Progress 09/15/23 to 09/14/24
Outputs
Target Audience:The target audience was adults (>18 years old) with high blood pressure (self-reported blood pressure reading >130/80 mmHg and self-reported diagnosis of hypertension) who were low-income (household earning <$58,231 per year and eligible for SNAP) and resided in West Dallas, TX. Efforts for the target audience included delivery of Texas A&M AgriLife Extension education and skill building on managing and lowering high blood pressure through healthy lifestyle behaviors (nutrition, physical activity, healthy cooking). The target audience also received brief education on measuring blood pressure at home. Through CareSignal, participants were prompted through a brief text message to report daily blood pressure values. Participants received periodic handouts on keeping produce fresh and a description of taste and cooking techniques for unfamiliar vegetables in weekly produce bags. Changes/Problems:1.We conducted interviews with control group participants during programmatic Wave 1 in lieu of focus groups with hypertensive West Dallas residents prior to implementing programmatic Wave 1. The interviews provided valuable insights into participants' experiences with high blood pressure and the factors influencing their lifestyle, which will inform improvements and new ideas for the program in Wave 2. 2.Communication was a minor problem regarding participants reporting their blood pressure measurements during programmatic Wave 1. An average of 17 participants reported their blood pressure measurements in the first wave. For this matter, during the second wave we reminded participants frequently during education sessions, produce pick up or through the handouts/Facebook posts to report their blood pressure measurements 3.Education sessions were poorly attended during programmatic Wave 1. This was due to a lack of clear communication from the research team, resulting in participants not being aware of the education. To resolve this, we improved communication strategies for Wave 2 by increasing reminders and outreach to participants, including online notifications through social media and text reminders, which will encourage greater participation in the subsequent sessions. Additionally, we created a Facebook group to share posts related to the handouts and infographics provided to participants alongside their weekly produce bags. 4.Additional participants were recruited for programmatic Wave 2 to reach pre- and post-intervention data collection goal of n=100. 5.Because statistically significant changes in health-related outcomes were not detected when comparing the intervention group to control group for programmatic Wave 1, a cost-effectiveness analysis is no longer appropriate. Rather, we will reconsider the cost-effectiveness analysis when combining Wave 1 and Wave 2 data, if statistically significant differences can be detected. What opportunities for training and professional development has the project provided?Under the supervision of the Program Director, the program has provided training to one medical student in statistical data analysis. 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?For our first objective, we will: 1.Meet with program leaders and researchers who have experienced success in recruiting and retaining produce prescription participants through in-person and virtual meetings and attendance at the Nutrition Incentive Hub's Produce Prescription Convening on May 20-22, 2025. 2.Prepare a conference abstract of control group interview findings 3.Prepare a manuscript of control group interview findings For our second objective, we will: 1.Complete implementation of Wave 2 of PRx-BP program for intervention group participants. 2.Complete bi-monthly survey and end-point data collection for Wave 2 participants. 3.Clean and analyze Wave 2 data. 4.Present Wave 1 results to community partners and to local Dallas community via Dallas Intercity Growers Summit (DIGS). 5.Preliminary research findings comparing changes in blood pressure, fruit and vegetable intake, and food security between the intervention and control group is scheduled to be presented at North American Primary Care Research Group 2024 conference. 6.Submit abstract of effectiveness outcomes and process evaluation to International Society for Behavioral Nutrition and Physical Activity 2025 conference. 7.Prepare manuscript of effectiveness and process evaluation findings (Objectives 2 and 3). For our third objective, we will: 1.Complete Wave 2 data collection of quantitative process evaluation outcomes. 2.Conduct post-intervention interviews with Wave 2 participants. 3.Conduct interviews with PRx-BP implementers (clinic staff and Extension educators) 4.Clean and analyze quantitative process evaluation data, post-intervention interviews, and implementer interviews 5.Submit abstract of effectiveness outcomes and process evaluation to International Society for Behavioral Nutrition and Physical Activity 2025 conference. 6.Prepare manuscript of effectiveness and process evaluation findings (Objectives 2 and 3). For our fourth objective, we will: 1.Collect data for all cost-effectiveness variables Wave 2 2.Clean data and determine cost-effectiveness for both waves, combined
Impacts
What was accomplished under these goals?
MAJOR GOALS OF THE PROJECT The overall goal of this project is to evaluate whether PRx-BP can improve blood pressure among adults with hypertension in West Dallas, TX, a largely underserved community. To achieve this goal, we will: 1) use feedback from focus groups with West Dallas residents who have hypertension to tailor the PRx-BP program; 2) test how effective PRx-BP is in lowering blood pressure through a pilot randomized wait-list controlled trial; 3) evaluate ways to improve program delivery through a process evaluation; and 4) analyze the cost-effectiveness of the program. WHAT WAS ACCOMPLISHED UNDER THESE GOALS? RELEVANCE This project addresses the high prevalence of hypertension and food insecurity in West Dallas, a community with significant racial and ethnic disparities in health outcomes. In West Dallas, 41% of adults experience high blood pressure. The PRx-BP program seeks to reduce these risks by providing participants with weekly produce prescriptions, including fresh, seasonal, and local produce, along with nutrition and cooking education, blood pressure self-management support, and physical activity classes. RESPONSE Objective 1: Tailor the PRx-BP Program Using Feedback from Focus Groups Due to scheduling issues, we were unable to conduct pre-program focus groups with West Dallas residents. However, we collected valuable feedback during Wave 1 (June-Dec 2023) through participant interactions at weekly produce pickups. This feedback led to several program modifications, including a "golden ticket" incentive, where one participant each week could redeem a ticket found in their produce bag for a small kitchen appliance or cooking tool. Educational materials about less familiar vegetables like sorrel and beets were also created to help participants feel more confident in preparing the produce. In addition to the changes in Wave 1, we conducted post-intervention interviews with 12 out of 30 participants from the control group, prior to their intervention in Wave 2 (January-February 2024). These interviews provided insights into participants' experiences with hypertension, barriers to healthy living, and suggestions for program improvements. Based on this feedback, adjustments were made to enhance the program, including the introduction of a Facebook group for Wave 2 participants. This digital platform allowed participants to access weekly educational infographics, reminders about produce pickup times, and session invitations. Of the 76 Wave 2 participants, 47 joined the Facebook group, enhancing communication and engagement. Objective 2: Evaluate PRx-BP's Effectiveness on Lowering Blood Pressure Wave 1 (June-Dec 2023) involved 104 participants, 52 of whom were assigned to the intervention group (PRx-BP) and 52 to the control group. Of the 104 participants, 52 completed baseline data collection. Preliminary data analysis from Wave 1 showed no significant differences in food security or fruit and vegetable intake between the two groups. The PRx group showed a greater reduction in food insecurity risk compared to the control group, but this was not statistically significant. Both groups experienced slight increases in fruit and vegetable consumption, but again, the differences were not significant. These preliminary findings were presented at the North American Primary Care Research Group 2024 conference. The intervention group had a modest increase in produce intake, while the control group showed a slight decrease. For Wave 2 (April-Sept 2024), we expanded the cohort, recruiting 76 participants, including 25 from the Wave 1 control group. Recruitment efforts were boosted by attending local Produce Days hosted by Brother Bill's Helping Hand, where research staff enrolled 51 additional participants. Objective 3: Understand Program Delivery Through Process Evaluation Process evaluation outcomes include retention rates, participant attendance at educational sessions, bag pickup rates, and blood pressure readings. In Wave 1, the retention rate was 58% for the control group and 69% for the intervention group. On average, 70% of produce bags were picked up by intervention participants, and 19% attended educational sessions. Participants reported taking one blood pressure reading per week. In terms of health outcomes, systolic and diastolic blood pressure increased slightly in both the control and intervention groups, with no significant differences between groups. Food security decreased for both groups, but again, the differences were not statistically significant. Fruit and vegetable intake increased slightly in both groups, but no significant difference was observed between the two groups. Exit interviews indicated that participants appreciated the blood pressure monitoring support and the fresh produce provided through PRx-BP, which helped offset food costs. However, educational session attendance was low, and strategies to boost participation in these sessions will be a focus for Wave 2. Objective 4: Conduct a Cost-Effectiveness Analysis For the cost-effectiveness analysis, we are tracking two main cost areas: 1) intervention development and dissemination, and 2) program participation. In Wave 1, data was collected on personnel costs (staff time), facilities and utilities (overhead), and produce costs (monthly purchases for produce bags). We also tracked time spent on delivering educational sessions and participant attendance. Wave 1 preliminary findings indicated no significant differences between the intervention and control groups in health-related outcomes, meaning a cost-effectiveness analysis based solely on Wave 1 data would not be appropriate. As a result, we plan to combine data from both Wave 1 and Wave 2 to provide a more comprehensive analysis, as we expect more significant changes in health outcomes by the end of Wave 2. OUTCOMES In Wave 1, 70% of produce bags were picked up, and 19% of participants attended educational sessions. The average number of blood pressure readings reported per week was one. Participants reported that the produce they received helped offset food costs, and they appreciated the blood pressure monitoring support. However, there were no statistically significant improvements in blood pressure, food security, or fruit and vegetable intake in the intervention group compared to the control group. IMPACT For Wave 1 of the PRx-BP program, the initiative increased access to local produce and blood pressure management support for 52 residents of West Dallas. Although no significant changes were observed in health-related outcomes such as blood pressure or fruit and vegetable intake, participants engaged in the program and valued the support it provided. It is possible that the program's provision of more produce than participants would typically purchase led to null findings in produce consumption and blood pressure outcomes. Moving forward, extending the program's duration, improving educational session attendance, and offering additional support may increase its effectiveness.
Publications
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Progress 09/15/22 to 09/14/23
Outputs
Target Audience:The target audience was adults (>18 years old) with high blood pressure (self-reported blood pressure reading>130/80 mmHg andself-reported diagnosis of hypertension)who were low-income (household earning <$58,231 per year and eligiblefor SNAP)and resided in West Dallas, TX. Efforts for the target audience included delivery of Texas A&M AgriLife Extension education and skill building on managing and lowering high blood pressurethrough healthy lifestyle behaviors (nutrition, physical activity, healthy cooking). The target audience also received brief education on measuring blood pressure at home. Through CareSignal, participants were prompted through a brief text message to report daily blood pressure values. Participants received periodic handouts on keeping produce fresh and a description of taste and cooking techniques for unfamiliar vegetables in weeklyproduce bags. Changes/Problems:1. The PRx-BP program had a hard start date of June 2023, due to the local agricultural growing season. While we attempted to recruit individuals for the focus group to further refine the PRx-BP program, we were unable to recruit in time for the program start date. To address this issue, we will recruit participants enrolled in the control group to inform Wave 2 of the intervention. 2. As previously mentioned, the program had a hard start date of June 2023. As such, recruitment and enrollment into the program had to occur in fast succession. For this reason, while we had planned to schedule participants to visit with a community healthworker to receive brief education, instead we had community health workers present at blood pressure screening events so that they could refer participants directly to the program. This likely made recruitment and enrollment more efficient and successful, as participantsdid not have the additional burden ofhaving to attend both a clinic visit with the community health worker and baseline data collection session. To compensate for eliminating the visit with the community health worker, at the baseline data collection session, participants were given brief education on how to use their blood pressure for at-home monitoring. 3. In the budget, salary coverage was planned for Year 1 to cover 8.3% of salary for Alexandra MacMillan Uribe(Principal Investigator), 1.25% for Rebecca Seguin-Fowler, and 33.3% for a research technician. During Fiscal Year 2022-2023,100%salary coverage was internally received by all employees in our research group.Therefore, the salaries were not spent but will be spent in Fiscal Year 2023-2024. 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?For our first objective, we will: Recruit delayed intervention control group participants for focus groups in which they will provide feedback to further refine the program, including the modifications and additions made during Wave 1 of the program. As previously stated, we were unable to meet the objective as planned because of our hard start date due to the local growing season and lack of success in recruiting participants for these focus groups between January and May 2023. Meet with program leaders and researchers who have experienced success in recruiting and retaining produce prescription participants through in-person and virtual meetings and attendance at the Nutrition Incentive Hub's Produce Prescription Convening on October 17-19, 2023. For our second objective, we will: Complete implementation of Wave 1 of PRx-BP program for intervention group participants. Complete end-point data collection for intervention and control group participants. Complete data collection for bi-monthly surveys for intervention group participants. Clean and begin analysis of Wave 1 data. Begin implementation of Wave 2 PRx-BP program with control participants and recruit additional participants to achieve the participation goal of n=100 participants. Complete baseline data collection for control participants and additional participants for Wave 2. Present Wave 1 results to community partners. For our third objective, we will: Clean and begin analysis of quantitative process evaluation data. Conduct post-intervention focus groups with intervention group participants. Conduct interviews with clinic staff and Extension educators Begin analysis of focus groups and interviews For our fourth objective, we will: Complete data collection for all cost-effectiveness variables from Wave 1 Determine cost-effectiveness for Wave 1 Collect data for all cost-effectiveness variables for Wave 2
Impacts
What was accomplished under these goals?
West Dallas, TX is a racially and ethnically concentrated area of poverty, closely linked with a high prevalence of food insecurity, low diet quality, and high chronic disease risk. In fact, 41% of adult residents in West Dallas have hypertension (elevated blood pressure above 130/80 mmHg), a dangerous condition that can lead to heart attacks, kidney failure, and stroke. Lifestyle changes like healthy eating, physical activity, and regularly monitoring blood pressure levels can help lower blood pressure and resolve hypertension. Produce prescription programs, in which participants are "prescribed" a regular allotment of fresh fruits and vegetables, can improve diet quality and blood pressure levels through increased FV intake. The Produce Prescription for Healthy Blood Pressure (PRx-BP) program is a comprehensive 6-month blood pressure management program that brings together produce prescription with other lifestyle modifications with strong evidence for effectively lowering blood pressure, including cooking and nutrition education, blood pressure educationand management support, and physical activity classes. We will evaluate the effectiveness of the PRx-BP program on blood pressure levels (primary outcome), hypertension medication use, diet quality, food security, and healthcare utilization among adult residents of West Dallas, TX with hypertension. West Dallas, TX residents with hypertension who participate in this program will be directly helped with this work through receipt of weekly produce bags containing fresh, seasonal, and local produce; evidence-based healthy lifestyle classes, hosted by Texas A&M AgriLife Extension that address healthy eating and cooking, blood pressure self-management, and physical activity; and blood pressure management support through daily text messages in which participants report daily blood pressure values. The overall goal of this project is to understand whether PRx-BP can improve blood pressure levels among adults with hypertension living in West Dallas, TX. Our first objective in achieving this goal was to use feedback from focus groups with West Dallas residents who have hypertension to tailor the PRx-BP program. Though we attempted to recruit participants for these focus groups with our community partners between January and May 2023, we were unable to recruit enough participants for a focus group. Because the local growing season is planned and executed beginning in November 2022, we had to launch the program as planned in June 2023. We decided to recruit Wave 2 participants for these focus groups to tailor Wave 2 of the program. This will be combined with the feedback we receive from Wave 1 participants to further tailor the intervention. Furthermore, participant feedback received by our community partners at weekly produce pickups and monitoring of weekly pickup numbers has led to valuable modifications in the program. For example, to incentivize participants to pick up their weekly produce, we are now placing a "golden ticket" in one produce bag, redeemable for a small kitchen appliance or cooking utensils. Additionally, we have created additional educational materials, and handouts on less familiar vegetables (e.g., sorrel or beets) that are placed in produce bags, in response to participants' concern that they did not know how to cook or store some of the vegetables they received. Our second objective is to test how effective PRx-BP is in lowering blood pressure, compared to a group who will not receive PRx-BP through a pilot randomized wait-list controlled trial. In achieving this goal, we were able to recruit 203 participants, of which 103 enrolled in the study and completed baseline data collection. During baseline data collection, 52 were assigned to receive the PRx-BP program between June and December 2023 (intervention group) and 51 were assigned to receive the program between March and September 2024 (delayed intervention control group). Baseline data is currently being entered into spreadsheets and cleaned for statistical analysis. The third objective is to understand how to improve the ways the program is delivered through a process evaluation. To date, intervention group participants have completed 13weeks of the 24-week intervention, with an average of 60% picking up their produce bag each week. A 6-week nutrition and cooking education program was completed between June and July 2023, delivered by Texas A&M AgriLife Extension, for which an average of 6 participants attendingper week. Our fourth objective is to determine how much the program costs relative to its ability to lower blood pressure through a cost-effectiveness analysis. We have collected data, including personnel, produce,and education costs and daily blood pressure levels to date. Data is currently being entered into spreadsheets and, once data collection is complete, will be cleaned for statistical analysis. Key outcomes, to date, have been the successful recruitment and enrollment of 103 participants. The Produce Prescription for Healthy Blood Pressure program has been successfully implemented for 52 participants through two blood pressure screening events, as well as referral by the Brother Bill's Helping Hand staff. Additionally, data for the successful execution of objectives 2, 3, and 4 is being collected as planned.
Publications
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