relationship with the new FQHC, determine workflow and data sharing, and receive legal and operational approval from the FQHC took an additional six months. We anticipate finalizing agreements with a new clinical partner, Lone Star Circle of Care Collinfield Clinic, in the next several months and will be able to get this program off the ground soon after that. There will be no additional reporting requirements anticipated in order to compy with the award terms and conditions so long as we are granted a one year extension. 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? Nothing Reported

          Impacts
          What was accomplished under these goals? When Farmshare was initially awarded this grant we had established a relationship with a Federally Qualified Health Center (FQHC) to participate as our clinical partner. Unfortunately, they were unable to complete the requirements for this agreement and had to rescind their participation well into the timeline established for this grant. Finding a new clinical partner that was able to meet the requirements for this project took a few months. The process to establish a relationship with the new FQHC, determine workflow and data sharing, and receive legal and operational approval from the FQHC took an additional six months. We anticipate finalizing agreements with a new clinical partner, Lone Star Circle of Care Collinfield Clinic, in the next several months and will be able to get this program off the ground soon after that. We have already begun hosting a Mobile Market on site at Lone Star Circle of Care Collinfield Clinic with wide interest and community support. All financial reporting, IRBs, and progress reports are up to date as best possible and will be maintained as required through the duration of this agreement.?

          Publications