Source: YUKON-KUSKOKWIM HEALTH CORPORATION submitted to NRP
GUS SCHUMACHER NUTRITION INCENTIVE PROGRAM PRODUCE PRESCRIPTION PROGRAM
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
ACTIVE
Funding Source
Reporting Frequency
Annual
Accession No.
1029159
Grant No.
2022-70423-38067
Cumulative Award Amt.
$500,000.00
Proposal No.
2022-06762
Multistate No.
(N/A)
Project Start Date
Sep 1, 2022
Project End Date
Aug 31, 2025
Grant Year
2022
Program Code
[PPR]- Produce Prescription
Recipient Organization
YUKON-KUSKOKWIM HEALTH CORPORATION
829 HOSPIN HWY STE 329
BETHEL,AK 99559
Performing Department
(N/A)
Non Technical Summary
The YKHC service area is approximately the size of Oregon state and is not on a road system, making the coordination of services and access to resources challenging. Due in large part to transportation challenges, the logistics involved in getting produce to communities throughout the region in a reliable and affordable fashion prevents many families from purchasing fruits and vegetables. In addition to the high cost of food, this region sees some of the highest poverty levels in the nation. YKHC's service area overlaps with three census areas - Kusilvak, Bethel, and Yukon-Koyukuk. According to the Percent of Households that Receive Food Stamps/SNAP - United States - County by State report from 2017, the Kusilvak Census area had the highest percentage of households receiving SNAP benefits in the nation, excluding Puerto Rico, at 58%. Bethel census area ranked number eleven at 39.2% and the Yukon-Koyukuk ranked thirty third with 33.4%. It is believed that providing financial incentives for purchasing fruits and vegetables would help to mitigate the negative health affects created, in part, by the high cost of living and high poverty rates in this region. In so doing, we anticipate increased overall health in the participants of this program. To evaluate the impact of this prescription produce program on participants' health, YKHC will be collecting surveys as well as lab values that assess blood sugar levels from participants. The surveys will evaluate changes in knowledge and behavior, while the blood sugar levels will measure a change in the actual health condition of the participant. The anticipated outcome is for the surveys to reflect increased knowledge on how to purchase fruits and vegetables on a budget, how to incorporate more fruits and vegetables in meals, and whether or not participants' shopping/food consumption habits have changed over the course of their participation. For the blood sugar values, theanticipated outcome is to see a decrease in average blood sugar values for participants, correlated to the number of prescriptions received and educational opportunities that participants engage in.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
(N/A)
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
70360101010100%
Knowledge Area
703 - Nutrition Education and Behavior;

Subject Of Investigation
6010 - Individuals;

Field Of Science
1010 - Nutrition and metabolism;
Goals / Objectives
YKHC's program is intended to improve the accessibility and affordability of healthy foods in a region that historically has limited access based on transportation and logistical complications in addition to limited agricultural production and an overall high cost of living, all of which threaten food security, diminish dietary adequacy and diversity, and ultimately overall health.The goals of this current "enhancement opportunity" to YKHC's PPR project are to continue to improve fruit and vegetable intake, reduce food insecurity, and improve health and related healthcare utilization costs. For this 2022 Gus Schumacher Nutrition Incentive Program Produce Prescription Program, we plan to expand PPR eligibility to include people that are SNAP and/or Medicaid eligible, that reside within the YK Delta, and have DM, pre-DM, gestational DM, or are at high risk of developing DM.
Project Methods
Method: Patients will be seen for appointments at their local clinic. If it is found that a patient is at risk for developing diabetes, or diagnosed with diabetes, and is covered by Medicaid then they will be eligible for participation in this program. Eligible participants must have their A1c values tested before they receive a referral to the diabetes department for a prescription for produce. The diabetes department will verify eligibility and, when appropriate, provide a prescription for FV in the form of a food voucher worth $45 that can be redeemed with participating vendors or coordinate the delivery of FV directly to the participant. The participant will be eligible for prescription refills that can be redeemed congruent to the method used to redeem the initial prescription. Participants will be able to receive FV at minimum quarterly, with an idea frequency of once per month. Participants will be requested to complete hemoglobin A1C testing semi-anually up to quarterly depending upon current health conditions.Efforts: Classes and educational opportunities will be provided to participants in an effort to promote change in knowledge and actions. Educational materials will be included with vouchers and box deliveries. The anticipated result is a change in conditions, mainly, lower A1c values compared to baseline A1cs.Evaluation: Results of this program will be analyzed by looking at the number of prescription refills redeemed per participantand the subsequent A1c values compared to baseline data. Additionally, surveys will be collected evaluating changes in actions regarding what items participants are purchasing at the store and how frequently. Success will be measured with majority of participants seeing a 0.5% decrease in their A1c values.

Progress 09/01/23 to 08/31/24

Outputs
Target Audience:The target audience reached during the reporting period included residentsof a community served by Yukon-Kuskokwim Health Corporationdiagnosed with diabetes, prediabetes, or gestational diabetes. Participants from all races and nationality were included in the target audience. Participants had to be enrolled in Alaska Medicaid during the enrollment process. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?The annual Project Director Meeting was attended by the Project Director as well as a partner agency representative. The 38th Annual Alaska Native Diabetes Conference was attended in October 2023 by the Project Director and other program support staff. The Special Diabetes Program for Indians Grantee Conference was attended in August 2024 by the Project Director and other program support staff. Several GusNIP Learning Circles were attended that were organized by the Technical Advisors for our program. Bi-monthy community of Practice meetings were attended: 9/2023, 11/2023, 1/2024, 3/2024, 5/2024. How have the results been disseminated to communities of interest?Bi-monthly and quarterly board reports were shared to YKHC's Board of Directors. Monthly report-outs were provided between partner agency and YKHC to communicate enrollment numbers and participant success. What do you plan to do during the next reporting period to accomplish the goals?We plan to collect surveys during the next reporting period to better understand improvements in participant health concerns and changes in food security.

Impacts
What was accomplished under these goals? By the end of the reporting period, 340 participants were actively enrolled in the Prescription Produce Program. This is an increase of 160% from the previous year. Surveys were not collected during the reporting period due to pending IRB approvals and lack of staffing resources to conduct surveys.

Publications


    Progress 09/01/22 to 08/31/23

    Outputs
    Target Audience: Nothing Reported 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? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?We plan to continue to recruit participants for our Prescription Produce Program. We currently have almost 300 active participants from our originally funded grant and will continue to provider produce prescriptions using 2022 ARPA funds. We will be offering participants the option for $45 monthly to redeem at a participating store or $45 procured produce box from a local farm. We have been able to add additional firms in village communities and will continue to attempt to recruit additional firms. We plan to increase educational opportunities for participants by implementing a monthly educational text message in addition to quarterly education tips.

    Impacts
    What was accomplished under these goals? YKHC has continued to execute the 2019 PPR project and was authorized to extend the project period through 8/31/2024 to expend awarded funds. YKHC has enhanced the 2019 PPR program to recruit participants residing in any of YKHC 58 village communities. Upon expenditure of 2019 funds, YKHC will begin working towards the goals of the 2022 ARPA Award.

    Publications