Progress 09/15/23 to 09/14/24
Outputs
Target Audience:Out of 105 participants with types I or II Diabetes recruited for our program, 71 participants regularly attended and graduated our 2024 cohort spanning three different locations for classes- Nuestras Raíces, The Holyoke Public Library, and Holyoke Health Center Chicopee Branch for our control group. 98.5% of participants indentified as Hispanic/Latino/x, 67.6% further identifying as Puerto Rican and 4 participants from each Columbia and The Dominican Republic, with 79.4% of participants preferring classes and materials in Spanish as their first language. Additionally, 82.4% of participants reported receiving SNAP benefits. Through a combination of outreach and referrals from Holyoke Health Center and the community organizing prowess of our Education Coordinator Darwin Cruz, participants were recruited and directed to the class location nearest them, with transportation provided for those who needed it. With such a large cohort, we decided to move our control group to a similar population center in the neighboring city of Chicopee to avoid any confusion as to why they weren't receiving the boxes and potentially skewing our data set. Changes/Problems:As it currently stands, our ED is putting time into this project as an in-kind match above what was originally anticipated to coordinate project meetings and communications, manage program staff, and support with challenges that arise, and our Education Coordinator still had to do a significant portion of the recruitment for this year's cohort as only a handful of patients made it in through the health center referal process. We were able to adapt and have a highly sucessful year, in no small part due to Education Coordinator Darwin Cruz's deep roots in the community and ability to bring people in. We also need to translate for Darwin to take part in meetings conducted in English. Our main logistical challenge was reducing attrition rates of program participants. To ensure that our participants continue to participate in Nuestros Productos, we have made weekly reminder phone calls, sent mailings of the upcoming classes, delivered produce prescriptions to those who were not able to come to class, and distributed raffles of small kitchen appliances that promote healthy eating (e.g., air popcorn popper, rice cooker, blender, etc.). For the last class we hosted a graduation with the participants' exit ticket being the completion of the final survey. What opportunities for training and professional development has the project provided?The undergraduate and graduate students in the project participated in hands on experience in community health education, correlating research and data with the lived experience of the participants they were interacting with. This built critical bridges for the students in applying research and data science to real world public health communication and advocacy. Student researchers will also have the potential of author credits for research publications related to the project, which will be especially impactful in career development for the undergrads, as these types of publications are rare at that level. As a whole, this project will be a valuable asset for our undergrads in progressing their careers. How have the results been disseminated to communities of interest?The results of this program have been disseminated through a number of channels: Regular program newsletters that provide a snapshot of the program and some of its impacts Shared through our social media to over 27,000 followers Featured on our Weekly Radio Show, which can reach up to 500,000 listeners Webinar Presentations reaching our regional partners through VT Farm to Plate, Tri-State Learning Collaborative on Aging, and others Shared with our network through Hampden County Health Improvement Plan and Let's Move Hampden County 5210 Meetings Tabling/Presenting at various conferences and health fairs including UMass Health Equity and Policy Showcase, YMCA Community Health Fair, Annual Regional Conservation Partnership Gathering, and more Shared through direct community outreach and canvassing, including through our mobile produce market program Shared with our partners at Baystate Medical Center through a presentation by community health interns we hosted this fall What do you plan to do during the next reporting period to accomplish the goals?During the final year of our program, we are instituting an extra cohort in January to complete our data set in early spring. Our research team will be analyzing the data and preparing conclusions. They plan to have some preliminary results in March, and will follow through with data collection and analysis until the final report at the project's end.
Impacts
What was accomplished under these goals?
Objective 1: Increase participant and household food and nutrition security. In tracking produce vouchers distributed this year, some participants became first time and repeat customers of our farmers market and mobile produce markets. All 71 participants of this program learned about opportunities to find fresh produce in the community including our various programs as well as through the Holyoke Farmers Market and our network of partners that they didn't previously know about as well as learning how to fully utilize the state Healthy Incentives Program that supplements their SNAP benefits. Additionally, many participants contact us regularly to talk about their improvements in health in part from accessing community resources for fresh produce. In aggregate, this trends towards an increase in food and nutirition security for the participants and their families, largely due to knowledge of resources for healthier eating and a better awareness of nutrition. Objective 2:Increase participant vegetable consumption. Annecdotally, participants receiving produce boxes reported eating more vegetables due to the produce boxes themsleves. Participants report also reducing consumption of less healthy foods, incorporating food preparation pracitces and ingredients that they learned through our food demos. Participants from last year's cohort report a continued improvement in their health due to a variety of factors from participation in this study, including eating more vegetables. Our research team is still processing surveys and data before they can make any concrete conclusions. Objective 3:Measurably improve participant health and reduce healthcare use and costs. While we have not completed data collection to see if there were measurable differences in health costs and utilization, annecdotally participants from the previous year's cohort are still contacting us to report improvements in their wieght and A1C levels from the changes in their diet and lifestyles due to this program, and the majority of participants from this year's cohort are also experiencing similar decreases in wieght, A1C levels, insulin use, and hospital visists. We are anticipating that the data will bear out the effectiveness of this program in acheiving this goal. A few participants also reported adopting healthier fitness practices, 4 reported starting to run for exercise, Objective 4:Demonstrate the effectiveness of this community-designed, culturally relevant model to support its continued ACO funding, growth, and replication. This program has been such a resounding success that due to participant and community demand we are now working on a separate initiative with Holyoke Medical Center to create a support group to continue delivering the curriculum and conducting nutrition classes and food demonstrations for type I and II diabetes patients. In addition, we are in dialogs with other local and regional perscription produce and food is medicine programs, all reporting the effectiveness and success of their respective programs, to share methods and resources and coordinate policy advocacy to better promote and sustain the existence of these types of programs. There is a clear community need, a developing network of partners dedicated to sustaining this deeply impactful work, and many thousands across the country who are living testaments to the impact and import of these programs who have received the benefits of new knowledge and healthier examples which have led directly to significant shifts in their lives which have led overwhelmingly to better health outcomes. We are also in communication with Community Care Cooperative, an ACO sponsored non-profit supporting health centers, to purchase cultrual crops from us for their Produce Rx Program to be distributed in our community.
Publications
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Progress 09/15/22 to 09/14/23
Outputs
Target Audience:Hampden County, Massachusetts, where the work took place, has the worst health outcomes in the Commonwealth of Massachusetts by county. High rates of chronic illness resulting from food insecurity, poor nutrition, poverty, and systemic and structual barriers negatively impact community health equity. Cohorts were drawn from minority Environmental Justice communities with mean household incomes 50% or less of the state average. Cohort 1 (2023) had 30 people recruited with 28 people receiving at least one produce prescription box and attending at least one nutrition education class. Our control group at Lyman Terrace, an affordable housing complex, had 10 participants aged 62 and up all of Hispanic heritage. These participants only received a produce box after the first session. Small appliances and kitchen equipment were raffled to the group each session to encourage attendance. Our second group received produce boxes each session and attended class at Nuestras Raices. This group was composed of 20 people, 18 of Hispanic descent and 2 of Caucasian. The average age of this group was about 60. We had a 36% attrition rate of participant attendance. This is largely due to participant fatigue from our Lyman Terrace control group who were not receiving produce boxes. The participants in our Nuestras group who received produce boxes attended sessions more consistently. Changes/Problems:The most significant project challenge arose when our partners at Holyoke Health Center experienced a change in leadership. During the transition and onboarding process, HHC's capacities to engage with the project were severely diminished. Nuestras had to step in to assume some of the project responsibilities of HHC, chiefly recruitment and intake. We were able to shift some of our staff capacities around to fill this need, but as our Health Center partners were better equipped for this part of the work, we were unable to recruit our target number of participants for the first year's cohort. We have worked out the project roles with the new Health Center leadership team, and we are on track to make our goals for the second year. The main problems UMass encountered were related to designing the recruitment and retention strategies with the Holyoke Health Center, given the organizational changes, and developing the Data Use Agreement and Data Management Plan between the clinic (i.e., patient's electronic health records), Nuestras Raices, and UMASS Center for Program Evaluation. Project leads and support staff have been meeting regularly over the last few months to address the issues that were faced and implement better plans for the 2nd year. There were other logistical challenges in providing transportation to our participants to attend the nutrition education classes and retrieve their produce prescriptions. Some of the transportation services did not come through, and organizers were left scrambling before classes to arrange participant pickup. As we didn't account for transportation in our initial budget, we had to pull funding from elsewhere to cover the surprise transporation costs. We are submitting a budget ammendment to include transportation costs for our subsequent years. For the second year, we are working on a contract with a regular transportation service to cover all the transportation needs of the program. What opportunities for training and professional development has the project provided?Airin Martinez, Pablo Fernandez, and Daniel Atassi from the UMass reseach team took an Institute for Social Science Research Workshop on Qualtrics, which is the survey platform that the USDA wants us to use. Angely Pantoja, Daniel Atassi, Pablo Fernandez, Megan Patton-López, Darwin Cruz, and Airin Martinez took theCollaborative Institutional Training Initiative (CITI Program)Training for Human Subjects ResearchGroup 2: Social Behavioral and Education Research Investigators and Key Personnel -Basic Course. This is a requirement for our IRB application. How have the results been disseminated to communities of interest?We present about the program at a monthly community organization networking event called Holyoke Safe Neighborhood Initiative. Some120 different organizations from our local community attend these events, with about 60-80 of the particiapting organizations represented each month. These meetings are spaces for organizations to share about their programs and look for connections and collaboations throughout the community. We've been sharing our GusNIP program progress at these meetings, and other organizations in turn share the information with relevant stakeholders in their circles. We are part of the Hampden County Health Improvement Plan. Over 100 local organizations from a number of fields and focuses including healthcare, agriculture, and social services all participate, dividing into 4 focus teams. We share information and results from our GusNIP work with our community partners in the Healthy Eating and Active Living team and at public meetings for the HCHIP. Community partners in turn share results within their spheres of influence. We share about all of our programs and events on our Facebook page. With an audience of 27,000 followers, a large portion of our local community relies on our social media to stay up to date with our work. We've shared information about this program through our social media. We prepared monthly newsletters about the program through the 3 month duration of classes. These newsletters were also shared with the broader community through print, social media, and email. We shared about the program on two local radio stations. Our UMass partners tabled at our farm events and at Holyoke Health Center to share details about the program. What do you plan to do during the next reporting period to accomplish the goals?For our Year 2 Program cohort, we are planning to recruit 105 participants with the goal of having complete data sets for at least 72 participants. We are planning to recruit new participants from March-June with the first class beginning on July 15. We will also be moving the participant group from the Lyman Terrace subsidized housing complex to have classes at a neighboring Holyoke Health Center site. We are also adding two other class locations- one at the Holyoke Library and one at a Holyoke Health Center location in the neighboring city of Chicopee. Nuestras Raices will serve again as another class and box distribution site, bringing the total t four different workshop locations. This will make it esaier to isolate our control group and ensure that the class locations are more accessible to participants. We are also working out an exclusive contract for transportation, as we experienced some difficulties with transportation companies dropping pickups and causing us to improvise last minute solutions in the first project year.
Impacts
What was accomplished under these goals?
Objective 1 Through the 3 month duration of classes for the first year of the program, 15-20 participants and their families all received farm fresh produce every two weeks to supplement household nutrition. During that period of time, they experienced increased food security and an increase in the variety and nutrient content in the foods consumed at home. 30 participants were also given training on how and where to use their Massachusetts Healthy Incentives Program benefits, offering $40 extra a month on top of SNAP benefits for purchasing produce from farmers markets and farm stores. Annecdotally, participants expressed an increase in the purchase and consumption of nutritious local foods based on what they learned in class. Objective 2 Annecdotally, participants who received produce boxes expressed an increase in their weekly vegetable intake throughout the duration of the program. Participants expressed a desire to maintain changes in their diet made through the course of the program because of increases in energy and decreases in reliance on hospital visits and medicine. With the additional knowledge they learned about HIP benefits and ways they can access more fresh produce, participants were excited to continue eating more vegetables. Objective 3 Participants from the first year expressed incresases in energy, weight loss, and less dependency on medical interventions. Many also shared that their A1C levels had markedly decreased, they were losing weight, and/or their cholesterol was lower. We will need to analyze data trends in the second year to make definitive conclusions, but based on participant testimonials we are on track for this objective. Objective 4 Annecdotally, participants expresseed deep appreciation for both the information they learned in class and for the produce boxes they received. Classes were conducted in the prinary language of the majority of participants, who spoke Spanish, and translated for the small number of participants with English as their first language. Many of the recipes were healthier adpatations of cultural foods commnonly enjoyed in the community. Particiapnts also expressed their gratitude for imparting deeper understanding about regulating the diabetes condition, and many sought to lower their dependency on perscription drugs.
Publications
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